June 14, 2019

Obsessive-Compulsive Disorder

An individual with OCD has frequent, upsetting thoughts (obsessions) that she tries to control by repeating particular behaviors (compulsions). The obsessions spark a great deal of anxiety because they are not only intrusive and unwanted but also recurrent, Dr. Rego says. “People with OCD will do anything to combat or escape the obsessions and therefore they resort to extensive compulsions and avoidance,” he explains.

Those with OCD are aware that their obsessions are unreasonable, and they can feel tortured by both the obsessions and compulsive behavior. Typically, OCD starts to develop in later childhood or during adolescence.1 Symptoms can wax and wane, with symptoms getting better at times and worse at others. “It’s not typical for OCD to start later in life,” Dr. Rego says. “But without treatment, the condition becomes chronic and worsens.”

OCD tends to be distressing because the person may realize that her symptoms are impairing her life but still feels compelled to do her compulsions, says Scott Krakower, DO, assistant unit chief of psychiatry at Zucker Hillside Hospital in Glen Oaks, New York.

“For example, someone with obsessive symptoms of germs and contamination may be doing unwanted rituals to stay clean,” he says.  “This may ultimately worsen to where it begins to impact relationships and other functioning.”

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Selective serotonin reuptake inhibitors (SSRIs) are commonly used in the treatment of OCD. The most effective form of psychotherapy for OCD is a type of cognitive behavioral therapy (CBT) called exposure and response prevention, says Anthony Pinto, PhD, director of the Northwell Health OCD Center, located at Zucker Hillside Hospital. “In this form of therapy, the patient works closely with the therapist to gradually approach a situation that the patient finds terrifying, and then the patient learns to cope with their anxiety without relying on their compulsions or avoidance,” Dr. Pinto says. “Touching surfaces in a public restroom and then not washing is an example.”

The goal of this treatment is not to limit having the intrusive thoughts, but instead to learn, over time, to be open to them and not react to them in fear. Both in session and through homework assignments, the person learns to notice and acknowledge the intrusive thoughts without responding with compulsions and, through this process, the person reclaims her life since her routine and functioning are no longer disrupted

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