Frequently Asked Questions

Obsessive Compulsive Disorder FAQ's

Miami OCD Treatment Question

The answer is "usually not". Trying to reason out or make sense from an obsessive thought usually only strengthens the thought. Parents or spouses often try to help a loved one with OCD work it through logically but this most frequently winds up being frustrating, not to mention futile.

Pure "obsessives" or pure "O's" refers to people who only suffer from obsessions, and have no compulsions. It is rather uncommon for someone to have only obsessions, and no compulsions. This would mean that the person with only obsessions would not attempt to relieve the anxiety produced by the obsession. Many professionals believe that a person who refers to himself/herself as a pure "O" is likely unaware of his/her compulsions or that the person may mistake their mental compulsions for obsessions. Mental compulsions include double checking thoughts, and "mind clearing."

The risk of having a child with OCD varies, depending on whether someone has childhood- vs. adult-onset OCD (higher risk of genetic transmission with childhood-onset OCD), and on whether someone also has Tourette's syndrome or a tic disorder (conveying a higher risk of familial transmission). If you have childhood-onset OCD, then there is a twofold increase in risk for OCD in relatives, including your children. There is also an increased risk for OCD if a parent has a tic disorder due to the similarity in these two neurobehavioral conditions.

Fear of somehow "catching" an OCD symptom is a fairly common problem. It is one of the reasons that some people avoid support groups or even learning about OCD in therapy. Of course, for a child, having a parent who models OCD can be an issue. But this being said- no, OCD is not contagious. After all, children with OCD often develop entirely different OCD symptoms from their parents who may have OCD. Further, listening to someone else's OCD symptoms may actually help someone with OCD see their own irrationality.

Yes, treated or untreated, obsessions may change over time. Sometimes a person simply adds new ones to old ones and sometimes the old ones are completely replaced by newer ones. At times, old obsessions can return.

The vast majority of people with OCD can be treated on an outpatient basis. Cognitive-behavioral therapy and medication allow most people to improve while being treated as outpatients. Hospitalization, however, is an important and valuable option for people with severe OCD who are unable to function as outpatients or unable to maintain treatment gains without supervision. There are some specialized hospital-based programs for unusually severe, complicated, or refractory OCD cases.

Yes. It is typical to notice a worsening of OCD symptoms during stressful periods. Stress does not cause OCD, but a stressful event (like the death of a loved one, birth of a child, or divorce) can actually trigger the onset of the disorder or exacerbate it. That is why OCD treatment involves learning how to cope with life stressors effectively.

Although marijuana is now legal in California for medicinal purposes, it is not a good treatment for OCD. It may provide some short-term relief, but it causes symptoms to later worsen. Marijuana can also interfere with OCD medications and make depression more severe or cause symptoms that resemble, or actually are, psychotic. Sorry, other recreational drugs and alcohol aren't good for OCD either. We hope you'll trust us on this one.

Come on, did you really think the answer to this would be "yes." After all, the attempt here is to do something that is very complex- change brain and behavioral functioning. Of course the answer here is a resounding "no", but it is the best method of permanently reducing obsessions and compulsions. Really, most people who try it find that it is not as bad as they thought it would be and some even find it challenging and fun (at least that's what they tell us).

Fort Lauderdale OCD Treatment Patient

This varies by individual, but generally a 20-50% decrease in symptoms can be expected. The medications may take from six to twelve weeks to start showing an effect. It is important to confer with the prescribing professional if you have any side effects that you are concerned about.
The initial mechanism of these medications is to increase the availability of the neurotransmitter serotonin as well as other neurotransmitters in some cases at the synapses (connections between brain cells) in the brain. This may lead to other desired changes in brain functioning over several weeks that can result in further improvement.

To date, the most effective medications for OCD are the SSRI's (Selective Serotonin Reuptake Inhibitors). Prozac (fluoxetine), Luvox (fluvoxamine), and a tricyclic antidepressant called Anafranil (clomipramine) have been shown to be effective in many cases. Paxil (paroxetine), Lexapro (escitalopam), and Zoloft (sertraline) have also been used. Other medications may be added to improve efficacy, potentiate drug action, or address co-occurring conditions. Although many medical professionals can prescribe medications for OCD, it is important to seek those who are highly experienced in this specialty.

The two most effective treatments for OCD are a form of cognitive-behavior therapy called Exposure and Ritual Prevention (ERP) and pharmacological therapy. To learn more about ERP see the related section in this website. Generally, behavior therapy is considered to be the first option, except in the most severe cases. Most experts would probably not consider medication alone to be an appropriate form of treatment for OCD as improvements do not tend to be robust without the commensurate learning of actual skills learned through cognitive-behavioral treatment. The most recent expert consensus highlights the effectiveness of combined medical and cognitive-behavioral treatments.

Yes there are. The most effective way to stop obsessions is to actually stop the compulsions. When one stops the compulsions, the obsessions will initially get stronger, but over time they will decrease and become less anxiety provoking. Interfering with the vicious cycle of accelerating an obsession is an important skill to learn.

Becoming obsessed with religion, sin or other moral issues is one of the virulent forms that OCD may take. In the problem of scrupulosity, a reasonable perspective on matters of conscience is compromised and the sufferer can feel as if they are constantly being subjected to final judgment and criticism. The concepts of what is right and what is wrong can become completely distorted and extreme. Compulsions to confess and repent, pray perfectly, tell the truth in the most literal sense, and ritualistic self-injurious behavior may be found. Even minor shortcomings are experienced as blasphemy and a sign of unworthiness.

The Cognitive Behavioral Therapy technique known as Exposure and Ritual Prevention works when the patient habituates (gets used to) to the anxiety produced by the obsession and refrains from any compulsions or avoidance behaviors. In order for habituation to take place, it often takes more than a 45-minute session. It is common for an extended session to last anywhere from 90 minutes to multiple hours to truly reduce discomfort without giving into the urge to perform the compulsion. Sometimes shorter sessions can backfire and the person actually leaves sensitized (more anxious) rather than habituated, thus, inadvertently, reinforcing rather than helping resolve the problem. Without extended sessions, treatment success can often be difficult to achieve.

Education about OCD is important for the family as OCD affects all concerned. Families can learn specific ways to encourage the person with OCD by supporting the medication regimen and cognitive behavioral therapy. Self-help books such as those found on this website are often a good source of information. Some families benefit from seeking the help of a family therapist who is trained in the field. Also, in the past few years, many families have joined one of the educational support groups that have been organized throughout the country. In some instances, family and friends can actually help out as "coaches."

There are a number of websites that can assist you in identifying professionals that are experienced in the treatment of OCD. The OC Foundation (http://www.ocfoundation.org/) is a not-for-profit organization that is dedicated to educating the public and assisting people find useful resources. Another organization, the Association for Behavioral and Cognitive Therapies, aka ABCT, (http://www.abct.org/dHome/) is an interdisciplinary organization that is largely dedicated to advancing evidence-based treatments for mental health conditions. This website can also assist you in identifying a Cognitive Behavioral Therapy specialist. You can also find out about treatment providers in your area by talking to other people with OCD. Support groups for OCD sufferers can be a great resource as well as treatment provider recommendations.

The Y-BOCS, or Yale-Brown Obsessive Compulsive Scale, is a questionnaire clinicians use to help diagnose and grade the severity of OCD in a patient. It is based on the amount of interference, distress, and control the person has related to their OC behaviors. The CY-BOCS, or Children's Yale-Brown Obsessive Compulsive Scale, is a similar scale used for children.

Weston OCD Treatment Patient Question:

The ultimate outcome can be very good, especially if the patient is determined to work hard. Up to 80% of OCD sufferers improve significantly with proper treatment including cognitive-behavioral therapy and, often, medication. Slips and relapses are common in the course of OCD intervention but with proper preparation, they can usually be caught and treated before blossoming into another full blown OCD episode.

The disorder most typically waxes and wanes, but left untreated OCD symptoms tend to get progressively worse and may continue indefinitely, at least to very old age. Untreated, those with OCD are at high risk for under-employment, lack of satisfying relationships, and a generally poor quality of life. Without treatment, very few OCD sufferers can expect a spontaneous remission of symptoms.

Making a diagnosis depends on many factors including the degree that symptoms or behaviors interfere with your thinking, reasoning, and/or life functioning, level of distress experienced by self or others, and time involved. If you think you might have OCD, the best course of action is to get assessed by an OCD-experienced professional.

Perfectionism, shame, embarrassment, magical thinking, slowed behaviors, procrastination, and tardiness are typical among those with OCD.

A list of all common and less common symptoms of OCD would go on for pages and bear in mind that multiple symptoms are frequently the norm but here are the basics:

  • Excessive checking- such as doors, locks, stoves, possessions, signs of health.
  • Constant counting- such as numbers, steps, tiles, letters.
  • Excessive washing and cleaning- ritualistic hand washing, staying in the shower for extended periods, using cleansers to excess.
  • Performing or avoiding certain actions or thoughts in response to desired and undesired numbers- such as washing body parts three times or having to repeat sentences under one's breath twice. Having special or "lucky" magical numbers.
  • Lining up, arranging, ordering, and symmetry- such as items on a desk, books on a shelf, clothes in a closet, positions of limbs, and items in pockets.
  • Disturbing thoughts or images- taboo violent, sexual or religious content is most common in this area.
  • Unwanted mental content- nonsensical words, phrases, numbers, or unwanted songs repeating in one's mind.
  • Fears of harm or contamination magically coming to oneself or others- such as giving a loved one cancer if you have a bad thought about them, getting a tumor yourself if you deviate even slightly from the truth, or suffering for diminished attractiveness or intelligence.
  • Hoarding- severe cluttering or disorganization of objects with no apparent value or value that is nullified by the process of hoarding- lint, bodily secretions, old newspapers, and paper bags are examples of this problem. Also, becoming overly attached to items with no apparent purpose.

OCD stands for Obsessive Compulsive Disorder. OCD is a complex, chronic neurobiological with a behavioral component that is characterized by Obsessions and Compulsions. Obsessions are intrusive and unwanted thoughts, sensations, or images that are discomforting, frightening, or disturbing. Compulsions are urges to perform repetitive or ritualistic actions or cognitions that reduce the discomfort from Obsessions. Compulsions may or may not be logically related to Obsessions. Doubting is an important third element in OCD and basically means difficulty trusting one's senses. Doubting is related to indecisiveness and excessive need for certainty. For a much more detailed answer, see the section about OCD on this website.

Yes and No. There is controversy in the scientific community about this question. Technically speaking, OCD is classified in the "Bible" of mental health disorders, the psychiatric Diagnostic and Statistical Manual, as an anxiety disorder because anxiety is common in individuals with OCD. The other point of view is that OCD is a genetically based, neurobiological condition that often results in anxiety but one in which anxiety is not the core issue.

Although once thought to be rare, OCD afflicts as many as five to seven million Americans, or at least one in fifty. The prevalence of OCD is 2-3% in adults and 1-4% in children and adolescents. It could be even more given that many people suffering with OCD may not seek treatment for many years or not at all. Generally speaking, OCD is found uniformly among men, women, and people of all races and socio-economic backgrounds. OCD affects people all over the world.

Usually symptoms are covered up because of feeling shame for doing/thinking such bizarre things, coupled with a fear of being considered "weird", "strange" or crazy. People are also sometimes afraid they will not be able to cope with life without their OCD since OCD often has evolved into a large part of their identity.

The answer here starts with problems in getting the proper diagnosis and continues on with accepting the diagnosis and being ready for treatment. Many with OCD, particularly children and adolescents, do not recognize the true nature of the problems they are experiencing. The shame and embarrassment that many with OCD experience is a big issue as well. Finding appropriately trained mental health professionals for cognitive-behavioral treatment and medication can present obstacles too. Additionally, lack of resources and unsupportive friends and family can create barriers to successful treatment. Another major issue that individuals find challenging is the prospect of facing anxiety-provoking thoughts and situations. The presence of co-morbid conditions such as depression, anxiety, eating disorders, and substance abuse can also complicate treatment.

Unfortunately, at this point, there is no cure for OCD. The good news is that OCD is now regarded as a treatable condition in many cases.

Although progress in understanding the brain is progressing rapidly, at the present time there is no definitive agreement among members of the medical community. So far, it seems that OCD is mediated by increased activity in the orbital frontal cortex and caudate nucleus of the brain. The orbital frontal cortex, located behind the eyebrows, is involved in the perception of fear and danger. The caudate nucleus is involved in one's ability to start and stop different thoughts and activities. The basal ganglia, which are involved in movement, seem to play a role too. OCD may also involve abnormal functioning of the neurotransmitter serotonin.

Some of the signs to look for are:

  • Loss of appetite
  • Problems concentrating
  • Slowed movements
  • Early morning awakening
  • Lack of energy
  • Too much or too little sleeping
  • Persistent sadness
  • Excessive self-criticism and guilt
  • Crying, especially without knowing why
  • Suicidal thoughts
  • Feelings of hopelessness
  • Feelings of helplessness
  • Social withdrawal and lack of interest in most activities
  • Lack of enjoyment in life

Approximately 30-78% of adult OCD sufferers have also had at least one major episode of depression at some point in their life. Some schools of thought feel the OCD causes the depression while others believe the OCD and depression simply tend to co-exist. Many people with OCD also suffer from bipolar disorder (manic-depression). Depression is one of many possible complicating factors in the treatment of OCD.

Several other disorders, called OC Spectrum Disorders, appear similar to OCD, including Body Dysmorphic Disorder (obsession with imagined or minor physical flaws), Trichotillomania (hair pulling), and Health Anxiety (Hypochondriasis), but the research in this area is ongoing. Tourette's Disorder (chronic vocal and motor tics) has been thought to overlap with OCD as well.
Other disorders, such as bipolar disorder, major depression, social phobia, ADHD, and panic disorder are more common in people with OCD. In fact, OCD can co-occur with almost any other psychological condition. For example, it is common for a child in the autistic spectrum to have OCD.

Individuals may be born with a predisposition for OCD. This predisposition, however, does not always manifest itself. Sometimes OCD appears to be triggered by a traumatic or stressful event. Although not yet well understood, there is a condition called PANDAS in which symptoms of OCD rapidly develop after incurring strep throat.

OCD is usually considered to have both psychological and biological components. OCD-like behavior has been observed in animals, including dogs, horses, and birds. Specific brain abnormalities have been identified that mediate the expression of OCD symptoms. The fact that some children display OCD symptoms without ever having been exposed to someone with OCD supports biological theories for OCD. These brain abnormalities may improve with medication, cognitive-behavioral therapy, and/or both. It is certain, however, that OCD has a strong learned component. This means that OCD progresses due to a process of self-perpetuating avoidance behaviors and negative reinforcement.

No, they might feel as if they are going insane, however. Insane is a legal not psychological term anyway. Most people with OCD are aware that their behavior does not make sense. Some people have very strong OCD belief system that is not quite at delusional levels. That is to say, OCD can be accompanied by insufficient insight that makes the prognosis poorer. In the past, OCD appeared so atypical that frequently there was a misdiagnosis of schizophrenia.

If only it was that easy. Even people with OCD sometimes feel that they should be able to stop and needlessly criticize themselves when they cannot. OCD is not a voluntary behavior like raising your hand. There is a very real biological basis. What fools people is that OCD is semi-voluntary, meaning that it can be stopped for a time and that it can be stopped on a consistent basis with appropriate treatment and individual effort.

No. Although the term OCD is used informally as a social commentary, this mainly refers to people who are workaholics, perfectionists, or tense and uptight. This is not true OCD. Sticking to the clinical definition, actual cases of OCD have been documented throughout the centuries. Until the fairly recent past, the secretive nature of OCD and lack of understanding and modern diagnostic concepts kept many away from doctors and other health care workers. After effective treatments were developed and the medical and psychological causes of OCD were better understood, more people stepped forward with their symptoms or were diagnosed by clinicians who now knew what to look for. Unfortunately, mental illness still carries a stigma. With time, experts and patients alike hope this will change.