by Scott Friedman, Psy. D.
OCD symptoms can range from irritating to crippling for the person and others in their life. There may be obsessive and intrusive thoughts that disturb the person, doubts about what they said or did and actions and rituals that must be done. There can be relentless and endless worries about not having done things “perfectly”.
The obsessive and intrusive thoughts can torture the person, even though they are often about things that the person would never really do. If there also are compulsions to do some things in a certain order or over and over again, they can take so much time and interfere with living.
The OCD bullies the person: it may make them think thoughts that they find disturbing; they may struggle with whether or not they are a “good” person; they may have to check and re-check what they did over and over; they can be paralyzed with the need to do things “perfectly”; they may need to count things---and the person understands that none of this makes sense, yet they are compelled to have the disturbing thoughts and may have the repetitive rituals and behaviors.
It is important to see a therapist who has experience treating this disorder. The first step is an educational component: to educate about OCD as having an emotional component, but being a brain-related problem. This means that the brain “tricks” the person to believe that certain thoughts are “bad” and reflect on them as a person; the need to do certain rituals over and over such as excessive hand washing and checking to see if the door is locked. OCD is a bully. With a better understanding, we can tell our self: “that is the OCD tricking me to think that a thought I had is terrible—we have thousands of thoughts”. The person is focusing on the “junk mail” that we throw out when they dwell on an unusual thought and worry about it. Also, just because we have a thought does not mean we will act on it. With young children, we have them draw a picture of the OCD, the brain bully that is making them think that they need to worry and/or do certain things over and over again.
Obsessive worry also is a bully. “If I don’t worry enough, I will be in a car accident when I drive home”. Then we were not in a car accident, we become convinced that we did a good job worrying and warded off the accident. What the OCD is doing is tricking the brain that there is at least a 50 percent chance of a bad thing happening.
In addition to education about OCD, therapy can be very useful in treating this disorder. This can include cognitive-behavioral therapy, exposure and response prevention (for example, if excessive hand washing is a problem, wash your hands briefly and avoid the usual response of needing to do it for a long time). Any change we make with a behavior, no matter how small, lets us to begin to take control back. For example, if a person feels compelled by the OCD to wash their hands for twenty minutes and can limit it to eighteen minutes, they have started to take control of the symptom.
An insight oriented aspect of the therapy may be useful to help the person come to understand what is behind their struggle with the “am I a good or bad person” issue if that is a part of the difficulties. Sometimes, understanding how one’s growing up contributed to a need to be “perfect”; and other OCD related symptoms can be helpful. Relaxation training can help reduce the anxiety, especially when the person “bosses back” the OCD rather than giving in to it, resulting in initial anxiety.
Medication may be a useful and needed adjunct to the therapy, at least for a period of time. Certain medications, such as the SSRI’s (like Lexapro, Zoloft, etc.) seem to help the person to not be as “stuck” in the OCD cycle of obsessions (intrusive thoughts) and/or compulsions (behaviors that the person feels they “have” to do).