Obsessive-Compulsive Disorder (OCD) is not what pop culture dictates. It does not manifest itself merely as an overarching focus on detail and order. Obsessive-Compulsive Disorder is invasive and intrusive and excruciating to individuals who struggle with the disorder. What I want people to understand most is one can overcome OCD. One can eradicate it from his/her life and it can be done without medication.
OCD is an anxiety disorder. The National Institute of Mental Health describes OCD as “a common, chronic and long-lasting disorder in which a person has uncontrollable, reoccurring thoughts (obsessions) and behaviors (compulsions) that he or she feels the urge to repeat over and over.” I strongly disagree that OCD has to be chronic or long-lasting. With the proper treatment, OCD can be eliminated. It can be a pervasive disorder that finds itself reignited under stress; however, this is true for most mental illnesses and/or health conditions. If children or adults suffering from OCD learn how to treat their symptoms, they can utilize the same techniques time and time again when needed.
Before delving into symptoms and treatment, I think it is vital to mention that the sudden onset of OCD in small children can be related to an underlying medical condition called PANDAS. “In some cases, children may develop OCD or OCD symptoms following a streptococcal infection—this is called Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS).” If you think PANDAS is a possibility, learn more here.
OCD does NOT have to include visible compulsions. For many people, the compulsions are circulating on replay in their mind. Think about it like this…Someone has a thought such as, “I want to harm my sibling/child/parent.” This thought then creates anxiety in the individual. Because the individual feels anxiety from the thought; he/she feels the compulsion to assess the thought, evaluate it, look for the origin of the thought time and time again. Now the thought is playing like a broken record. Because the thought has now repeated itself; the person falsely assumes there must be truth to the thought. The person identifies the thought as meaningful where no meaning truly exists.
A person struggling with obsessional OCD must be aware that his/her intrusive thoughts are simply intrusive thoughts. 4 out of 5 people experience intrusive thoughts. What this means is your intrusive thoughts are normal. The issue is the person’s belief that his/her thoughts are abnormal, which causes the anxiety. In an effort to minimize the anxiety, the person performs mental rituals to eradicate the thought. And so the cycle of OCD begins.
Intrusive thoughts/Obsessions that cause distress typically involve themes of:
- Ill health
- Body Image
Compulsions are repetitive behaviors, mental or physical, that a person feels the urge to do in response to an obsessive thought. NAMI states compulsions may include:
- Excessive cleaning
- Ordering and arranging things in a particular, precise way
- Repeatedly checking on things
- Compulsive counting
- Stating a “positive” word/thought to erase a “negative” word/thought
- Seeking assurance from family members that he/she is not capable of harming oneself or others
- Seeking assurance that one did not previously commit a crime
- Scanning thoughts looking for “bad” thoughts in an attempt to control thoughts
- Repeatedly going to the doctor to ensure he/she does not have a particular illness
How to treat OCD in children and adults:
Current research finds that most children and adults with OCD find success in Exposure and Response Prevention (ERP), which is a type of (CBT) Cognitive Behavioral Therapy. Anywhere from 65% to 80% of children and adolescents are successful in reducing and/or eliminating their OCD with ERP. You must find a therapist who is appropriately trained in ERP. The International Obsessive Compulsive Disorder Foundation states, “ERP is based on the premise that OCD is maintained and exacerbated because compulsive behaviors (also called rituals) and avoidance behaviors provide relief from anxiety. For instance, when 8-year-old Casey touches crayons, he worries about poison. He quickly washes his hands and then feels much better. Casey soon learns that washing his hands lessens his anxiety. However, Casey’s OCD is actually worsened by washing his hands because it prevents him from learning that his obsessions are improbable and that his anxiety will subside naturally.”
The IOCDF goes on to say, “ERP teaches youth with OCD to face their fears while refraining from compulsions. It helps them realize that their obsessive fears do not come true and that the anxiety they experience subsides as a result of a process referred to as habituation, or a gradual lessening of their anxiety response. ERP for Casey would involve having him face his fear that the crayons are “poisonous” by touching them and not washing his hands afterwards.”
The same can be said for those with mental obsessions and compulsions. In therapy terms, we call it “thought immersion.” Rather than conducting “thought stopping,” where an individual seeks to stop a troubling thought; “thought immersion” helps the person invite the scary thought in. We want the individual to take away labels and judgment of the thought and sit with the thought without attempting to erase it, stop it or counter it. When the thought is no longer associated in the brain as scary or negative; the thought begins to lose its power. When the thought loses power, it begins to go away.
As with all anxiety disorders, forms of CBT are found to be most effective. The person must learn to experience the anxiety, realize it will rise and fall, and cope with the associated feelings. If anxiety is medicated the patient does not learn to become comfortable with the rise and fall of the anxiety and, as a result, a patient may have difficulty overcoming the disorder. However, some individuals may find help in a combination of medication and therapy. If you seek medication for your child or yourself, please visit a psychiatrist as he/she will be the expert in the medication and the illness.
IOCDF states, “OCD medications control symptoms but do not “cure” the disorder, much like insulin does not “cure” diabetes, but rather, helps to manage symptoms. This means that the positive effects of an OCD medication only occur while the drug is being taken and some symptoms often remain, although with lower severity. When the child stops taking the OCD medication, symptoms usually return within a period of months.”
“All OCD medications work slowly. This can be frustrating for youth, families, and clinicians. It may take up to two to three months to see improvement. Also, ongoing further improvement of OCD may continue between twelve weeks to a year after starting medication.”
***It is important to note that research states repeatedly that anxiety/OCD sufferers benefit most from consistent therapy, exercise and diet alterations.
What would I suggest if you came to my office?
- Weekly CBT therapy, which would include ERP and thought immersion techniques
- Daily exercise
- Eliminate sugar, caffeine, simple carbohydrates and processed foods
- Increase Omega-3’s in the diet
- Increase foods high in tryptophan combined with small amounts of carbohydrates. Example: turkey sausage followed by a small portion of steel-cut oats. The combination of the two allows for an increase in serotonin in the body.
- Increase fresh fruit, dark leafy greens, whole grains
- Daily probiotics
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