Obsessive Compulsive Disorder (OCD)
Obsessive-compulsive disorder (OCD) is a mental health condition where a person gets unwanted, intrusive thoughts (obsessions) and feels driven to do repetitive behaviors or mental rituals (compulsions) to ease the anxiety those thoughts cause. People with OCD don’t want these thoughts and usually know they don’t make sense, but that doesn’t stop them from feeling intense anxiety.
Obsessive Compulsive Disorder can be a debilitating thing to live with. It can rob the sufferer of their time, their relationships, and their productivity. As a family member, it is very hard to see a loved on trapped in rituals that everyone, including the sufferer, know are unnecessary. At the root of OCD is uncontrolled anxiety. The goal of treatment is to get the sufferer to a point where they can tolerate their anxiety without indulging in their obsession.
What is OCD?
Do I have OCD?
How can I tell?
OCD is broken down into two parts, the obsession and the compulsion. While lots of people follow routines or like to double-check things, OCD becomes a disorder when it takes up a lot of time (often hours a day), it causes significant distress, or it interferes with daily life, work, school, or relationships.
Obsessions are thoughts, images, or urges that pop up against your will and feel distressing or scary. Common ones include fear of germs or contamination, worry about harming someone, needing things to be “just right” or perfectly symmetrical, and disturbing or taboo thoughts.
Compulsions are actions or mental rituals done to reduce anxiety or prevent something bad from happening. The relief from compulsions is usually temporary, so the cycle repeats. Some examples include:
Excessive hand-washing or cleaning
Checking locks, stoves, or appliances over and over
Counting, repeating words, or praying in a specific way
Re-arranging things until they feel “right”
Seeking reassurance constantly
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Perfectionism is driven by high standards and achievement. There are thoughts of “I want to do this really well.” The discomfort of perfectionism comes from not meeting your own expectations or a fear of judgment.
OCD is driven by anxiety and fear. There are thoughts of “something is wrong or dangerous—and I have to fix it.” The discomfort of OCD comes from intrusive thoughts that feel urgent and threatening.
Perfectionist thoughts are usually logical and based on personal values. OCD thoughts usually feel intrusive, unwanted, and extreme in nature.
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OCD is often quieter and more exhausting than people think. It can look like waking up anxious and immediately scanning for danger, showering until it feels “just right”, or repeating routines in exactly the same order. Sometimes there is “mental noise” of intrusive or distressing thoughts or a constant mental review of past conversations and questioning yourself.
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OCD can show up early, even before children can fully explain their thoughts, though it typically comes to the forefront in your teen years. OCD that shows up in adulthood has usually been sitting quietly for years and gone unrealized or untreated. OCD can be treated at any age and is very effective.
How Do You Diagnose OCD?
At Good Day Psychiatry, OCD is diagnosed through a comprehensive, team-based evaluation process designed to get it right the first time. Our psychiatric providers work closely with a licensed testing psychologist, allowing us to look beyond surface symptoms and understand how OCD is affecting your daily life.
Our diagnostic process may include a detailed clinical interview, developmental and academic history, behavioral questionnaires, and formal psychological testing when appropriate. The result is a clear, evidence-based diagnosis and a thorough report that explains findings in plain language and outlines personalized treatment recommendations.
By combining psychiatric expertise with in-depth psychological testing, we help patients and families feel confident, informed, and supported in the next steps of care.
How do you treat OCD?
The best treatment for OCD is Cognitive Behavioral Therapy (CBT) with exposure therapy. This style of therapy consists of teaching the patient about how thoughts, feelings, and actions can influence each other in order to reduce anxiety. Critically, successful treatment for OCD also involves the therapist and the patient going outside the office and exposing the client to their trigger while not giving in to the compulsion. This therapy helps the client challenge the belief that leads to their compulsion, in order to exhibit control in the future. It is by far the most effective treatment for OCD with the best outcomes in the medium and long-term.
Sometimes the compulsions can be too overwhelming to be overcome with therapy alone. This is where the psychiatric professionals at Good Day Psychiatry can help. We can prescribe psychiatric medication that can take the edge off the anxiety of the obsession, allowing you to exert control. If you are already in therapy, it can enhance the benefits of therapy. The most common and safest treatment for OCD are Selective Serotonin Reuptake Inhibitors such as escitalopram and sertraline. More advanced treatments can involve ondansetron or aripiprazole. The latest in cutting edge treatments such as Transcranial Magnetic Stimulation (TMS) or ketamine can also be discussed.
True Obsessive Compulsive Disorder is rarer in children than it is adults. More often highly-sensitive or highly-anxious children can develop strong preferences for rituals, but these preferences are more closely associated with anxiety rather than true OCD. The treatment remains very similar for these two problems.
