Obsessive-Compulsive Disorder

What is OCD?

Obsessive-compulsive disorder (OCD) affects 1 in 40 adults in the U.S. and is a chronic disorder for 60-70% of those who are diagnosed.  People with OCD struggle with unwanted, distressing thoughts or fears that cause them to engage in repetitive rituals to ease their anxiety.  These compulsive behaviors can become burdensome and take up a significant amount of time and energy. People with OCD commonly struggle with high levels of guilt and shame, but they find themselves unable to break free from the vicious cycle of intrusive thoughts and reactive rituals.

What Causes OCD?

Doctors and scientists have been unable to pinpoint the exact cause of OCD.  There are numerous factors that are believed to play a role.  Some people with OCD have areas of the brain that are unusually active, or their brains seem to underproduce serotonin (the feel-good chemical).  OCD also tends to run in families.  Abuse, neglect, overly-strict parents, traumatic events, bullying, or unexpected life changes can all contribute to the development of OCD.  In rare situations, OCD can appear suddenly due to the body’s immune system response to an infection, such as strep, mononucleosis, or Lyme disease.

What are the Symptoms of OCD?

OCD has three parts:  obsessive thoughts, distressing emotions, and compulsive behaviors.  Obsessive, unwanted thoughts can involve fears of harming yourself or others, fear of contamination or disease, or a need for symmetry, exactness, or organization.  While it is common for people to experience all kinds of thoughts, people with OCD find their thoughts incredibly disturbing and experience high levels of distress in response.  In order to relieve the distress, people with OCD engage in rituals or compulsions.  These can include, but are not limited to, hand washing, checking or counting, seeking reassurance, ordering and organizing, or even playing a scenario or phrase over and over in their minds. 

How is OCD Treated?

First-line treatments for OCD include medication (usually SSRIs) and a type of Cognitive Behavioral Therapy called Exposure & Response Prevention (ERP).  The goal of treatment is to target the body’s fight-or-flight response.  Eye Movement Desensitization & Reprocessing (EMDR) is an alternative treatment for OCD that can be particularly effective if there is a history of trauma. 

Exposure & Response Prevention Therapy (ERP)

ERP is an intensive, goal-oriented treatment that is considered the “gold standard” for OCD.  The exposure component of ERP involves deliberately confronting the thoughts or situations that provoke anxiety under the guidance of a mental health professional.  The response prevention component of ERP involves making a choice not to perform the compulsion and tolerating the unpleasant feelings.  While this is very difficult in the beginning, over time it will train the mind to stop seeing the intrusive thoughts as a threat.  ERP has a 65-80% success rate for individuals who complete the treatment. 

Eye Movement Desensitization & Reprocessing (EMDR)

EMDR can help people with OCD integrate their distressing thoughts so they become more tolerable.  It can also target any specific memories or past trauma that contributes to OCD.  Because OCD can be triggered by stressful life events, EMDR can help process those events and alleviate underlying anxiety.  EMDR can be used as a standalone treatment for OCD, and as a complement to ERP.  In studies, people who received both ERP and EMDR have shown more improvement that those who received one treatment or the other.