Obsessive-Compulsive Disorder (OCD)

OCD is a neuropsychiatric disorder. It is characterized by persistent, unwanted thoughts, images, or impulses known as obsessions, which can cause significant distress or anxiety. In a failed attempt to alleviate the distress or anxiety, the individual may engage in repetitive behaviors known as compulsions and/or avoidance behaviors. Compulsions can be categorized as either mental or physical compulsions. Examples of some mental compulsions include analyzing, praying, counting, self-reassurance, thought neutralization, or comparing and contrasting. Examples of physical compulsions include washing, checking, asking for reassurance, google searching, or arranging. Engaging in compulsive behaviors may bring momentary relief. Nonetheless, in the long term, it only worsens the symptoms of OCD, causing substantial distress in daily functioning or overall quality of life.

Although OCD was once considered a rare disorder, today, the research indicates that about 1 in 40 adults and 1 in 100 children have OCD. Unfortunately, it remains a seriously misunderstood disorder, which explains why on average it can take 14 to 17 years for someone to be correctly diagnosed and treated. Many people continue to suffer without proper treatment. The “gold standard treatment” for OCD is Exposure and Response Prevention (ERP), a form of Cognitive Behavioral therapy, and Medication Management.

Subsets of OCD:

Contamination OCD

A preoccupation and fear surrounding germs, bacteria, bodily fluids, and environmental contaminants.

Common compulsions can include ritualized hand washing or showering, excessive health checking, excessive use of cleaning agents or hand sanitizers, and/or avoidance of items believed to be contaminated.

Violent/Harm OCD

A preoccupation with harming others or oneself. 

Common compulsions may include avoiding anything that can trigger these thoughts, excessively seeking reassurance, checking and mental reviewing, or praying.  

Sexual Orientation OCD/Homosexual-OCD (H-OCD)

A preoccupation with one’s “true” identity or sexual orientation. For example, someone with SO-OCD may fear that they are in denial of their “true” sexual orientation or may later discover their sexual orientation wasn’t what they had identified with.

Common compulsions can include avoidance of specific triggers, mental or physical checking for arousal or stimulation in the presence of others (same sex or opposite sex, depending on their fear), and searching for evidence for or against your sexual orientation.

Pedophile OCD

A fear of being a child predator or having sexual interest or desire towards children.  

Common compulsions include avoiding environments with children, analyzing arousal levels around children, and avoiding any photos or social media exposure featuring children.

Relationship OCD (R-OCD)

Fear of being in the wrong relationship or a preoccupation with whether or not one feels the appropriate amount of attraction or love for their partner and vice versa. 

Frequent compulsions in R-OCD may consist of seeking reassurance, confessing doubts, comparing the relationship to others, scouring the internet for relationship advice, and scrutinizing one’s emotions towards their significant other.

Religious/Scrupulosity OCD

An irrational fear of breaking the laws or precepts of a religion or non-religious moral code and being subjected to eternal damnation or punishment by God.

Common compulsions include excessive praying, punishment, confessions to religious figures or significant others, and mental reviewing behavior related to their moral/religious standards.  

Hyperawareness OCD/Sensory-Focused OCD

There are two categories of this form of OCD: external and internal hyperawareness. Internal hyperawareness is the constant awareness of automatic bodily processes. External hyperawareness is the continual awareness of external sounds, smells, pictures, words, songs, old obsessions, etc.

Compulsions may include mental checking of triggers, avoidance of situations that may lead to greater awareness, and reassurance that their symptoms will return to their unconscious awareness.  

“Just Right” OCD/Perfectionism OCD

An excessive preoccupation that something is not exactly as it should be or a feeling that something is not quite right.  

Compulsions may include repeating tasks until they feel “just right” or rearranging objects to make them look straight or perfectly lined up.

Existential OCD

A constant questioning about the meaning of life or reality.  

Compulsions may include mental reviewing and analyzing, researching online, reassurance seeking, or a determination to find the answers.  

Treatment for OCD

Cognitive Behavioral Therapy (CBT) is the recommended and effective treatment for OCD. CBT for OCD typically involves Cognitive Restructuring and Exposure and Response Prevention (ERP).

Cognitive Restructuring focuses on identifying and challenging the distorted thoughts and beliefs that drive OCD. The therapist helps the individual recognize irrational thinking patterns and replace them with more rational and realistic thoughts.

Exposure and Response Prevention (ERP) is a fundamental component of CBT for OCD. It involves gradually exposing the individual to situations or triggers that provoke their obsessions while preventing compulsive behaviors. The goal is to help people confront their fears and increase their tolerance for uncertainty as they understand that absolute certainty is impossible in many aspects of life. In addition, ERP also enhances our ability to cope with distress and provides a novel perspective that suggests our worries may be less likely or consequential than we initially thought.

In recent years, research has also shown that incorporating Acceptance and Commitment Therapy (ACT) and Mindfulness techniques can enhance the treatment for OCD.

Medication for OCD

Psychotropic medication has been shown to enhance the effectiveness of ERP because OCD is associated with abnormal brain circuitry and chemical changes. According to research, medication can reduce symptoms by 40-60%.  The medication most often prescribed for OCD are Selective Reuptake Inhibitor (SSRI), such as Sertraline (Zoloft), Fluoxetine (Prozac), Escitalopram (Lexapro), and Citalopram (Celexa).

It’s worth noting that medication isn’t always necessary for treatment, as some individuals may encounter adverse side effects from SSRIs or opt not to take them for personal reasons.

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