Clinicians who are particularly interested in treating OCD

Ben Johnson, Ph.D., ABPP
Aaron Kaiser, Ph.D.
Selene MacKinnon, Psy.D.
Kristin Maki, Ph.D.
Meredith McElroy, Psy.D.
Joseph McGlinchey, Ph.D.
Ethan Moitra, Ph.D.
Wendy Ossman, Psy.D., MBA
Mary Previte, LICSW
Sabine Schmid, Ph.D.
Kristen Stone, Ph.D.
Ronald Thebarge, Ph.D.
Tony Wells, Ph.D.

What is OCD?

Obsessive-Compulsive Disorder, OCD, is an anxiety disorder and is characterized by recurrent, unwanted thoughts, images, or impulses (obsessions) and/or repetitive behaviors (compulsions). Repetitive behaviors such as handwashing, counting, checking, or cleaning are often performed with the hope of preventing obsessive thoughts or making them go away. Performing these so-called "rituals," however, provides only temporary relief and individuals find that the obsessions return and become even more pronounced.

Case Examples

Some people with OCD may be obsessed with germs or dirt, and wash their hands over and over. Other individuals may be filled with doubts about an action, such as turning off the stove, and feel the need to check things repeatedly. Below are some brief examples of different ways that OCD can present itself.

Jennifer's symptoms began in college when she started living away from home for the first time. Whenever she finished a paper for class, had to pay a bill, or fill out an important form, she would doubt herself - did she make a serious mistake? What if she didn't sign her check and her electricity would be turned off...what if she forgot something critical in her paper and failed her class? To be sure that she never made any mistakes, she made herself reread everything she wrote. However, even after rereading several times, she still had doubts. Her rational mind told her that this was senseless - she never made any of the mistakes she was was scared of, but checking gave her reassurance. She felt like she would go on obsessing forever unless she had a guarantee that everything would be okay.

Tom was a cable guy and went into different people's homes all the time. He started thinking that he could be spreading germs from one house to another. What if he got an innocent person sick? It would be his fault. He also thought about stepping on fertilizer and tracking it into someone's home  - what if a baby crawled over where he had stepped? Tom couldn't get these thoughts out of his head. To deal with them, he would carefully watch where he walked and would scrub his hands and wash his shoes with wipes before going into people's homes. He still felt like he could spread contamination without realizing it and hurt innocent people, so he started rearranging his routes so he could go home, shower, and wash his uniform between houses. Eventually, his work started to suffer and he lost his job.

Valerie's issues started when her son, Michael, was born. She had always been a worrier, but having a tiny, helpless infant made her terrified! She couldn't stop thinking of awful thoughts about the worst possible things she could do to this innocent, defenseless baby. She also found herself having sexual thoughts when she changed his diaper. She tried hard to think of nice things instead, but the bad thoughts kept coming back. She thought to herself "Am I a pedophile? A pervert? Will I actually act on these ideas?" She avoided changing her son until her husband came home to try to avoid these thoughts and kept asking him if he thought she was a horrible person. Her dream of becoming a parent had turned into a nightmare.

Treatment

Cognitive-Behavioral Therapy has been shown to be extremely effective in reducing OCD symptoms.  Scientific studies show that CBT can actually change the activity in a person's brain — in a sense "retraining" the brain and weakening the connections between obsessions and compulsions.  The treatment of OCD using CBT involves several stages including assessment, education, treatment planning, cognitive work, and exposure and response prevention.  We will describe more about these phases of treatment in upcoming articles.

Comparing OCD and Panic Disorder

Though a full description of the issues would take more time, there are strong similarities between the phenomenology of Obsessive-Compulsive Disorder and Panic Disorder. Individuals with panic disorder develop an intense sensitivity to bodily sensations. Though these bodily reactions (such as a rapid heart beat or sweating) are part of an adaptive response to a perception of danger, patients often fear that these sensations are the sign of a medical or mental health catastrophe. Therapy often involves helping individuals learn not to fight their anxious sensations, so that they can really experience that these sensations are not dangerous.

In OCD, patients have upsetting, intrusive thoughts that bother them greatly (e.g., of being contaminated or of being responsible for a horrible mistake). Though having such thoughts is actually quite common, individuals with OCD often fear that their thoughts are a sign of a serious problem and should be taken quite seriously. Some individuals, for instance, fear that their thoughts of causing harm to a loved one are a sign that they might act violently and need to take great precautions to prevent themselves from doing so. However, such inviduals typically have no history of violence and find the idea quite abhorrent.

So, whereas panic disorder involves a catastrophic reaction to feared bodily sensations, OCD involves a catastrophic reaction to feared thoughts. Cognitive-Behavioral Therapy (CBT) has been shown to be very effective in helping patients to accept their physical sensations (such as being short of breath) and their anxious thoughts without struggling against them. Once this struggle is dropped, individuals are able to move in the direction of recovery from these anxiety disorders.