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What is Obsessive Compulsive Disorder (OCD)?
Obsessive-Compulsive Disorder (OCD) is categorized as an anxiety disorder in which its sufferers experience persistent intrusive thoughts, impulses, and/or images known as obsessions, and may perform senseless repetitive behaviors which temporarily decrease the anxiety caused by these disturbing obsessions.
The obsessions can manifest themselves in a variety of ways, including a preoccupation with aggressive or violent images, religious concerns, repugnant sexual or perverted thoughts, safety and health issues, cleanliness, orderliness and exactness, etc.
Compulsions, or repetitive behaviors, may be overt actions (i.e. hoarding, cleaning, arranging, repeating, checking, tapping, rubbing) or mental rituals ( i.e. mental counting, mental reviewing, repeated prayer, silent list making, etc.). Typically, rituals are performed to allay fears or ward off physical tension. Unfortunately, they bring only short-term relief to the sufferer and act to further reinforce the obsessions.
Individuals with Obsessive-Compulsive Disorder fall along a continuum of psychosocial impairment, ranging from a slight impediment in daily functioning to an incapacitating level of interference. The milder cases of OCD may be considered a mere annoyance whereas the more severe cases can result in upheaval and disruption in a person’s personal relationships, leisure activities and occupational life.
People with OCD often rely on relatives for emotional, instrumental and informational support. The pathological doubting, so commonly associated with OCD, causes people to doubt their senses (i.e. what they see, hear or touch) and can profoundly impair their daily performance.
Thus, they may rely on relatives to offer them constant reassurance or may request that the family participate in their ritualistic behaviors to assure them that they indeed have completed a task or performed it correctly. Families may become overly involved in the patient’s decision making and daily responsibilities, further fostering the dependence and insecurities that are characteristic of this disorder.
Cognitive Behavior Therapy (CBT) is quite effective in ameliorating symptoms of OCD. We use a specific type of CBT called Exposure Therapy and Response Prevention (ERP) in which we introduce specific anxiety-provoking stimuli and help the person habituate to the stressor. This could be a tangible exposure (i.e. touching an allegedly contaminated object) or an imaginal exposure (i.e. inviting distressing thoughts into the mind). Response prevention is a technique in which the person is discouraged from performing any compulsions. Although anxiety is expected to increase with the initial phases of ERP, the ultimate goal is to decrease the long-term anxiety and time-consuming rituals.