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    Regain Positive Control With OCD (Obsessive Compulsive Disorder) Treatment

    I get over one fear only to replace it with another.

    I feel blown off by people if I voice repeated concerns and anxiety over people’s safety.

    I feel like my life is one big meme.

    These feelings above were all written by different people—as far as I could tell from the other side of a computer screen. I had been checking in every few weeks with a local support group for people with obsessive-compulsive disorder.

    Much like people who enjoy running or the arts tend to gravitate towards communities of like-minded individuals, those with obsessive-compulsive disorder (OCD) bond through social media over their shared mental struggle of OCD behavior.

    “I can only find ways to tame it, manage it, and try to use it for my benefit,” one person writes in an online community forum.

    “I feel empowered because reducing has helped, give it a shot,” I type today.

    I am referring to a therapy skill I had learned to minimize my need for counting. I like stopping at five. It’s a good, fat number and easy to count in multiples. Today, I am continuing what I started yesterday and no longer using the number “five” in a series.

    I have a habit of counting before I can answer a question. Out loud. If I’m sitting in a restaurant and the server asks if I would like something to drink, it goes like this:

    “One. Two. Three. Four. Four and a half. I would like an iced tea, please.”

    The server looks at me for a minute, collects the rest of the drink orders, returns shortly to deliver them, and asks for our dinner order.

    “And you, Miss?”

    “One. Two. Three. Four. Four and a half.” I feel her perplexed stare and place my order.

    My 2-year-old son watches this and starts saying “four and a half.” Again and again. I tell my husband I’ll be right back, go to the ladies’ room and just close my eyes in utter humiliation.

    “You are so stupid, Lisa,” I say to my reflection. I take a deep breath, return to the table and the rest of the dinner goes without incident. Sometimes I tell myself positive attributes, but today is not that kind of day. Having no control over control-oriented behavior was the most bizarre aspect of my OCD diagnosis. And it makes complete sense at the same time.

    Some version of this has been going on for the past eight years. When I was 18, I started college at Baylor University to study information systems. The language of computers spoke to my nature of order and procedure. The partial scholarship spoke to my pride to keep costs to minimal post-graduation debt.

    To keep my scholarship though, meant no wiggle room for academic performance. As an only child, I felt the weight doubly both in meeting my self-imposed need to please my parents with strong grades and the economic impact personally. The scholarship had become somewhat paralyzing in my life.

     

    I felt the stress the most when taking tests, which were done in computer labs where we had to fix problems our professor had created on the simulated office workstations. I discovered by “doing my numbers,” as I referred to it internally, I could begin to breathe and the stress would lighten. As each step was correctly navigated, the numbers in my head would begin to recede in prominence and I moved faster and faster, adeptly finishing a few minutes shy of our five-minute warning.

    The guy seated next to me used to watch me work because I seemed so at ease with the programs. He said the out-loud counting just seemed like I was putting on my cape and ready to come to some poor worker’s aid in fixing their daily computer nightmare at the fictitious office where we all worked. That guy’s name was Jared, and he was now my husband. He is also my strongest supporter.

    He drives me to therapy appointments just to show us we’re both in “it” together. He means everything and anything by “it” and I have no problems getting places on my own. But he likes to make it more fun by telling me goofy work stories and listening to weekly family updates from each other. On the drive back home he blares “Roxanne” by The Police as we pull back into the driveway. Jared calls it our fight song.

    My doctor told me OCD is pretty normal and evenly distributed to both men and women. She also told me while it may be chronic, therapy could help me live a life to be enjoyed, not endured. That word, when she said it, struck a chord with me and resonated so soundly. Endured. 

    People called me quirky or found my repetitive counting amusing. Me? Not so much. I disliked the people who presumed to think I was their personal entertainment. I was frustrated both by their good-natured ribbing and my inability to stop counting. I don’t find my counting as an entertainment source.

    The numbers were invading my head, destroying any peaceful times, and ruining my self-esteem. I became quite proficient at hiding my repetitious behaviors so less attention would come my way. 

    My story is one of many who have OCD in the United States and around the world.

    SUN OCD lonely girl at table

    OCD Prevalence in the United States and Worldwide

    According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) OCD

    • affects 2.2 million adults, or 1% of the U.S. population
    • is equally common among men and women
    • has an average age of onset of 19, and it is unusual to first experience it after age 35
    • has occurred by age 14 in 25% of cases
    • was first experienced during childhood about one-third of the time
    • is recognized in males at an earlier age of onset than females; nearly 25% of males have onset before age 10 years
    • the onset of symptoms is typically gradual; however, acute onset has also been reported

    The World Health Organization points to the fact it doesn’t discriminate either between wealthy and developing countries and can be a global burden as a mental disability if there is no treatment provided.

    Causes of OCD Have Wide Net of Possibilities

    Studies have been done and consideration given to five main factors:

    • genetics
    • neurology
    • cognitive
    • behavioral
    • environmental

    To date, any information is more suggestive than definitive as to the cause. The main focus is on treatment.

    Neurologic Studies Suggest Genes, Brain Wiring Links Possible Causes of OCD

    In one 2016 clinical study where the participants were shown pictures of typical symptom-triggering images, increased activity in the amygdala was apparent through MRI brain scans. The amygdala is an area of cells in the brain’s limbic region at the base of the brain where emotions are processed; if it is in a hyperactive state for anxiety, increased levels show a triggering of the OCD. This neurologic link is still being studied.

    Further, links to neurologic wiring in the brain are shown to have a potential genetic link, with serotonin symptom gene variants in youth studies. This brain chemistry may have genetic origins, as noted when the condition is already diagnosed within a family, according to a 2020 study published in Translational Pediatrics.

    Behavioral, based on a possibly learned response, cognitive, and environmental considerations may also be factors behind OCD, according to BeyondOCD.org.

    So if I Can’t Be Cured of OCD, What Can I Do?

    Identifying the behavior for what it is can be incredibly helpful for understanding the nature of the disorder and developing coping mechanisms for a chronic condition.

    “OCD is characterized by the presence of obsessions and/or compulsions,” according to the Diagnostic Statistical Manual of Mental Disorders. “Obsessions are recurrent and persistent thoughts, urges, or images that are experienced as intrusive and unwanted, whereas compulsions are repetitive behaviors or mental acts that an individual feels driven to perform in response to an obsession or according to rules that must be applied rigidly.”

    The DSM-5 further defines the level of impact OCD might have on a person in terms of time spent (more than one hour is typically defined as impactful) and effect on work/social/family time through avoidance of triggers such as crowds or unhygienic areas.

    It can truly impair parts of your life. You may be repeatedly late for work in order to complete your routine and subsequently find yourself out of a job. You may miss dates for potential life partners and find yourself alone. You may miss events important in your children’s lives as you are captive to your obsessive behavior. This is how OCD debilitates and why the person with the disorder finds it frustrating and not harmless at all.

    OCD can also be episodic and be in remission for a time.

    Let’s examine the following example of someone’s journey to seek help when he realized his OCD was beginning to really affect his life. This patient realized his anxiety went away briefly by checking the stove burners before he left home, only to recur a few minutes later. It monopolized his thoughts and affected his productivity at work and interrupted his ability to enjoy a fun outing afterward. He realized he was having some kind of mental struggle.

    He had an entire protocol related to the task of “checking the burners, front right, back right, front left, back left, one more time” affecting his life. He realized he may have a disorder and needed professional help to find out what was behind his obsession with the burners. Through his presentation of symptoms, his primary care physician recommended he meet with a team that is experienced with OCD, possible diagnosis, and treatment methods.

    This patient learned the following during his journey, as many who seek help and their loved ones who support them will also learn through education.

    OCD Actions Are Attempts To Stop Compulsive Thoughts

    Sun OCD Counting fingers

    Four Areas of OCD Thoughts

    The compulsions behind OCD are manifested in the mind with thoughts, images, and needs in these general areas:

    • cleanliness due to fear of germ-related contamination or unhygienic conditions
    • unprovoked aggressive thoughts
    • desire for symmetry of order placement
    • fixation of thoughts on sex, religion, or harm that the person finds repulsive or immoral

    Four Categories of OCD Actions

    SUN OCD Washing hands in sink

    Obsessive OCD symptoms are actions in an attempt to neutralize the compulsive thought and can be shown through the following examples:

    • counting (sometimes called arithromania)
    • precisely organizing items
    • handwashing or cleaning to excess
    • repetitive checklist (re-entering a home to see if lights are turned off or calling a loved one to ensure they are okay)

     

    Many experts in the field have gone further to categorize the actions into four specific categories:

    1. Compulsive actions such as checking boxes, handwashing, locking, moving objects, staring, praying, or seeking symmetry and order.
    2. Seeking reassurance from loved ones, typing a search in Google, or asking Siri.
    3. Avoiding triggers such as social interaction, objects, or walking around things.
    4. Mental compulsions such as repeating words, counting, mental checking, rumination, visualization, thought suppression, neutralizing (replacing an unpleasant thought with a pleasant one), and mental reviewing (reviewing past actions).

    SUN OCD Keeping Spoons Organized

     

    OCD Diagnosis Typically Delayed by Person Not Publicly Acknowledging Behavior and Symptoms

    Patients are often reluctant to volunteer the information that they have OCD symptoms because they are aware their behaviors are extreme. This leads to isolation as they withdraw from environments in work and society, and this can affect their overall well-being as a result. It can take more than a decade to be diagnosed, therefore delaying the treatment of symptoms.

    As a result, they may be considered mentally disabled.

    Dr. Michael A. Jenike, a psychiatrist and world-renowned OCD expert wrote about clinical practice with OCD in the New England Journal of Medicine in 2004 that three routine screening questions would “greatly increase the likelihood of diagnosis.” He suggested more investigation for OCD consideration should be given if a person said they did the following:

    • questioning about repeated thoughts causing anxiety that won’t go away
    • cleaning to the extreme and frequent handwashing
    • repeated “checking” on things

    Other field practitioners have noted if the time a person allows daily is over one hour or interrupting their day-to-day life so other commitments cannot be met, these are primary indicators.

    SUN-OCD checking if door is locked

    While it is a lifelong, chronic condition, its symptoms may ebb and flow in frequency and severity. OCD can be managed through behavioral therapy most effectively among individuals that have a fair amount of insight regarding their emotions and fears and an understanding when that level is not the norm for most people.

    Help and Treatment Target for Living with OCD

    Being able to resist compulsions and be free from the disabling behavior is the ultimate goal with OCD treatment. Instead of asking yourself, “Why did this happen to me?” sometimes it can be more productive to focus on “What can I learn from this?”

    Easier said than done, right? But with the right therapeutic approaches, your chronic condition can be eased when you learn effective management solutions.

    Medication

    Medications that are typically prescribed for depression may be helpful in OCD treatment, but they are rarely effective alone and it can take weeks to see any effectiveness. Therapy is a valuable tool and is often done in conjunction with medication or alone.

    Therapy

    Exposure and response prevention (ERP) and imaginal exposure (IE), habit reversal training, cognitive training, and cognitive therapy are most suggested for treatment by professionals who specialize in OCD therapy. These are all types of cognitive behavioral training (CBT) which is an evidence-based treatment to help a person learn behaviors that give proven strategies for problem-solving.

    ERP is a technique where a patient is put in situations that would generally trigger their compulsions, and then they are directed to not act upon them. Generally, the time in which they have to wait will begin as a short period and grow longer over time. An ERP therapist would direct the patient to do the exercise at their own pace. These situations would continue from the least anxious situations to more stressful situations. Through the slow growth and mastery of more difficult levels, the patient can build confidence, eventually leaving the behavior behind or result in a much more tolerable disruption to daily activities.

    IE is a technique much like ERP, except the scenarios, are generally visualized before actively doing them. This is better suited for those who are slower to warm up to real-world situations.

    Habit reversal training works to make a person more aware of their behaviors and symptom developments and work an opposite movement to disturb completion of the task. This could be done in a mirrored environment where the patient can see themselves acting out the task. The therapist will work to develop a competing strategy, such as using the opposite hand, to retrain a habitual behavior.

    Cognitive therapy acts to help you look at behaviors that cause anxiety from a more third-party lens. This helps a person realize their thoughts are not the only ones and perhaps they could be incorrect.

    At SUN Behavioral Houston, we provide mental health services to treat patients with OCD. Our full continuum of specialized care truly makes us proud to assist Houston and the surrounding communities to solve unmet needs. Call for a telehealth consultation at 713-796-2273.

    FAQs:

    What is the best treatment for OCD?

    Cognitive behavioral therapy is an evidence-based treatment that helps people with OCD. Exposure and response prevention (ERP) is the sub-category that has been proven most effective for OCD patients. With this type of therapy a professional works with the patient to slowly introduce behaviors by exposing triggering situations and directing the patient not to do the behavior they typically do to temporarily relieve their anxiety. The length of time becomes extended and the situations progress to more stressful situations.

    How successful is OCD treatment?

    OCD has the ability to ebb and flow throughout a person’s lifetime. About 10% fully recover and another 50% improve with the therapy procedures of CBT and/or antidepressant medication.

    What are the four types of OCD?

    There are four types of OCD:

    • cleanliness due to fear of germ-related contamination or unhygienic conditions
    • unprovoked aggressive thoughts
    • desire for symmetry of order placement
    • fixation of thoughts on sex, religion, or harm that the person finds repulsive or immoral

    Can OCD go away?

    Because there is no cure and OCD is generally chronic, symptoms may come and go but will generally need to be managed throughout a person’s life.

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      If you're in need of help, fill out this form, and a SUN representative will contact you. For emergencies, please call 713-796-2273.

      What Can We Help With Today?