Obsessive-Compulsive Disorder: Diagnosis and Treatment

Obsessive-compulsive disorder, or OCD, is a mental disorder categorized by a combination of anxiety-inducing thoughts and behaviors. The disorder can be time-consuming, cause significant distress to those suffering from it, and impair life functions in a number of areas.

Obsessive Thoughts

OCD acts as an overactive defense mechanism that disrupts the individual’s mental health system. This is due to distress and anxiety that arises from ruminative, obsessive thoughts and repetitive, compulsive behavior that is often meant to dissipate them.

The following four categories are the most common types of obsessive thoughts, beliefs, urges or images relating to OCD, which can appear individually or in combination with one another:

• Cleanliness and concern from contamination (e.g. touching the dishrag may have transferred an illness).
• Worry about harmful or disastrous consequences (e.g. the gas was not shut all the way off).
• Focus on symmetry, organizing, counting or “just right” thinking (e.g. the dishes were not put back in the “correct” order).
• Taboo thoughts or mental rituals (e.g. a violent thought about a loved one facing harm).

Such thoughts and beliefs are experienced as intrusive and unwanted. They can severely disrupt the individual’s daily routine and cause them a great deal of distress, worry, and frustration.

In addition to the type of content the obsession focuses on, OCD is assessed by the level of insight an individual has into their condition, ranging from a good level of insight (recognizing they are facing a mental difficulty) to no insight (an inability to acknowledge it).

OCD is part of a range of OCD and related disorders. This group includes trichotillomania (hair pulling), excoriation (skin picking), hoarding, and body dysmorphic disorder (a preoccupation with one or more perceived defects in physical appearance. When considered as a wider spectrum of disorders, this makes OCD and related disorders much more commonplace.

One of the most frequently used clinical assessments for OCD is the Yale-Brown Obsessive Compulsive Scale (Y-BOCS). In addition to identifying specific symptoms, the Y-BOCS scale assesses how much time is occupied by obsessions or performing compulsions, the degree to which they interfere with daily life, the level of distress caused, how able the patient is to resist, and the degree of control over obsessive thoughts and compulsions.

Compulsive Behaviors

A person battling OCD often feels attacked by their own obsessive thoughts and may develop compulsive behavior mechanisms as a means to suppress the strong levels of anxiety they raise within them. However, these mechanisms can also cause a great deal of distress, resulting in both a high level of anxiety and a detrimental effect on the individual’s physical, social, mental and emotional well-being.

There are many examples of OCD-related compulsive behaviors, from excessive hand washing, endless checking that all appliances are safely shut off, repeatedly setting the table due to real or imagined asymmetry, or staying in bed until an aggressive thought about someone dear is staved off.

While the compulsive action or ceremony is performed as a way to find relief from an obsessive thought, it does not actually have the power to banish it; instead, the compulsive behavior begins to feed the obsession, as self-doubt trickles into their thought process and demands they repeat the ritual—and this time do it flawlessly.

As an example of this circular mental process, an individual whose OCD focuses on food contamination may find themselves cooking dinner for hours on end, throwing away pot after pot of chicken soup, worried that the bacteria in the meat was not completely destroyed. Due to a high level of insight, this person understands their way of thinking is illogical. They have even read numerous articles on how boiling water protects against virtually all the harmful elements that raw chicken may hold. Regardless of the statistical improbability, though, they cannot shake the fear that this time, their cooking did not eliminate some rare contaminant that might harm their family. And so they defrost another chicken and start over.

Demographics and Possible Risk Factors

While OCD can start at any age, OCD symptoms commonly first appear between ages ten and early adulthood. Because OCD can be challenging to diagnose and is often rationalized by sufferers as quirks or idiosyncrasies, it takes an average 14-17 years from the time symptoms appear for patients to receive appropriate treatment.

Individuals with OCD also often suffer from additional mental health conditions. Approximately three in four have a lifetime history of anxiety disorders and nearly one in two suffer from depression.

OCD has been linked to several different risk factors. They include genetics, environment, temperament and life events.

OCD Treatment

OCD can be treated with several different treatment options, or a combination thereof.

Deep TMS: As the only noninvasive device FDA-cleared to treat OCD, Deep Transcranial Magnetic Stimulation (Deep TMS™) utilizes magnetic fields to safely regulate the neural activity of brain structures found to be related to OCD. The treatment’s efficacy was confirmed in 2019, in a multicenter, sham-controlled study published in the American Journal of Psychiatry: the study found that regulating the functions of “the medial prefrontal cortex and anterior cingulate cortex significantly improved OCD symptoms.”

Cognitive Behavioral Therapy: CBT is a form of psychotherapy often used in treating OCD. The treatment examines the thoughts, feelings, behaviors and physical reactions that are linked to OCD, and helps the patient become less anxious from the different facets of the disorder. Several types of CBT are effective for treating OCD, most notably acceptance and commitment therapy (ACT). ACT helps patients emphasizes psychological openness and flexibility in reacting to intrusive, obsessive thoughts, in addition to commitment to behavioral change and wellness.

Exposure and response prevention therapy (ERP) has also been shown to be effective in treating OCD. With ERP, the patient is gradually exposed to the source of their anxiety, as the therapist accompanies and supports them during this process, yet is prevented from acting out compulsions. The goal is to acclimate the patient’s brain to the intrusive thoughts and build skills to overcome them without resorting to compulsions.

Psychopharmacology: Certain psychiatric medications are also prescribed for OCD, with several antidepressants FDA-approved to treat the disorder. Approved medications include four selective serotonin reuptake inhibitors (SSRIs), as well as one tricyclic antidepressant (TCAs). While many find them helpful in reducing the frequency and severity of OCD symptoms, they also include possible side effects.

Psychodynamic Therapy: Another form of psychotherapy considered for OCD treatment is psychodynamics. This form of therapy focuses on the interaction between formative relationships and life events, needs and desires, theoretical mental structures and personality traits, as a way to understand what may have contributed to the development of OCD. Once the relevant factors are uncovered, the therapist and patient work together to deconstruct rigid, maladaptive patterns linked to the disorder, and consider more beneficial alternatives that can provide the patient with a better quality of life.

Consult your doctor if a question arises regarding your mental health.