Obsessive-compulsive disorder (OCD) is a common anxiety disorder that affects about 1 to 2% of the population. As its name implies, the symptoms of OCD involve obsessions that lead to compulsions. Obsessions are recurrent and persistent ideas, thoughts, images, or impulses that may cause a great deal of anxiety or distress. People experiencing these obsessions typically find them to be disturbing and intrusive, and usually recognize that they don't make a lot of sense. In response to obsessions, people with OCD try to get rid of them by way of compulsions-acts that are done over and over again, and often according to certain personal rules. Also called rituals, compulsions are usually aimed at preventing or reducing distress and anxiety, or preventing some feared event or situation.
Obsessions and compulsions can take many forms. A few examples include: drivers who fear that they've hit a person every time they run over a pothole or bump on the road. In response to such an obsession, these persons may resort to compulsions such as retracing their routes to be sure no harm was done, or avoid the particular road altogether in the future. Individuals who fear or are obsessed with germs may wash their hands repeatedly throughout the day after touching any potentially "germy" objects, such as door handles, money, or newspapers. Often, their hands are sore and raw from repeated washing, but they can't seem to stop washing. Others who might be obsessed with order and cleanliness may compulsively arrange items in a particular order, or clean their home floors many times a day. Those who fear burglary, fires, or floods may repeatedly check door locks, stove burners, and taps to ensure that their homes are safe. Over time, such repetitive actions work less and less effectively, and the persons may experience anxiety and often depression in response to the increasing obsessions and compulsions.
Besides causing a great deal of stress, OCD symptoms may take up a lot of time (more than an hour a day for some diagnosed people) and may significantly interfere with a person's work, social life, or relationships. OCD can be a challenging problem but fortunately, very effective treatments for OCD are now available to help individuals and families lead a more satisfying life.
What causes OCD?
There is no single, proven cause for OCD. There is, however, growing evidence that biological factors are a primary contributor to the disorder. Research suggests that OCD involves problems in communication between the front part of the brain (the orbital cortex) and deeper structures (the basal ganglia). These brain structures communicate with each other by using serotonin, a chemical messenger. It is possible that serotonin plays a significant role in the development or maintenance of OCD. Other psychological, familial, social and cultural factors may contribute to OCD, but it is not clear whether they cause the disorder.
What is the effect of OCD on family members?
Family members often feel confused and frustrated by the symptoms of OCD. They may have difficulty understanding the exaggerated behaviors seen in a person with OCD, and they may think that the person is behaving oddly on purpose or that he/she has simply "lost their mind." Understandably, the family may find it difficult to cope with the behaviors seen in the member with OCD and they may not know how to handle the situation. The family may react negatively to the person, possibly causing a lot of family and marital stress. In order to avoid and/or deal appropriately with family reactions, it is very important for family members to learn about OCD, including its symptoms, causes, and treatment. Families who educate themselves about the disorder can contribute to the successful treatment of the individual with OCD.
What treatments are available for OCD?
There are several types of effective treatments for individuals with OCD and their families. The most common types of treatments are the following:
- Cognitive Behavioral Therapy (CBT)
- This treatment has two parts: behavioral therapy and cognitive therapy. Behavioral therapy involves exposure and response prevention. Exposure is designed to reduce the negative emotions (anxiety and guilt) brought on by obsessions. It is based on the idea that anxiety usually decreases after lengthy contact with something feared. For example, people with obsessions about germs will be advised to stay in contact with "germy" objects, such as money. In order for exposure to be most helpful, it needs to be combined with response prevention (RP). In RP, the person's rituals (or compulsions) are blocked. For example, those who worry a lot about germs will be advised to stay in contact with "germy" objects, but avoid the compulsion to wash their hands excessively. This repeated exposure without rituals assists individuals to understand that coming into contact with certain objects or situations will not lead to the initial fear-in this case, becoming ill from the germs found on common objects.
- CBT's second part is cognitive therapy (CT). It is often combined with behavioral therapy to help reduce the catastrophic thinking and exaggerated sense of responsibility often seen in OCD. In cognitive therapy, the therapist asks the client a series of questions to help him/her identify and evaluate the interpretations and beliefs that lead to typical OCD behavior. Once these beliefs are identified, the therapist will use a variety of strategies to assist the client in challenging the faulty assumptions that are seen in OCD.
Behavioral Family Treatment
- Whenever possible, it is helpful for family members to participate in the treatment of OCD. Family members and persons with OCD both tend to benefit when the family members participate in psychoeducational groups. These groups educate family members about OCD and provide strategies that the family can use to assist and support the member with OCD.
- Research shows that the use of medication, specifically serotonin reuptake inhibitors (SRIs), is beneficial for the treatment of OCD. Most research shows that medication alone does not get rid of OCD, but it reduces the force of obsessions and urges to engage in rituals (for example, excessive hand washing), thereby allowing the person with OCD to have more control over their thoughts and behaviors.
How can a family therapist help?
Family therapists are trained to assist individuals, couples, and families with a variety of clinical issues, including OCD. A family therapist will carefully assess a person's condition and assist him/her in determining which of the above treatments will be most appropriate and beneficial. A family therapist will also encourage the family to actively participate in the treatment of OCD in a variety of ways, including participation in a psychoeducational group. If medication is necessary, the therapist will refer the client to a physician who can guide the person in determining which medication is the most appropriate to take. Often, the family therapist and physician will work together to coordinate and carry out the treatment of the person with OCD. This will ensure that the person receives the best possible treatment.