OCD - TOC
Obsessive-compulsive disorder is an illness in which individuals experience recurring or repetitive thoughts or ideas (these are the obsessions). These obsessions make them feel driven or compelled to perform repetitive actions (compulsions). The compulsions or repetitive behaviors such as handwashing, checking/ rechecking, counting, cleaning, can have a major impact on an individual’s quality of life, daily activities, and social interactions. Individuals with OCD have these anxiety driven thoughts and worries which persist. If the person attempts to suppress or avoid the compulsive behaviors, this causes a great deal of distress. Although the person may recognize that the thoughts are irrational, sometimes illogical, and unrealistic, they still feel driven to perform the ritualistic behaviors to alleviate the anxiety.
Mary is a 16-year-old female who came to the office with a past diagnosis of OCD. Mary presented with severe anxiety which was accompanied with fears of her dying from a contagious illness (obsession). In order to alleviate these fears, Mary began to perform these ritualistic hand washing rituals which would last 45 minutes to an hour. She spent hours in the bathroom scrubbing her hands with different soaps, then soaking her hands with hand sanitizer, then air drying them. This cycle occurred over 10 times where she performed this ritual methodically. She could not exit the bathroom without completing this strict regimen of handwashing. When her parents tried to end the ritual prematurely, Mary would experience severe paralyzing panic episodes. When she came to the office, her hands were raw and ultra-sensitive due to hand washing. She understood that her obsession with dying was irrational. She also understood that her hand washing rituals were interrupting her extremely time consuming and negatively impacting her quality of life.
There are a variety of methods that are used to treat OCD. Exposure Response Prevention (ERP) is the gold standard modality of therapy that is used to treat OCD. Exposure refers to the patient exposing themselves to the thoughts, objects, situations, images that trigger anxiety and begin the obsessions. The “Response Prevention” portion of ERP refers to the prevention of compulsive behavior. During this type of therapy, you will be under the guidance of the therapist while you learn the techniques of ERP that you will later implement on your own. It is also possible to accompany ERP with medications to help alleviate the anxiety that accompanies the OCD.
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