OCD: Appropriate Diagnosis and Treatment is Essential Author: Kristy Cobillas, LPC

The unfortunate truth.....

On average it takes approximately 17 years before an accurate diagnosis for OCD is given.

Studies show that OCD impacts approximately 2% of the population, however one cannot help but think that perhaps OCD is more pervasive, as it is often misdiagnosed as Generalized Anxiety Disorder, Anxiety Disorder NOS, Bi Polar Disorder, Mania or even Psychosis or Paranoia. This is problematic, as OCD cannot be treated therapeutically or biologically in the same manner as these other diagnoses.

Known as the “doubting disease”, OCD plagues its victims with consuming repetitive “fringe thoughts”; thoughts that would never enter the mind of those who do not suffer from this insidious disease. Those who suffer with OCD may experience such musings as “what if I don’t exist”, “what if I am a child molester and don’t know it”, “what if I secretly want my parents to die” or “I just saw broken glass on the parking lot, I better clean that up or I will be responsible for someone getting hurt.” These distressing, unreasonable ideas are followed by an endless search for whether or not these ideas are true or if the sufferer is safe. This search for assurance is done via compulsions such as intense researching, excessive assurance seeking, cleaning, confessing, rumination and other repetitive and sometimes superstitious behaviors. These compulsions give momentary relief, but unfortunately the distressing ideas always return.

As aforementioned, these OCD thoughts are unreasonable. The tendency to want to meet these unreasonable ideas with logic is only natural. Unfortunately, logic doesn’t work, and often typical therapeutic interventions such as Socratic questioning, Checking the facts, Experimentation, Argumentation and other cognitive interventions, only drive the client further into the cycle.

Many sufferers don't understand what is happening to them, and as evidence shows, OCD is even overlooked by well-meaning therapists. OCD requires specified treatment that includes Exposure and Response Prevention and Cognitive Behavioral Therapy techniques. Further, OCD requires a higher dose of SSRI intervention as well, so if the diagnosis is overlooked, the client will not receive adequate biological intervention.

So, what is Exposure and Response Prevention (ERP)? To put it in the simplest of terms, ERP involves therapeutic techniques that expose the client to feared ideas and situations without following up with compulsive behaviors. The client is to work towards accepting uncertainty and sitting with the strong feelings of anxiety, incompleteness, and/or disgust. The client is to abstain from doing the compensatory checking behaviors that they usually use to gain “certainty.” For instance, in doing imaginal exposure, the client will want to have the mindset that “maybe I want my parents to die/maybe I don’t” or “I'm not cleaning up that glass in the parking lot, maybe I will be to blame if someone gets hurt, maybe I won’t.” It sounds so simple, but it is extremely anxiety provoking. The anxiety doesn’t go away immediately, there is always a lapse. But, if done correctly, this technique will break the neurological OCD loop and weaken the neural pathways associated with the disorder.

The diagram at the top of the page is a depiction of the OCD cycle. OCD obsessions are characterized by an over importance of thoughts, overestimation of threat, inflated sense of responsibility, perfectionism, and an intolerance of uncertainty. Everyone experiences intrusive thoughts, but for the OCD sufferer, these thoughts are taken seriously. The sufferer feels as though they must prove to themselves that that intrusive thought is not true. There is a high level of anxiety, a sense of incompleteness, and sometimes OCD is experienced as extreme disgust. These sensations can feel intolerable and there is a strong urge to neutralize the feelings via compulsions. This behavior brings a sense of relief momentarily, but only strengthens the neurobiological loop, resulting in the distressing thought and accompanying disturbing emotions will intrude again. In order to break this cycle, the loop has to be severed between the distressing emotions and the compulsion; meaning the client has to “sit with” and tolerate these feelings without doing anything about it. This is very, very unsettling and uncomfortable, but this is the process in which the brain rewires itself.

If typical talk therapy is used with clients who have OCD, there will be a prolonging or even possible worsening of symptoms. It feels relieving and comforting to have someone confirm a sense of safety and correctness. It feels really good at the moment, however the assurance that is received is “scratching the itch” of the OCD only to have it return again, as it reinforces the neurological connections.

It is so very important to find a therapist who understands the mechanisms of the OCD, and will utilize the appropriate therapeutic interventions. If there are not confounding issues such as a trauma history, a bipolar diagnosis or symptoms of depression, OCD treatment can be relatively short depending on whether or not there is a willingness to tolerate the anxiety and sit with the uncomfortableness associated with accepting uncertainty.

If you think you or someone you love might have OCD, please find a specialist, this disease can be managed if handled appropriately.