By: Michael Butkus, PhD

Obsessive-compulsive disorder (OCD) afflicts about 2-3% of the adult population and about 0.5 to 1% of children and adolescents. If one includes those who do not have a diagnosable condition (i.e., subclinical condition), then these figures are much higher. Many individuals may have OCD and still function quite normally but many experience negative quality of life changes because of it.

OCD is considered an anxiety disorder and characterized by obsessions or intrusive, unwanted thoughts and compulsions, ritualistic behavior that must be performed. The compulsions serve to diminish the anxiety caused most often by the obsessions. If the individual did not become anxious by the obsessions, there would not be much ritualizing.

There are generally several classes of obsessions and compulsions such as: responsibility obsessions, checking rituals, contamination obsessions and decontamination rituals, symmetry (“just right”) obsessions and ordering/arranging rituals, violent, sexual, and religious obsessions and reassurance-seeking. Interestingly, studies have shown that on average we have about 4000 thoughts per day and some of them are similar to those that plague people with OCD. It’s just that the individual with OCD can’t stop thinking about them, is made anxious by them, and tries to make them go away with rituals. OCD sufferers have tried to stop their obsessions and are often told by others to “just stop thinking about them.” But as has been shown in research, trying not to think about something (e.g., pink elephant) makes one think about it more.

Researchers have investigated the cause of OCD. While there is not one good causal theory there are believed to be many contributing factors that explain why someone gets OCD and another does not such as: genetics, brain structure and chemical differences, proneness to anxiety, and tendency to over interpret the significance of one’s thoughts. What has been shown in research is that OCD is not caused by early childhood trauma, fixations, or conflicts although it is not unusual for OCD to begin in childhood. A sufferer does not cause their OCD. But fortunately there are medical and behavioral treatments that can relieve or reduce OCD symptom frequency and intensity.

Research shows that those with OCD benefit from well-conducted Cognitive Behavioral Therapy (CBT). In this form of therapy, the individual learns that there is a reliable relationship between certain thoughts and consequent feelings and actions. Via cognitive restructuring, where irrational or error-based thoughts are challenged and replaced, the individual learns a better way to think about their obsessions. In OCD treatment the individual learns about the nature of anxiety, what OCD is, and how it is treated. Then a hierarchy of least to most anxiety provoking OCD symptoms is generated. The most important treatment component is called Exposure and Response Prevention (E/RP), where the individual with OCD faces the dreaded thought and purposefully does not engage in the corresponding ritual. E/RP is based on the well known phenomenon that facing a fear repeatedly will make the fear decrease in intensity and avoiding the fear will prolong or make it worse. Using E/RP and cognitive restructuring, each item on the hierarchy is attacked until it no longer generates much tension or urge or anxiety. OCD treatment, particularly E/RP, can produce tension and uncomfortable feelings at times but a good therapist will not move faster than the individual can handle.

Medication, e.g., citalopram (Celexa©) or paroxetine (Paxil©) can be a useful adjunct to therapy for OCD. Some individuals with OCD respond better to behavioral treatment if they are also taking medication.

Is everyone with OCD helped by the kinds of treatments described above? The short answer is no. But many are, in varying degrees, depending on a number of factors such as therapist skill, motivation to fight the OCD, frequency of E/RP, to name a few. For many, unfortunately, the length of time between symptom onset and treatment is long-in some cases 10 years or more. An individual with OCD, especially if the quality of their life is impacted negatively, can be helped if they get the right treatment. Finding a therapist skilled in treating OCD can be a challenge but therapists are out there. There is no good reason to delay treatment and prolong suffering.

There are support groups for those with OCD and organizations, such as The International OCD Foundation.