Obsessive-compulsive disorder is a frequent, chronic, costly, and disabling disorder that presents in several medical settings, but is under-recognized and undertreated.
For many years, obsessive-compulsive neurosis was seen as a disorder that provided an important window into the workings of the unconscious mind. Today it is viewed as a good example of a neuropsychiatric disorder, mediated by pathology in specific neuronal circuits, and responsive to specific pharmacotherapeutic and psychotherapeutic interventions.
Let us understand the various treatment options and management modalities of OCD in this blog.
The diagnosis of OCD is based on the clinical picture. Unlike patients with psychotic illnesses, patients with OCD usually exhibit insight and realize that their behavior is extreme or illogical.
Often embarrassed by the symptoms, patients may go to extreme lengths to hide them. In severe cases, insight can become tenuous, and patients may truly believe that their obsessional concerns are justified; such cases are designated as “OCD with poor insight” according to the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV).
Since patients are often reluctant to volunteer the information that they have symptoms of OCD, three routine screening questions can greatly increase the likelihood of diagnosis. These are as follows
- “Do you have repetitive thoughts that make you anxious and that you cannot get rid of regardless of how hard you try?”
- “Do you keep things extremely clean or wash your hands frequently?”
- “Do you check things to excess?”
An affirmative answer to any of these questions strongly suggests a diagnosis of OCD, indicating the need for further investigation to determine whether the diagnostic criteria are met (1).
The first step is to talk with your healthcare provider about your symptoms. Asking questions and providing information to your healthcare provider can improve your care (2).
Your healthcare provider will perform a physical exam and ask you about your health history to make sure that your symptoms are not caused by other illnesses or conditions.
Your healthcare provider may refer you to a mental health professional, such as a psychiatrist, psychologist, social worker, or counselor, for further evaluation or treatment.
Treatment for OCD typically includes specific types of psychotherapy (such as cognitive behavioral therapy), medication, or a combination of the two. A mental health professional can talk about the benefits and risks associated with different treatment options and help identify the best treatment for you.
Sometimes people with OCD also have other mental illnesses, such as anxiety, depression, and body dysmorphic disorder, a disorder in which someone mistakenly believes that a part of their body is abnormal. It is important to consider these other disorders when making treatment decisions.
It is important to follow your treatment plan because both psychotherapy and medication can take some time to work. Although there is no cure for OCD, current treatments help many people with the disorder manage their symptoms, engage in day-to-day activities, and lead full, active lives.
Psychotherapy can be an effective treatment for adults as well as children with OCD. Certain types of psychotherapy like cognitive behavioral therapy (CBT) can be as effective as medications. It can also be used as an adjunct to medicines.
A specific type of CBT called Exposure and Response Prevention (ERP) is effective in reducing compulsive behaviors even for those who do not respond well to medications.
With ERP people spend time in a situation that triggers their compulsion and they are prevented from engaging in their typical compulsion. Although this approach may cause anxiety in the beginning the compulsions reduce as the treatment continues.
Children with OCD may need help from family members and their healthcare providers when it comes to recognizing and managing their symptoms. mental health professionals can work with young professionals to identify strategies for managing stress and increasing support so that they can manage their symptoms at home as well as in school.
Your healthcare provider may prescribe medication to help treat OCD. Serotonin reuptake inhibitors (SRIs) are the most common type of medication prescribed for the treatment of OCD.
SRIs, including selective serotonin reuptake inhibitors (SSRIs), are often used to treat depression, and they also help treat symptoms of OCD. With SRI treatment, it may take up to 8 to 12 weeks before symptoms begin to improve, and treatment for OCD may require higher SRI doses than are typically used in treating depression. For some people, these medications may cause side effects such as headaches, nausea, or difficulty sleeping.
People respond to medication in different ways, but most people with OCD find that medication, often in combination with psychotherapy, can help them manage their symptoms.
Your healthcare provider can adjust medication doses over time to minimize any side effects or withdrawal symptoms. Do not stop taking your medication without talking to your healthcare provider first. Your healthcare provider will work with you to monitor your health and can adjust the treatment plan safely and effectively.
Common Obstacles To Effective Treatment
Studies find that it takes an average of 14 to 17 years from the time OCD begins for people to obtain appropriate treatment (3). Usually, obstacles are as follows
- Some people choose to hide their symptoms, often in fear of embarrassment or stigma. Therefore, many people with OCD do not seek the help of a mental health professional until many years after the onset of symptoms.
- Until recently, there was less public awareness of OCD, so many people were unaware that their symptoms represented an illness that could be treated.
- Lack of proper training by some health professionals often leads to the wrong diagnosis. Some patients with OCD symptoms will see several doctors and spend several years in treatment before receiving a correct diagnosis.
- Difficulty finding local therapists who can effectively treat OCD.
- Not being able to afford proper treatment.
- OCT Treatment and Management.
How can I help myself?
Obsessions and compulsions can take over your life, and leave you feeling helpless. However, there are some things you can try to help manage your OCD and improve your well-being (4).
Remember that different things work for different people at different times. If something isn’t working for you (or doesn’t feel possible just now), you can try something else or come back to it another time.
- Try self-help resources
- Build a support network
- Try peer support
- Learn to let go
- Look after your physical health
Author: Dr Pooja Nilgar (Content writer and editor)
- Jenike, M.A., 2004. Obsessive–compulsive disorder. New England Journal of Medicine, 350(3), pp.259-265.
- Logan, K. (2008) ‘Obsessive Compulsive Disorder’, Handbook of Evidence-based Psychotherapies: A Guide for Research and Practice, pp. 143–158. doi: 10.1002/9780470713242.ch9.
- ‘OCD mind 1’ (2019), pp. 1–16.
- Greist, J. and Baudhuin, M., What you need to know about obsessive compulsive disorder. International OCD Foundation.