OCD/CBT

Obsessive Compulsive Disorder (OCD) is a common anxiety disorder that affects millions of people. In the United States, it is estimated that about 1 in 50 people have OCD. Males and females are affected equally. In the U.S. about 1 in 200 children and 1 in 40 adults suffer from the disorder. OCD usually presents in the teen and young adult ages although it can present at earlier or later ages. Other disorders such as Hair-Pulling, Skin-Picking, Attention Deficit/ Hyperactivity Disorder (ADHD), Body-Dysmorphic Disorder (BDD), tic disorders, and eating disorders commonly occur with OCD and should be ruled out.

Persons with OCD perform rituals, either behavioral or mental, that serve the purpose of neutralizing anxiety related to obsessive thoughts about specific situations, objects, or people. A person with OCD is aware that the thoughts may not be true, and that performing the rituals may be irrational, but is compelled to perform them to relieve severe stress and anxiety. OCD may have many themes. Some common ones involve: contamination, germs, symmetry, checking, religiosity (scrupulosity), magical thinking, superstition, and sexual obsessions. There are seemingly an unlimited number of “targets” for OCD, which often focuses on issues of great importance or fear to the individual.

The treatment for OCD is Cognitive Behavioral Therapy, or CBT. This form of psychotherapy stresses the relationship between faulty thoughts, mood, and behavior. Treatment includes therapist-directed “homework” through which the patient learns cognitive tools to address and process the faulty thinking that has led to their anxiety and subsequent rituals. CBT can be successful with children as young as four or five years of age. OCD can be put into remission however sufferers need to be vigilant regarding return of symptoms and impairment. During these relapses patients will need to return to the use of the cognitive tools they have learned in CBT.

ERP

Exposure-Response Prevention (ERP) is an important tool used in CBT. ERP involves patient exposure to the anxiety-provoking situation and prevention of the “OCD response”. This technique is optimally used after the patient has been able to restructure some of the faulty thinking causing the ritual. Successive ERP results not only in habituation to the anxious thought but realization that the feared result (of not participating in the ritual) will not occur. As I tell my patients, “You must be willing to practice being anxious to not have anxiety anymore.”

On an individual basis, medication may be an adjunct to CBT for OCD. Medications such as Zoloft or Luvox may help a person with severe anxiety be able to better assimilate therapy and facilitate progress. Medications in the benzodiazepine class (e.g. Klonopin, Xanax, Ativan) are addictive, dangerous, and highly discouraged.

Resources

International OCD Foundation (iocdf.org)

National Institutes of Mental Health (nimh.nih.gov)

Book: Imp of the Mind by Max Baer

Testimonials Family Mediation Contact