Understanding OCD and How to Cope with it

The OCD cycle can be used to explain the causes of OCD. In brief, the OCD cycle suggested that OCD patients feel the need to carry out the compulsions because their actions lead to relief of their anxiety. Obsession and compulsion are an entwined process which makes the cycle difficult to escape if patients do not receive appropriate treatment. 

The 4-Step Process of OCD

1. Firstly, when an obsessional thought intrudes the person’s thinking, an obsession is formed. Repetition of this obsession leads to the patient experiencing anxious feelings.
2. As the patient hopes to reduce anxiety, they develop compulsive behaviors to manage the anxiety. 
3. By performing these compulsive behaviors, the anxiety is temporarily ameliorated. 
4. After a while, the obsession returns and creates anxiety again. The patient will have to repeat compulsive behaviors to gain relief and to reduce anxiety.

OCD patients experience obsessions that are associated with specific themes. Common obsession themes include dirt, contamination, aggression, bodily functions, the need for order and symmetry in lives, the need to do things in a particular sequence and a specific number of times.

Common examples of obsessions include:

According to the American Psychiatric Association, there are some common obsessions that OCD patients experience:

• Fear of getting contaminated by people or the environment 
• Disturbing sexual thoughts or images 
• Fear of blurting out obscenities or insults 
• Extreme concern with order, symmetry, or precision 
• Recurrent intrusive thoughts of sounds, images, words, or numbers
• Fear of losing or discarding something important

Furthermore, patients with OCD show compulsive behaviors which as mentioned, are conducted to reduce anxiety. Therefore, compulsive checking is a common form of compulsion in many OCD patients. Compulsive behaviors are also known as coping mechanisms to reduce the anxiety caused by obsessive thoughts. Examples of compulsions include:

• Grooming
• Excessive hand washing
• Unstoppable action (e.g. going in and out of a door)
• Frequent checking behavior (e.g. check if the door is locked)
• Counting
• Ordering

When obsessions and compulsive behaviors occupy the majority of your time, you may consider seeking help from OCD therapists. In general, OCD therapists rely on diagnostic manuals such as the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and conduct diagnoses through the use of psychiatric assessments. One example of the assessments would be the Obsessive-Compulsive Inventory (OCI), which measures the frequency of 1) washing; 2) checking; 3) doubting; 4) ordering; 5) having obsessional thoughts; 6) hoarding; and 7) mental neutralizing.

Examples of questions include asking the patient to rate their agreement on the following statements:

• Unpleasant thoughts come into my mind against my will and I cannot get rid of them.
• I wash and clean obsessively.
• Even when I do something very carefully I feel that it is not quite right.

There are various intervention approaches for treating OCD. Some common approaches for OCD are discussed as follows:

Cognitive-behavioral therapy

Cognitive-behavioral therapy (CBT) can help patients identify their thought patterns and the associated emotions and behavior. One specific type of CBT is known as exposure and response prevention (ERP). Exposure treats obsessions by directly exposing the patient to thoughts, images, objects and situations that lead to anxious feelings and obsessions. By repeated exposure, the treatment allows patients to experience the fear until it subsides. Response prevention treats compulsions. To take washing hands as an example, ERP eliminates the rewarding effect of handwashing. Ultimately compulsive hand washing will become extinct.

Medications

Medications are often used to treat OCD. Examples of antidepressants commonly used to treat OCD include selective serotonin reuptake inhibitors (SSRIs) and clomipramine. These medications are used to treat OCD by increasing the concentration of serotonin in the brain. 

Biological treatment

In more severe cases, biological treatments are often combined with other approaches to treat OCD. One example of biological treatments would be surgery. Surgery is exceedingly rare. A typical surgery for treating OCD is deep brain stimulation. However, this treatment approach is only applicable for patients with severe OCD as it involves a high risk of side effects. Therefore, patients need to evaluate different treatment approaches before seeking help from an OCD therapist.