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Obsessive Compulsive Disorder in Adults

OCD affects many millions of people around the world. It occurs at about the same rates for males and females. Many cases begin in childhood but on average OCD starts to become a problem for many people during teenage years or in early adulthood. The exact cause of OCD is still somewhat of a mystery but there is increasing evidence for a genetic/neurobiological vulnerability that once triggered is reinforced by learning.

OCD is characterized by Obsessions and Compulsions. Symptoms may wax and wane over time, be episodic, or in a minority of cases, unrelenting. An Obsession is an intrusive and recurrent thought or image. An example is an unwanted thought about a loved one being harmed in some way. Other common Obsessions are about being contaminated, saying the wrong thing, and having inappropriate thought content. A Compulsion is like a ritual, it can be observable like checking, having to place items in certain ways, and hand washing or mental like counting. Just about any behavior can become a compulsion. A third important aspect of OCD is Doubting. Doubting is about not trusting one’s senses. For instance, a person might not trust that they have locked a door even though they have just seen this behavior with their own eyes. Problems and symptoms associated with OCD include anxiety, depression, perfectionism, and phobic avoidance. OCD is often worse during periods of stress or life transitions.

The very nature of OCD often makes it difficult to engage or agree to treatment for some patients. Nonetheless, the treatment of OCD has come a long way in recent years. However, there is still no cure. Medications can help and there is a behavior therapy called Exposure and Ritual Prevention (ERP) that is highly supported by numerous research studies. ERP involves learning to face one’s fears while refraining from the Compulsions and avoidance behaviors that are like fuel to the fire of OCD. The goal is habituation. Habituation means that what once caused fear no longer has the power to do so. ERP can be done gradually. However, some individuals with severe OCD may require intensive ERP programs to get good results.

Another promising treatment for OCD is Cognitive Therapy that is specifically focused upon learning to correct maladaptive thought patterns that typify this condition. An inflated sense of responsibility and thought-action fusing are two examples cognitive errors that are characteristic of OCD. Helping those with OCD accept rather than struggle with intrusive thoughts one of the many contributions that a type of CBT called Acceptance and Commitment Therapy (ACT) to OCD treatment. For the very few individuals who cannot improve with CBT or medications there are now some surgical options to consider. Support groups and the involvement of friends and family members can help too. Getting help for yourself if you are in a relationship with someone that has OCD but is resistant to treatment is highly recommended. Finally, for very severe OCD, specialized intensive outpatient or residential programs are indicated.

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