Obsessive Compulsive Disorder
 What is Obsessive Compulsive Disorder?

Obsessive-compulsive disorder (OCD), is a very common illness affecting as many as 6 million people a year. OCD is a potentially disabling condition that can persist throughout a person's life. The individual who suffers from OCD becomes trapped in a pattern of repetitive thoughts and behaviors that are senseless and distressing but extremely difficult to overcome. OCD occurs in a spectrum from mild to severe, but if severe and left untreated, OCD can destroy a person's capacity to function at work, at school, or in the home.

Recent research suggests that OCD affects more than 2 percent of the population, meaning that OCD is more common than such severe mental illnesses as schizophrenia, bipolar disorder, or panic disorder. OCD strikes people of all ethnic groups. Males and females are equally affected. OCD sufferers often attempt to hide their disorder rather than seek help. Often they are successful in concealing their obsessive-compulsive symptoms from friends and coworkers. An unfortunate consequence of this secrecy is that people with OCD usually do not receive professional help until years after the onset of their disease. By that time, they may have learned to work their lives-and family members' lives-around the rituals.

A person with OCD has obsessive and compulsive behaviors that are extreme enough to interfere with everyday life. People with OCD should not be confused with a much larger group of individuals who are sometimes called "compulsive" because they hold themselves to a high standard of performance and are perfectionistic and very organized in their work and even in recreational activities. This type of "compulsiveness" often serves a valuable purpose, contributing to a person's self-esteem and success on the job. In that respect, it differs from the disabling obsessions and rituals of the person with OCD.

OCD usually strikes people in adolescence or in the early twenties, but symptoms may become apparent in young children as well. The causes of OCD are still relatively unknown, although current research points to a biochemical imbalance in the brain involving serotonin, a chemical that affects sleep, appetite, anxiety and repetitive behavior. Genetics may also play a part. Studies show that about 25 percent of OCD sufferers have an immediate family member with the disorder. additionally, psychological factors and stress may heighten symptoms. Because it is a neurobiological disease, psychotherapy that seeks to find the cause in one's early childhood experiences, is not effective.
 
Describe some of the characteristics of OCD:

Obsessions: These are unwanted ideas or impulses that repeatedly well up in the mind of the person with OCD. Persistent fears that harm may come to self or a loved one, an unreasonable belief that one has a terrible illness, or an excessive need to do things correctly or perfectly, are common. Again and again, the individual experiences a disturbing thought, such as, "My hands may be contaminated, I must wash them"; "I may have left the gas on"; or "I am going to injure my child." These thoughts are intrusive, unpleasant, and produce a high degree of anxiety. Often the obsessions are of a violent or a sexual nature, or concern illness.

Compulsions: In response to their obsessions, most people with OCD resort to repetitive behaviors called compulsions. The most common of these are washing and checking. Other compulsive behaviors include counting (often while performing another compulsive action such as hand washing), repeating, hoarding, and endlessly rearranging objects in an effort to keep them in precise alignment with each other. Performing rituals may give the person with OCD some relief from anxiety, but it is only temporary. 

Insight: People with OCD usually have considerable insight into their own problems. Most of the time, they know that their obsessive thoughts are senseless or exaggerated, and that their compulsive behaviors are not really necessary. However, this knowledge is not sufficient to enable them to stop obsessing or carrying out rituals. 

Resistance: Most people with OCD struggle to banish their unwanted, obsessive thoughts and to prevent themselves from engaging in compulsive behaviors. Many are able to keep their obsessive-compulsive symptoms under control during the hours when they are at work or attending school. But over the months or years, resistance may weaken, and when this happens, OCD may become so severe that time consuming rituals take over the sufferers' lives, making it impossible for them to continue activities outside the home. 

 
 What Types of Treatment Are Available?

Obsessive-compulsive disorder is usually chronic. Those who do not receive treatment are likely to continue having problems, though the symptoms may become less severe from time to time. Here are the main treatment options usually considered for OCD: 

Medication. Many people who have OCD can benefit from medications. There are several medications which are commonly used for OCD that affect the neurotransmitter serotonin. Different people respond differently to these medications, so deciding which one to try should be done under the care of a physician or psychiatrist. Some medications can have side effects and cannot be used by certain people, and not all people who can take medications benefit from them. People who do benefit typically have a substantial reduction in symptoms, but they may also continue to experience some symptoms. Often when medications are stopped, the OCD symptoms will return. Most people can benefit from a combination of medication and behavior therapy.

Behavior therapy. A specific behavior therapy approach called "exposure and response prevention" is effective for many people with OCD. In this approach, a person is voluntarily exposed to the feared object or idea, either directly or by imagination, and then is discouraged or prevented from carrying out the usual compulsive response. For example, a compulsive hand washer may be urged to touch an object believed to be contaminated, and then resist washing their hands for several hours. When the treatment works well, the person gradually experiences less anxiety from the obsessive thoughts and becomes able to do without the compulsive actions for extended periods of time. Studies of behavior therapy for OCD have found it to produce long-lasting benefits for about 80% of those completing a full 30-session course of treatment. To achieve the best results, a combination of factors is necessary: The therapist should be well trained in the specific method developed; the patient must be highly motivated; and the patient's family must be cooperative. In addition to visits to the therapist, the patient must be faithful in fulfilling "homework assignments." With a combination of medication and behavioral therapy, the majority of OCD patients will be able to function well in both their work and social lives. 

Combination of Medication and Cognitive-Behavior Therapy. Probably the best approach for the treatment of OCD is a combination of medication and behavior therapy. Experts estimate that over 90 percent of people with OCD can learn to manage their symptoms by this two-pronged approach.

 Other psychological therapies. There are many different types of psychological therapies. Many of these therapies were not developed specifically for OCD, but for other reasons, such as reducing depression, improving relationships, or for personal growth. While these other therapies may be useful for reaching other goals, they are generally not helpful for OCD. 
 
Help for Families. OCD affects not only the sufferer but the whole family. The family often has a difficult time accepting the fact that the person with OCD cannot stop the distressing behavior. Family members may show their anger and resentment, resulting in an increase in the OCD behavior. Or, to keep the peace, they may assist in the rituals or give constant reassurance. Education about OCD is important for the family. Families can learn specific ways to encourage the person with OCD by supporting the medication regime and the behavior therapy. Self-help books are often a good source of information. Some families seek the help of a family therapist who is trained in the field. Also, in the past few years, many families have joined one of the educational support groups that have been organized throughout the country such as the OC Foundation.

Many people who have OCD, have other problems including depression, alcohol and substance use, and relationship difficulties. The decision to try a specific treatment depends upon several factors, including the types of other problems that are present and individual preferences. Treatment often includes coordination of several services, including medication, individual therapy, and/or group therapy. These decisions should be made after consultation with a qualified professional who has thoroughly evaluated the situation and can describe the best treatment options.
 
Evaluation and Treatment at Apex Therapy Services. Apex Therapy recognizes that their  treatment approach may not be for everyone. Treatment generally begins with an evaluation that allows for a full understanding of the problem so that different treatment options can be discussed and decided upon. These options often involve services available at Apex Therapy, from other mental health professionals in the community, or some combination of services.
 

 
Cheryl checks and rechecks the door several times as she leaves for work. On the bus, she constantly questions whether or not she locked the windows, turned off the stove and unplugged the hair dryer. She knows she's being irrational, but can't stop. Finally, unable to concentrate at work, Cheryl goes home early to check the house. 
 Johnny, an exceptionally bright student, is starting to have problems at school. During exams, he spends so much time shading in answer boxes, arranging writing utensils and rechecking answers, he rarely completes tests on time. Johnny's need for symmetry and order follow him home. Although his parents are concerned by his strange behavior, they oblige him by staying up late to help him rearrange his room, hoping it will ease his suffering.