Obsessive compulsive disorder
Obsessive Compulsive Disorder (OCD) is a mental health disorder that affects people of all ages and occurs when a person gets caught in a cycle of obsessions and compulsions.
What are obsessions and compulsions?
Obsessions are thoughts, images or impulses that occur over and over again and feel outside of the person’s control. Individuals with OCD do not want to have these thoughts and find them disturbing. In most cases, people with OCD realize that these thoughts don’t make any sense. Obsessions are typically accompanied by intense and uncomfortable feelings such as fear, disgust, doubt, or a feeling that things have to be done in a way that is “just right.” In the context of OCD, obsessions are time consuming and get in the way of important activities the person values. This last part is extremely important to keep in mind as it, in part, determines whether someone has OCD — a psychological disorder — rather than an obsessive personality trait.
Not all obsessions are OCD
You can be “obsessed” with a new song you hear on the radio, but you can still manage your day to day affairs.Most people have obsessive thoughts and/or compulsive behaviors at some point in their lives, but that does not mean that we all have “some OCD.” In order for a diagnosis of obsessive compulsive disorder to be made, this cycle of obsessions and compulsions becomes so extreme that it consumes a lot of time and gets in the way of important activities that the person values
Someone without OCD may have these thoughts, be momentarily concerned, and then move on. In fact, research has shown that most people have unwanted “intrusive thoughts” from time to time, but in the context of OCD, these intrusive thoughts come frequently and trigger extreme anxiety that gets in the way of day-to-day functioning.
Common Obsessions in OCD
Fear of Contamination
⦁ Body fluids (examples: urine, feces)
⦁ Germs/disease (examples: herpes, HIV)
⦁ Environmental contaminants (examples: asbestos, radiation)
⦁ Household chemicals (examples: cleaners, solvents)
Fear of losing Control
⦁ Fear of acting on an impulse to harm oneself
⦁ Fear of acting on an impulse to harm others
⦁ Fear of violent or horrific images in one’s mind
⦁ Fear of blurting out obscenities or insults
⦁ Fear of stealing things
Fear of causing Harm
⦁ Fear of being responsible for something terrible happening (examples: fire, burglary)
Fear of harming others because of not being careful enough (example: dropping something on the ground that might cause someone to slip and hurt him/herself) Unwanted Sexual Thoughts
⦁ Forbidden or perverse sexual thoughts or images
⦁ Forbidden or perverse sexual impulses about others
⦁ Obsessions about homosexuality
⦁ Sexual obsessions that involve children or incest
⦁ Obsessions about aggressive sexual behavior towards others
⦁ Concern with getting a physical illness or disease (not by contamination, e.g. cancer)
⦁ Superstitious ideas about lucky/unlucky numbers certain colors
Obsessions Related to Perfectionism
⦁ Concern about evenness or exactness
⦁ Concern with a need to know or remember
⦁ Fear of losing or forgetting important information when throwing something out
⦁ Inability to decide whether to keep or to discard things
⦁ Fear of losing things ⦁
Compulsions are the second part of obsessive compulsive disorder. These are repetitive behaviors or thoughts that a person uses with the intention of neutralizing, counteracting, or making their obsessions go away. People with OCD realize this is only a temporary solution but without a better way to cope they rely on the compulsion as a temporary escape. Compulsions can also include avoiding situations that trigger obsessions. Compulsions are time consuming and get in the way of important activities the person values.
Similar to obsessions, not all repetitive behaviors or “rituals” are compulsions. You have to look at the function and the context of the behavior. For example, bedtime routines, religious practices, and learning a new skill all involve some level of repeating an activity over and over again, but are usually a positive and functional part of daily life. Behaviors depend on the context. Arranging and ordering books for eight hours a day isn’t a compulsion if the person works in a library. Similarly, you may have “compulsive” behaviors that wouldn’t fall under OCD. “compulsive” refers to a personality trait or something about yourself that you actually prefer or like. In most cases, individuals with OCD feel driven to engage in compulsive behavior and would rather not have to do these time consuming and many times torturous acts. In OCD, compulsive behavior is done with the intention of trying to escape or reduce anxiety or the presence of obsessions
Common Compulsions in OCD
Washing and Cleaning
⦁ Washing hands excessively or in a certain way
⦁ Excessive showering, bathing, tooth-brushing, grooming ,or toilet routines
⦁ Cleaning household items or other objects excessively
⦁ Doing other things to prevent or remove contact with contaminants
⦁ Checking that you did not/will not harm others
⦁ Checking that you did not/will not harm yourself
⦁ Checking that nothing terrible happened
⦁ Checking that you did not make a mistake
⦁ Checking some parts of your physical condition or body
⦁ Rereading or rewriting
⦁ Repeating routine activities (examples: going in or out doors, getting up or down from chairs)
⦁ Repeating body movements (example: tapping, touching, blinking)
⦁ Repeating activities in “multiples” (examples: doing a task three times because three is a “good,” “right,” “safe” number)
⦁ Mental review of events to prevent harm (to oneself others, to prevent terrible consequences)
⦁ Praying to prevent harm (to oneself others, to prevent terrible consequences)
⦁ Counting while performing a task to end on a “good,” “right,” or “safe” number
⦁ “Cancelling” or “Undoing” (example: replacing a “bad” word with a “good” word to cancel it out)
⦁ Putting things in order or arranging things until it “feels right”
⦁ Telling asking or confessing to get reassurance
⦁ Avoiding situations that might trigger your obsessions
Treatment of OCD
Cognitive/Behavioral Therapy is the best form of treatment for OCD
Cognitive/Behavioral Therapy (CBT) is considered to be the best form of treatment for OCD. OCD is believed to be a genetically-based problem with behavioral components, and not psychological in origin. Ordinary talk therapy will, therefore, not be of much help. Reviewing past events in your life, or trying to figure out where your parents went wrong in raising you have never been shown to relieve the symptoms of OCD. The type of behavioral therapy shown to be most effective for OCD is known as Exposure and Response Prevention (E&RP).
E&RP consists of gradually confronting your fearful thoughts and situations while resisting the performing of compulsions. The goal is to stay with whatever makes you anxious so that you will develop a tolerance for the thought or the situation, and learn that, if you take no protective measures, nothing at all will happen. People with OCD do not stay long enough in feared situations to learn the truth. Our goal is to wear the thought out. There are two things that tend to sustain compulsions. One is that by doing them, the sufferer is only further convinced of the reality of their obsessions, and is then driven to do more compulsions. The other is that habit also keeps some people doing compulsions, sometimes long after the point of doing them is forgotten. The cognitive component of CBT teaches you to question the probability of your fears actually coming true (always very low or practically nil), and to challenge their underlying logic (always irrational and sometimes even bizarre).
Medications for OCD
It is human nature to always want quick, easy, and simple solutions to life’s problems. There is no magical medicine to take away their symptoms.Relying solely on meds most likely means that all your symptoms will not be relieved and that you will always be vulnerable to a substantial relapse if you discontinue them. This is because drugs are not a cure, but are rather a control.When you stop taking them, your chemistry will soon revert (usually within a few weeks) to its former unhealthy state. Meds are extremely useful as part of a comprehensive treatment together with CBT. They should, in fact, be regarded as a tool to help you to do therapy. They give you an edge by reducing levels of obsession and anxiety. While those with mild OCD can frequently recover without the use of meds, the majority of sufferers will need them in order to be successful. One unfortunate problem with meds is the stigma attached to them. Having to use them does not mean that you are weaker than others, only that this is what your particular chemistry requires for you to be successful. You can’t always fight your own brain chemistry unaided. Using psychiatric drugs also does not mean that you are “mad.” People with OCD are not crazy, delusional, or disoriented. When relieved of their symptoms, they are just as functional as anyone.
Try to manage your anxiety by yourself
If you come to depend upon others to manage your anxiety by reassuring you, answering your questions, touching things for you, or taking part in your rituals, it will be difficult for you to do things,when they are not around. The same is true if you only work on your therapy homework when others are nagging or reminding you. If your motivation is so poor that you cannot get going on your own (assuming that you are not also suffering from an untreated case of depression), then you will have learned nothing about what it takes to recover from OCD. As mentioned at the beginning, since OCD is chronic, you will have to learn to manage it throughout your life. Since you can find yourself on your own at any point, unpredictably, you will always need to be fully independent in managing it.
Seek an expert’s help to deal with OCD
In using your intuition to deal with what obsessions may be telling you, there is one thing you can always count on: it will always lead you in the wrong direction. It is only natural to want to escape or avoid that which makes you fearful. It’s instinctive. This may be fine when faced by a vicious dog or an angry mugger but, since the fear in OCD results from recurring thoughts inside your head, it cannot be escaped from. The momentary escape from fear that compulsions give fools people into relying upon them. While compulsions start out as a solution, they soon become the main problem itself as they begin taking over your life. People with OCD never stay with what they fear long enough to find out that what they fear isn’t true. Only by doing the opposite of what instinct tells you will you be able to find this out.
Goal of Therapy
Good Cognitive/Behavioral treatment should aim to give you the tools necessary to manage your symptoms effectively. As therapy progresses, the responsibility for directing your treatment should gradually shift from your therapist to you. Whereas the therapist may start out by giving you assignments designed to help you face and overcome your fears, you should eventually learn to spot difficult situations on your own and give yourself challenging homework to do. This will then be a model for how you will need to handle things throughout your life.
Duration of treatment
How long does it take? As long as is necessary for a given individual. An average uncomplicated case of OCD takes from about six to twelve months to be successfully completed. If symptoms are severe, if the person works at a slow pace, or if other problems are also present, it can take longer. Also, some people need to work on the rehabilitation of their lives after the OCD is brought under control. Long-term OCD can take a heavy toll on a persons ability to live. It may have been a long time since they have socialized, held a job, or doing everyday household chores, etc. Some people have never done these things. Returning to these activities may add to the time it takes to finish treatment.
However long it takes, it is crucial to see the process through to the finish. There is no such thing as being “partially recovered.” Those who believe they can take on only those symptoms they feel comfortable facing soon find themselves back at square one. Untreated symptoms have a way of expanding to fill the space left by those that have been relieved.
Prevention of relapse
Although there is no cure, you can successfully recover and live a life no different from other people. Once a person gets to the point of recovery, there are several things that must be observed if they are to stay that way. The goal of proper therapy is to teach people to become their own therapists. It gives them the tools to accomplish this. One of these tools is the knowledge that feared situations can no longer be avoided. The overall operating principle is that obsessions must therefore always be confronted immediately, and all compulsions must be resisted. When people are seen to relapse, it is usually because they avoided an obsessive fear which then got out of hand because they went on to perform compulsions. Another cause can be an individual believing that they were cured and stopping their medication without telling anyone. Unfortunately, the brain doesn’t repair itself while on medications, and so when drugs are withdrawn, the chemistry reverts to its former dysfunctional state. Finally, some people may have fully completed their treatment, but have neglected to tell their therapist about all of their symptoms, or else they did not go as far as they needed to in confronting and overcoming the things they did work on. In pursuing treatment for OCD, it is vital to go the distance in tackling all of your symptoms, so as to be prepared for whatever you may encounter in the future.
It is vital to remember that no one is perfect, nor can anyone recover perfectly. Even in well-maintained recoveries, people can occasionally slip up and forget what they are supposed to be doing. Luckily, there is always another chance to re-expose yourself and so, rather than a person beating themselves up and putting themselves down, they can soon regain their balance if they immediately get back on track by turning again and facing that which is feared, and then not doing compulsions.
Finally, because health is the result of living in a state of balance, it is extremely important, post-therapy, to live a balanced life, with enough sleep, proper diet and exercise, social relationships, and productive work of some type.
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