AAMFT Consumer Update
Obsessive
Compulsive Disorder
Obsessive-compulsive disorder
(OCD) is a common anxiety disorder that affects about 1 to 2% of the
population. As its name implies, the symptoms of OCD involve obsessions
that lead to compulsions. Obsessions are recurrent and persistent ideas,
thoughts, images, or impulses that may cause a great deal of anxiety
or distress. People experiencing these obsessions typically find them
to be disturbing and intrusive, and usually recognize that they don’t
make a lot of sense. In response to obsessions, people with OCD try to
get rid of them by way of compulsions—acts that are done over and over
again, and often according to certain personal rules. Also called rituals,
compulsions are usually aimed at preventing or reducing distress and
anxiety, or preventing some feared event or situation.
Obsessions and compulsions
can take many forms. A few examples include: drivers who fear that they’ve
hit a person every time they run over a pothole or bump on the road.
In response to such an obsession, these persons may resort to compulsions
such as retracing their routes to be sure no harm was done, or avoid
the particular road altogether in the future. Individuals who fear or
are obsessed with germs may wash their hands repeatedly throughout the
day after touching any potentially “germy” objects, such as door handles,
money, or newspapers. Often, their hands are sore and raw from repeated
washing, but they can’t seem to stop washing. Others who might be obsessed
with order and cleanliness may compulsively arrange items in a particular
order, or clean their home floors many times a day. Those who fear burglary,
fires, or floods may repeatedly check door locks, stove burners, and
taps to ensure that their homes are safe. Over time, such repetitive
actions work less and less effectively, and the persons may experience
anxiety and often depression in response to the increasing obsessions
and compulsions.
Besides causing a great deal
of stress, OCD symptoms may take up a lot of time (more than an hour
a day for some diagnosed people) and may significantly interfere with
a person’s work, social life, or relationships. OCD can be a challenging
problem but fortunately, very effective treatments for OCD are now available
to help individuals and families lead a more satisfying life.
What
causes OCD?
There is no single, proven
cause for OCD. There is, however, growing evidence that biological factors
are a primary contributor to the disorder. Research suggests that OCD
involves problems in communication between the front part of the brain
(the orbital cortex) and deeper structures (the basal ganglia). These
brain structures communicate with each other by using serotonin, a chemical
messenger. It is possible that serotonin plays a significant role in
the development or maintenance of OCD. Other psychological, familial,
social and cultural factors may contribute to OCD, but it is not clear
whether they cause the disorder.
What
is the effect of OCD on family members?
Family members often feel
confused and frustrated by the symptoms of OCD. They may have difficulty
understanding the exaggerated behaviors seen in a person with OCD, and
they may think that the person is behaving oddly on purpose or that he/she
has simply “lost their mind.” Understandably, the family may find it
difficult to cope with the behaviors seen in the member with OCD and
they may not know how to handle the situation. The family may react negatively
to the person, possibly causing a lot of family and marital stress. In
order to avoid and/or deal appropriately with family reactions, it is
very important for family members to learn about OCD, including its symptoms,
causes, and treatment. Families who educate themselves about the disorder
can contribute to the successful treatment of the individual with OCD.
What
treatments are available for OCD?
There are several types of
effective treatments for individuals with OCD and their families. The
most common types of treatments are the following:
Cognitive Behavioral Therapy
(CBT)—This treatment has two parts: behavioral therapy and cognitive therapy.
Behavioral therapy involves exposure and response prevention.
Exposure is designed to reduce the negative emotions (anxiety and guilt)
brought on by obsessions. It is based on the idea that anxiety usually
decreases after lengthy contact with something feared. For example,
people with obsessions about germs will be advised to stay in contact
with “germy” objects, such as money. In order for exposure to be most
helpful, it needs to be combined with response prevention (RP). In
RP, the person’s rituals (or compulsions) are blocked. For example,
those who worry a lot about germs will be advised to stay in contact
with “germy” objects, but avoid the compulsion to wash their hands
excessively. This repeated exposure without rituals assists individuals
to understand that coming into contact with certain objects or situations
will not lead to the initial fear—in this case, becoming ill from the
germs found on common objects.
CBT’s
second part is cognitive therapy (CT). It is often combined with behavioral
therapy to help reduce the catastrophic thinking and exaggerated sense
of responsibility often seen in OCD. In cognitive therapy, the therapist
asks the client a series of questions to help him/her identify and evaluate
the interpretations and beliefs that lead to typical OCD behavior. Once
these beliefs are identified, the therapist will use a variety of strategies
to assist the client in challenging the faulty assumptions that are seen
in OCD.
Behavioral Family Treatment— Whenever possible, it is
helpful for family members to participate in the treatment of OCD. Family
members and persons with OCD both tend to benefit when the family members
participate in psychoeducational groups. These groups educate family
members about OCD and provide strategies that the family can use to assist
and support the member with OCD.
Medication— Research shows that the
use of medication, specifically serotonin reuptake inhibitors (SRIs),
is beneficial for the treatment of OCD. Most research shows that medication
alone does not get rid of OCD, but it reduces the force of obsessions
and urges to engage in rituals (for example, excessive hand washing),
thereby allowing the person with OCD to have more control over their
thoughts and behaviors.
How
can a family therapist help?
Family therapists are trained
to assist individuals, couples, and families with a variety of clinical
issues, including OCD. A family therapist will carefully assess a person’s
condition and assist him/her in determining which of the above treatments
will be most appropriate and beneficial. A family therapist will also
encourage the family to actively participate in the treatment of OCD
in a variety of ways, including participation in a psychoeducational
group. If medication is necessary, the therapist will refer the client
to a physician who can guide the person in determining which medication
is the most appropriate to take. Often, the family therapist and physician
will work together to coordinate and carry out the treatment of the person
with OCD. This will ensure that the person receives the best possible
treatment.
Consumer Resources:
Organizations
Obsessive Compulsive Foundation,
Inc.
Phone: 203.315.2190
Website: www.ocfoundation.org
This national organization
provides information and referral services for those seeking help for
OCD. An annual conference on OCD and related topics is held during the
summer and provides an excellent forum for clinical training and for
sufferers to meet each other and the experts. The OCF also has an extensive
publication list of books, articles and videos available for sale.
Books
Van Noppen, B., Pato, M.,
& Rasmussen, S. (2003). Learning to live with OCD: Help for Families.
New Haven, CT: Obsessive Compulsive Foundation. This booklet is a mainstay
for family members trying to understand OCD and how to deal with these
symptoms in the family environment.
Baer, L. (2000) The Imp
of the Mind. New York: Little, Brown & Co. An excellent book
describing how obsessions become embedded in the psyche. This is a
useful resource for patients and therapists.
The information in this brochure was provided by Gail Steketee, Ph.D.
and the Obsessive Compulsive Foundation, Inc., www.ocfoundation.org.
