Treatment of Obsessive Compulsive Disorder (OCD)

Obsessive compulsive disorder (OCD) involves the recurrence of distressing thoughts (the obsessions) accompanied by repeated attempts to reduce the anxiety associated with the distressing thoughts (the compulsions).  OCD occurs in both children and adults.

Compulsions can be overt and tangible, such as compulsive handwashing or tapping.  But compulsions can also be covert, that is, not observable to others.  These sorts of compulsions involve various strategies in which the individual mentally reviews their worries and tries to reassure themselves in an attempt to reduce the anguish associated with their obsession.

Dr. Sherry Henig has received advanced training in the treatment of OCD from professionals affiliated with the International OCD Foundation.  She routinely attends conferences that address OCD and she regularly consults with experts in the field.  The treatment for both children and adults typically involves exposure with response prevention (ERP), and often includes acceptance and commitment therapy (ACT) and cognitive behavioral therapy (CBT).  How friends and family members interact with the sufferer is often a part of the treatment as well, as these individuals, such as parents and spouses, often appreciate and benefit from learning productive ways to support the individual who is suffering.  Utilizing these more productive approaches can often have a very positive impact on the treatment.

The following describes some characteristics of some of the types of OCD and OCD-related disorders that Dr. Henig treats:

Contamination Fears

The obsessions in this form of OCD typically involve worry about getting sick, or getting others sick, or simply not feeling right, from touching, eating, or in some way having involvement with something that is felt by the individual to be harmful, such as something particularly germy (like paper money and coins), or spoiled (like food that the sufferer might think is insufficiently clean or fresh, or has surpassed the expiration date), or something that is presumably poisonous (like household cleansers).  Some individuals obsess about being contaminated by bodily products (like urine or feces).  And some individuals suffer from a feeling that might be described as “icky” when they feel they’ve been contaminated.  Compulsions associated with contamination fears might include excessive handwashing, excessively long showers, and checking and rechecking and mentally reviewing if and how they might have come into contact with the thing that they find worrisome.  Compulsions can also involve reassurance-seeking from others, and/or a general avoidance of things (such as certain foods and certain surfaces) that are felt to be potentially problematic.  While COVID may contribute to making this presentation of OCD seem difficult to treat, the nuances in the obsessions and compulsions can, nevertheless, be addressed and the distress can often be reduced.

Fear of Vomiting

Fear of vomiting is an experience that many individuals consider to be a contamination fears-type of OCD, and for that reason it is mentioned here.  The obsession is the fear of vomiting, and the compulsion involves avoidance of things (like food that has exceeded the expiration date) or people (individuals who the sufferer knows or thinks have been sick).  In addition to avoidance, the compulsions can also include various types of reassurance-seeking, both from others and from themselves (in the form of mental review).  Fear of vomiting is also considered a phobia (emetophobia), and the treatment, whether considered a form of contamination fears OCD or a phobia, is essentially the same.

Perfectionism

Obsessions related to perfectionism are often associated with a discomfort experienced if a task is not performed perfectly.  Compulsions associated with this sort of obsession might include excessive time spent doing classwork and homework assignments, perfecting the content of the task or perfecting the writing associated with the task, which might involve writing, rewriting and excessive erasing.  Another sort of compulsion associated with perfectionism is avoidance.  This tends to involve procrastination, as putting off the task by way of procrastination reduces, for a brief period of time, the discomfort associated with needing to make something perfect.

“Just Right” and Symmetry OCD

“Just Right” OCD is similar to perfectionism.  This type of OCD involves needing for things to be done just so.  For example, the sufferer might feel that the items on the nightstand need to be arranged in a very specific order, or the hair style needs to be combed out exactly right.  Symmetry OCD involves the desire for things to be experienced or performed in a perfectly symmetrical fashion, such as having each sock fit exactly the same way on each foot.  The obsessions in this category are sometimes associated with the individual simply worrying that they won’t feel right unless the thing is done “just right”.  If the issue is not done “just right,” the individual might feel a certain tension,  a physical feeling of being ill at ease, and they may struggle trying to feel comfortable in their body or feel at peace with the object of their concern that they feel is not exactly right.  They may worry that the uncomfortable feeling associated with things not being “just right” may last forever.  On the other hand, the obsession might be related to a worry about something bad happening to themselves or to someone they care about if the issue that they are worried about isn’t just right.  Compulsions associated with these obsessions might involve touching, ordering, arranging, and needing to take excessive amounts of time performing tasks, sometimes resulting in the individual being late for their activities.  It might involve needing to repetitively redo the activity until they feel that it’s been done “just right.”

Scrupulosity (Morality) OCD

The obsessions involved with scrupulosity pertain to worry about things that the individual might have said, done or thought that are felt to be blasphemous, immoral or insensitive to someone’s feelings.  Compulsions might include praying or confessing excessively and/or repetitively, in an attempt to undue or atone for the behavior that was felt to be irreverent and/or they might involve excessive mental reviewing and reassuring so as to alleviate the anxiety.

Violent thoughts OCD

Obsessions in this category tend to involve worry about harming oneself (self-harm) or harming someone else (other-harm).  Compulsions in this category may involve avoiding certain activities that the individual feels might trigger them to do something dangerous.  An example of other-harm obsession would be a fear that the individual might stab someone they care about, and a related compulsion might include an avoidance of using a knife while eating a meal with the person they’re worried they might harm.  Obsessions pertaining to a fear about self-harm often involve a fear that the individual will kill themselves.  Individuals that have OCD self-harm obsessions are often people who lead quite happy and successful lives, but the intrusive suicidal-themed thoughts are upsetting and contribute to great distress and a worry that they might somehow be triggered to act on the thoughts of suicide.  Compulsions for individuals with these violent thoughts can involve avoidance of certain activities or people, reassurance-seeking (from others and from themselves) and mental review in an attempt to neutralize the thoughts.

Sexual thoughts OCD

Two common obsessions in this category include sexual orientation OCD (SO) (sometimes known as homosexual OCD (HOCD)), and pedophilia OCD (POCD).  Sexual orientation OCD obsessions involve the individual worrying that they may have a sexual orientation that doesn’t feel consistent with their actual sense of themselves or their actions, and they spend time analyzing thoughts, feelings and behaviors to see if they may not truly have the sexual orientation that they think they have.  Compulsions for these individuals often include reassurance-seeking, mentally evaluating their thoughts and behaviors, and checking for feelings of sexual arousal when around individuals who are the gender to which they hope that they are not attracted.  This is quite different from an individual who indeed is experiencing a same-sex sexual attraction, and whose worry about what this might ultimately mean in their lives may result in their fretting about the experience.  It can be difficult for a therapist who is not trained in working with individuals with OCD to distinguish the difference.

Pedophilia OCD involves obsessions associated with worry that the individual has been sexually inappropriate with children or has had thoughts about behaving in this manner.  Compulsions associated with these obsessions include attempts to avoid being around young people and mental review in an attempt to reassure and neutralize any worrisome thoughts.

Relationship OCD

Obsessions in this category involve the individual worrying about whether or not they feel the appropriate degree of love or attraction towards their partner.  Compulsions in this category often involve checking to see whether or not they are experiencing the feelings they are worried about; and mentally reviewing their own thoughts and feelings and analyzing the romantic behaviors of others (people they know or people they see in the media) to figure out whether or not their own romantic feelings are what they think they ought to be.  Relationship OCD can also involve obsessions pertaining to whether or not their partner is sufficiently attracted or in love with them, and the related compulsions may involve reassurance-seeking and checking to see whether the partner is exhibiting the proper degree of attraction or love.

Existential OCD

Obsessions in this category often involve the individual experiencing worry and/fear regarding philosophical issues, such as the meaning of life, and questions about the nature of reality and the nature of human existence. The individual may ruminate over these unanswerable issues, or may struggle with uncomfortable, almost out-of-body sensations associated with a feeling of not being real. Compulsions in this category often involve mental review and reassurance, both from oneself and from others, especially related to the worry that these experiences will result in them going crazy and/or that the experiences will never go away.