OCD NOVEL APPROACHES
Dennis B. Kottler, MD
Westlake Village, CA
Return to Homepage
Click images for more information:
INSIDE OCD AND HOW TO GET AROUND IT
Obsessive-Compulsive Disorder--OCD-- involves impulses to perform irrational behaviors until a TENSE FEELING is resolved. These behaviors are repetitive thoughts or actions or mental images, often morbid in nature. The behaviors are repeated with the number of repetitions sometimes having a "magical" meaning. Or the number may have to be even, odd, or a certain "good" number.
The behaviors are diverse. Examples are turning a faucet or switch on and off repetitively, making tic-like movements, making sounds in the throat, and repeating a thought or phrase. There is a feeling of URGENCY and TENSION until the behavior is satisfactorily performed. The behaviors are repeated incessantly throughout the day and consume a huge amount of time, making it difficult to be productive. In computer terms, it is as though the brain has been hijacked by a "virus" which resists eradication.
The most common behaviorial approach is called "exposure response prevention"--ERP. This involves placing oneself in the situation that evokes the OCD behavior and then attempting to prevent or at least delay the response. A hierarchy of OCD behaviors can be created with the least troublesome and easiest to resist behaviors the first to tackle with "ERP."
Another techniques is "quieting the mind," through meditation, which creates confidence in controlling intrusive behaviors.
A third technique is "habit substitution." This involves replacing the target behavior with another behavior, such as rolling a marble, which may be concealed in a pocket; also works for stuttering.
OCD is a heterogeneous disorder and there needs to be flexibility in treatment approaches.
Medication is often a necessary adjunct to behavioral treatment.
See: OCD Self-Test
Obsessive-compulsive disorder (OCD) is not the same as Obsessive-Compulsive Personality Disorder (OCPD).
Obsessive-Compulsive Disorder, once thought to be a rare condition, is now thought to affect perhaps 3% or more of the (US) population. This number may be much higher, since relatively few individuals with this disorder seek treatment. Many OCD sufferers carefully conceal or camouflage their rituals for fear of embarrassment. Frequently, people with this disorder are not aware there are now effective treatments.
Related to Obsessive-Compulsive Disorder (OCD) is Obsessive-Compulsive Personality Disorder (OCPD). In this disorder, a person feels compelled to have things in his environment arranged in a very neat and particular manner. This individual might, for example, experience extreme anxiety if all the pillows are thrown off the couch, if dinner plates are left in the sink, or if objects are not properly aligned. Although some of this behavior might resemble Obsessive-Compulsive Disorder (OCD) there is an essential difference. Most people with Obsessive-Compulsive Personality Disorder (OCPD) do not consider their behavior to be a problem, but they often drive their partners or roommates "crazy." On the other hand, most people with Obsessive-Compulsive Disorder (OCD) drive themselves "crazy."
Gender Prevalence: Obsessive-Compulsive Disorder (OCD) appears to be about equally prevalent in both sexes. However, Obsessive-Compulsive Personality Disorder (OCPD) appears to be diagnosed about TWICE as often in males vs. females.
Prominent Features of Obsessive-Compulsive Disorder (OCD)--not everyone has all these features:
1. Compulsions: Repetitive Behaviors which are often done to relieve a sense of tension or to "ward off" an imagined, undesired event. Common compulsions include repetitive touching, checking, counting, handwashing, body movements, retracing one's path, repetitive looking at something, avoidance of certain colors or words, repetitive reading, and numerous other behaviors which can be quite unique and idiosyncratic to a given individual.
2. Obsessions: Repetitive Thoughts, Images, or Impulses which intrude into one's conscious mind and are often morbid and extremely disturbing.
3. Constant doubting. E.g., "Did I lock the door?" "Did I put the stamp on the envelope I just mailed?" This leads to constant checking. Much time can be consumed with the checking, doubting, and rechecking...sometimes over and over.
4. High level of stress and often disgust regarding the presence of compulsions and obsessions and the feeling that they are "foreign" behaviors (or thoughts) which the individual has little apparent ability to control or avoid.
5. Frequent concomitant depression and anxiety.
6. Sometimes associated with "OCD Spectrum Disorders" such as hair-pulling (trichotillomania), picking at scabs, and motor tics.
7. Often starts in childhood, but can occur later in adulthood.
8. Strong sense of embarrassment about the symptoms; attempt to camouflage the behaviors.
9. Frequent guilty feelings about having repetitive, morbid thoughts, images, and frightening impulses about loved ones.
Other Features -- which seem to get less attention in the scientific literature, include:
1. Difficulty making transitions. The person with OCD will often have trouble leaving a situation. There seems to be a "stickiness" phenomenon. Sometimes this looks like separation anxiety, but it is not quite the same.
2. Difficulty with time. Sometimes the person with OCD is eternally late. This seems to relate to the difficulty making transitions and being able to put aside an activity. Sometimes the person feels that he has to "finish" something before he can move on, even if that activity may not be all that important.
3. Difficulty setting priorities. This is again related to difficulty with transitions and time. Sometimes the person with OCD seems to give equal weight to trivial things and important things. The trivial things often seem to take up large blocks of time. Sometimes there is the problem of "having to get one more thing done." Then, of course, the person is late for the next activity, even though it may be a very serious commitment.
The frustrated spouse, roommate, boss, or whomever, usually thinks of this problem as a "simple" problem of "Time Management." However, the problem is much more complex than that, and simple "Time Management" training, whether by participation in a workshop or by reading a self-help book, rarely has much lasting impact.
4. "Quirky" Movements
These include repetitive "cracking" of the neck, back, jaw, or other part of the skeleton. If the reason for this action is explored, the person will often relate the "habit" to a feeling of tension which builds up and can only be relieved by the movement in question.
Sometimes these individuals develop chronic physical conditions related to the constant stress on the muscles and/or skeleton. An example of this is an aching upper or mid back, an aggravated tempero-mandibular joint (TMJ syndrome), or sore muscles. Sometimes one develops hypertrophied muscles, for example in the neck, from a neck "tic." A head "jerking" or banging tic can result in damage to the neck or head as well as possibly to the eyes (detached retinas, ?). As is apparent, some of these symptoms are indistinguishable from a tic disorder, such as Tourette's. Some believe that Tourette's Syndrome is essentially a form of OCD.
5. Various forms of "picking" at different areas of the body, including picking scabs, pulling out hair (trichotillomania), picking at the tissue around the nails, and various other similar behaviors. The person, when pressed, will state that he "doesn't know why he does this" but "it seems to relieve a build-up of tension." But the tension constantly returns and results in the behavior being constantly repeated.
6. Difficulty with many different activities, such as reading, playing sports, playing a musical instrument, etc.
Some individuals, for example, compulsively "re-read." They are constantly going back and re-reading the sentence, or certain words or phrases. Sometimes they "believe" something "bad" will happen if they do not do this. A similar need to repeat or avoid certain actions can wreak havoc with sports, playing a musical instrument, and in fact, almost any activity.
Many of these individuals with OCD are labeled "slow readers" or "spastic" or "uncoordinated" when in fact the problem is OCD.
As with many psychiatric disorders, some of these symptoms are found to some degree in "normal" individuals. A skilled psychiatrist will be able to make a definitive diagnosis of this disorder and recommend treatment, which often includes a combination of medication and cognitive-behavioral therapy.
See: OCD Self-Test
Article by Author: "Why We Have Obsessive Compulsive Disorder and What We Can Do About It"
Additional Suggested Readings
Return to Top
Return to Homepage