Abstract

Obsessive Compulsive Disorder, OCD, is an anxiety disorder that causes unwanted and intrusive thoughts or feelings that cause an individual to feel driven to do something. OCD affects one in every 50 individuals in the United States. Often times, OCD begins in childhood or adolescence and if untreated, will continue into adulthood. This research paper will address the symptoms of OCD and the current counseling techniques used to treat it.

Keywords: obsessive compulsive disorder, rituals, obsession, exposure and response prevention, compulsions, obsessions

Obsessive Compulsive Disorder, OCD, is an anxiety disorder characterized by recurrent, unwanted thoughts (obsessions) and/or repetitive behaviors (compulsions). Individuals with OCD are often plagued by persistent, unwelcome thoughts or images, or by the urgent need to engage in certain rituals. Patients with OCD usually recognize the fact that their obsessive thoughts and compulsive behaviors are extreme or illogical, but this awareness does not help control their symptoms. An equal number of men and women are diagnosed with OCD, however, men tend to develop it earlier than women. Clients with OCD tend to suffer in many areas of their lives because so much of their time and energy is spent doing their rituals. For more than 7 out of 10 patients, the disorder severely impairs their family relationships, and 6 out of 10 have impaired friendships because of their OCD. Nearly 60 percent of OCD suffers experience academic underachievement and 40 percent of them are unemployed or underemployed (Hollander, Kwon, Stein, Broatch, Rowland & Himelein, 1996).

Most forms of OCD fall into five main categories, with most individuals having symptoms in more than one. The five categories include washers, checkers, doubters and sinners, counters and arrangers, and hoarders. Washers fear contamination and usually have cleaning compulsions. For example, they believe that if they don’t clean, something bad will happen. Checkers will repeatedly check things such as ovens and doors to ensure they are turned off. Each time doubt sets in, the person will check again, up to twenty times per day or more. Doubters and sinners fear that terrible things will happen if everything is not perfect and in order. Counters and arrangers tend to have obsessions about order, symmetry, and numbers. Certain number or certain colors may be “bad,” and asymmetry may lead to an imagined catastrophe. Hoarders are individuals that cannot throw anything away because they fear that if they do, something terrible may happen. However, not all hoarders are suffering from OCD. Some hoarders may be lazy or simply don’t have the time to sort through piles to discard unwanted items. When trying to determine if a hoarder has OCD, a therapist may ask the person what they believe will happen if they were to discard all of the items. If the person becomes upset or anxious at the idea of throwing away some items, they may be suffering from OCD.

In the past few years, the number of diagnosed cases of OCD has increased. Currently, OCD is the fourth most common mental disorder in the United States. It affects one in every five adults in the United States, with one third of them reporting they have been suffering from the disorder since childhood. OCD has been diagnosed in children as young as three years of age. In the article, “Just a Phase? Normal Developmental Rituals Versus OCD in Young Children,” the author provides an example of a six-year old girl who was being treated for OCD. The child’s parents first became concerned when the young girl began experiencing intrusive thoughts and images about bad things happening to her or her siblings. From there, the child began washing her hands excessively and seeking constant reassurance from her parents that her food was “clean” and wasn’t going to make her sick. She also required her parents to prepare her meals while she watched to ensure that her food was not being contaminated. If prevented from performing any of her rituals, the child would throw tantrums that would last up to two hours.

Compulsions and Rituals

Some individuals perform compulsive rituals because they feel they inexplicably have to. The person may feel these actions may somehow prevent a dreaded event from occurring, or will erase the event from their thoughts. Most people with OCD are aware that their thoughts and behavior are not rational, but they feel compelled to comply with them to fend off feelings of panic or dread.

One common ritual individuals suffering from OCD perform is counting specific things. For example, a person may count the steps as they walk up the stairs or count the number of steps they take while walking. A common compulsion that affects people with OCD is having to do something a certain amount of times before leaving a room. An example of this compulsion is a person who must flick the light switch a certain number of times before leaving a room. Another example is a person who has to lock their car door a certain number of times before feeling their car is locked and secure.

Some individuals can be diagnosed with OCD and Obsessive-Compulsive Personality Disorder. Although the two disorders have similar names, the manifestations of these disorders are quite different. Obsessive-Compulsive Personality Disorder does not involve obsessions and compulsions, but rather a preoccupation with orderliness, perfectionism, and control and must begin by early adulthood.

Treatment

Obsessive Compulsive Disorder often leads to relationship, social, and occupational difficulty. In its most severe form, the disorder can leave its victims completely housebound. Depression, anxiety, and eating disorders are common illnesses that occur in alongside OCD. OCD symptoms can vary widely from patient to patient. For example, obsessions about dirt or germs, illness, harming, morality, exactness, symmetry, and intrusive unwanted images are all very common. These obsessions are usually followed by attempts to suppress or ignore the thought or neutralize them with another thought or compulsive action (Wilhelm, Tolin, and Steketee, 2004)

Many techniques have been used to treat patients with OCD. One technique is called Exposure and Response Prevention, ERP. This entails exposure to situations that cause obsessive anxiety or discomfort. For example, a patient who fears becoming ill as a result of touching doorknobs would practice touching doorknobs to prove it will not cause them to become ill. Another important component of ERP is to have the patient abstain from rituals, such as hand washing or checking. EPR addresses each ritual separately according to the patient’s level of anxiety. Situations that cause moderate anxiety are addressed first, followed by more situations that produce the most anxiety. The process continues until the most feared situations evoke little or no anxiety.

According to the article, “Family-based CBT for OCD in very young children,” the author states that ERP is not very effective in treating children with OCD and is much more effective in treating adults or older children. The author points out that because young children rely so heavily on their family, an individual treatment model is not appropriate. Sometimes, parents try to protect their child from anxiety-provoking situations by accommodating their child’s behaviors and rituals. Therefore when treating young children with OCD, therapists must provide the parents with the tools to help the child overcome their illness. The article also mentions that about 20% of children diagnosed with OCD are also diagnosed with ADHD. Therapists try and treat both illnesses concurrently, noting that the ADHD behavior will often decrease while treating the OCD.

Since OCD is usually accompanied by other mental illnesses, treating it can often be difficult task for therapists. The diversity of symptoms and the comorbidity in OCD pose substantial challenges to practitioners seeking to treat this disorder. Along with other anxiety disorders, major depression occurs with OCD more often than any other mental disorder. The article, “Challenges in Treating Obsessive Compulsive Disorder,” points out that the incidence of major depression in patients seeking treatment for OCD is about 25-30%. Anxiety disorders may also be prevalent in patients with OCD. Social phobia is especially frequent, occurring in approximately 40% of patients with OCD.

The goal of therapy with clients suffering from OCD is to rid them of the anxiety that causes them to perform rituals and compulsions. Treatment strategies may include exposure to reduce fear of specific thoughts or situations, response prevention to reduce reliance on compulsions and promote habituation, and cognitive restructuring to help the patient put the thought into its proper perspective (Wilhelm, Tolin, & Steketee, 2004).

References

1. Hollander, E., Kwan, J.H., Stein, D., Broatch, J., Rowland, C.T., & Himelein, C.A. (1996). Obsessive-compulsive and spectrum disorders: overview and quality of life issues. Journal of Clinical Psychiatry, 8, 3-6.

2. Jr., W. L. (2006). An Uncommon Treatment of Obsessive Compulsive Disorder. Journal of Family Psychotherapy, 17, 1-19.

3. Steketee, G., & Noppen, B. V. (2003). Family Approaches to Treatment of Obsessive Compulsive Disorder. Journal of Family Psychotherapy, 14, 1-18.
4. Maxmen, J., Ward, N., & Kilgus, M. (2009). 14. Essential Psychopathology (pp. 397-403). New York: W.W. Norton & Company Inc.
5. Wilhelm, S., Tolin, D., & Steketee, G. (2004). Challenges in treating obsessive-compulsive disorder. JCLP, 60, 1127-1131.
6. Freeman, J., Garcia, A., & Coyne, L. (2008). Family based CBT for OCD in very young children. Brown University, 47, 3-4.
7. Garcia, A., & Freeman, J. (2009). Just a phase: normal developmental rituals versus OCD in young children. Brown University, 25, 4-6.