You made sure multiple times to unplug your steam iron but now you’re in your Chemistry lab, unable to focus on your lab report for the past half an hour because you can’t seem to be sure if you really did unplug it and if it would cause the entire building to burn down. You’re having thoughts about walking back to the dormitory and seeing everything aflame. Police cars, ambulance, fire trucks and people crying all over because you forgot to unplug that iron. How will you ever live past being responsible for the lives of all those unsuspecting students? Jail is waiting for you and you’ll have to give up all your dreams of getting into grad school. What would your family and friends think? How would you console the parents of these students? This is the thought process of those enduring symptoms related to the checking form of Obsessive Compulsive Disorder (OCD).
OCD is different from person to person and is considered a chronic disease. If diagnosis of this mental illness in itself wasn’t difficult enough due to the existence of the numerous variations (ruminations, contamination, checking, hoarding, etc.), finding the right treatment also becomes problematic. Presently, OCD can be treated through a combination of means, but there is not necessarily a cure. If proper treatments are employed, a chance for recovery over time is definitely possible. A lot of different medications and treatment methods have been tested and were found ineffective and the research is still ongoing. According to Stanford Medicine: Clozapine, carbamazepine, lithium, clonidine, stimulants, ECT, sleep deprivation, and bright light therapy are not effective.
So then, what actually works? Medications such as selective and non-selective Serotonin Reuptake Inhibitors (SRIs), antidepressants, neuroleptics and other psychiatric ones are now commonly being used. Clinical psychologists or psychiatrists may prescribe more than one medication to effectively control OCD symptoms. Side effects are common with any form of medications but the risk for self-harm and suicide is higher with psychiatric meds. Although it’s reported that about 50% of patients respond well with solely behavior therapy, there are still many who have to take medication in conjunction with other forms of behavior therapy as well.
Some patients have tried forms of therapy which include: support groups, cognitive behavioral therapy (CBT), aversion therapy, psychoeducation, rational emotive behavior therapy, Exposure-response prevention (ERP), psychotherapy, systematic desensitization, group psychotherapy, and etc (Mayo Clinic). Out of these, many claim that ERP has been the most effective. Exposure-response prevention is a type of Cognitive Behavior Therapy (CBT) which has the patient face his or her fear without allowing them to perform their rituals (compulsions). It is effective for many, but not for all.
The ERP exposures may be applied in two ways; in real life (in vivo) or in imagination (imaginal). To better illustrate this form of treatment, in vivo ERP for someone experiencing concerns related to contamination would consist of having the patient shake hands with someone and having them resist the compulsions related to hand washing. Imaginal ERP for the same would involve having the patient imagine scenarios where they would shake hands and resist washing their hands. These procedures are followed through a structured manual and even if they don’t necessarily decrease the resulting distress, they are said to increase the tolerance towards the patient’s fears. It is then overtime repeated until the patient’s rituals in response to the fear decreases.
Although it isn’t discussed enough, OCD is one of the most debilitating mental illnesses. For similar reasons, it is often underdiagnosed and therefore, access to specialized treatment is also very limited. Everything related to treatment becomes even more difficult when there are chances of comorbidity with OCD and other forms of mental illnesses. For example, the relationship between obsessional ruminations and depression is particularly close: a diagnosis of obsessive-compulsive disorder should be preferred only if ruminations arise or persist in the absence of a depressive disorder. This makes it strenuous for those who are experiencing a variety of these symptoms. Research revolving more effective treatment is still at large and an ongoing effort. Hopefully, the search leads to giving these patients a peace of mind in their tumultuous times.
References:
The Different Types of Obsessive-Compulsive Disorder. Retrieved October 09, 2017, from www.ocduk.org/types-ocd
My experience of Postpartum OCD (2013, October 13). Retrieved October 09, 2017, from http://www.ocduk.org/my-postpartum-ocd
Obsessive-compulsive disorder (OCD). (2016, September 17). Retrieved October 09, 2017, from http://www.mayoclinic.org/diseases-conditions/obsessive-compulsive-disorder/diagnosis-treatment/treatment/txc-20245962
Behavior Therapy. (n.d.). Retrieved October 09, 2017, from http://ocd.stanford.edu/treatment/psychotherapy.html
Gillihan, S. J., Williams, M. T., Malcoun, E., Yadin, E., & Foa, E. B. (2012, May 30). Common Pitfalls in Exposure and Response Prevention (EX/RP) for OCD. Retrieved October 09, 2017, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3423997/
