The study of Obsessive Compulsive Disorder has advanced significantly in recent years and effective treatments for OCD continue to be developed. This article presents a summary of the current understanding of OCD and the most effective forms of treatment.
What is OCD
OCD is defined by the presence of obsessions, which are persistent intrusive thoughts which cause significant distress, and compulsions, which are repetitive behaviours or mental acts designed to prevent the distress caused by the obsessive thoughts. A typical example of OCD would be someone who has obsessive worries about cleanliness, who has to compulsively wash their hands in order to satisfy these obsessions.
Prevalence of OCD
Recent estimates state that 1% of the population will have suffered from OCD in the past 12 years, making it a relatively rare condition. OCD is often comorbid (diagnosed alongside) depression and anxiety, and is sometimes linked to eating disorders, especially in women.
Theoretical Explanation of OCD
OCD can be understood in terms of fear and avoidance. The obsessive thought produces some level of fear (eg “if the door is not locked by house could be burgled”) and the compulsion (checking and re-checking the door) removes that fear. And so this avoidance behaviour becomes firmly established as a way of eliminating the fear.
There are also several unhelpful thought processes which contribute to OCD. People with OCD will over-estimate the danger of something bad happening if they do not perform their compulsions (eg “If I don’t wash my hands after touching a doorknob I’ll get an infection”) and also over estimate how bad such an outcome would be (eg thinking that getting even a minor cold would be disastrous).
Types of Treatment for OCD
Exposure and Response Prevention (EX/RP).
This form of OCD treatment has been studied around the world for over 40 years and proven highly effective as a cure for OCD. The current model of EX/RP is based around exposure to obsessive thoughts and the cues which trigger them, while observing procedures to block or cut out the corresponding compulsion. This, along with discussion about the faulty thought processes at play, is enough to demonstrate that nothing bad will happen if the compulsive behaviour is not completed, thereby destroying the link between obsession and compulsion. Once the obsessive thought no longer produces fear there is no need to perform the compulsion, and the cycle is broken.
Exposure can be done in real life settings or, for more abstract or impractical obsessions, can be done using visualisation and imagery. Exposure can either be gradual-slowly exposing yourself to more severe or more frightening situations- or by confronting the most feared situation straight away. Treatment is just as effective in their condition, although patients often find it less stressful to gradually build up the level of exposure they use.
This basic idea of confronting the distressing obsessive thoughts is simple enough that EX/RP can be easily adapted to treat children and adolescents with OCD. Rates of response prevention may be slightly slower for younger people but the overall treatment approach remains effective.
Several forms of medication have been found to have a significant effect on reducing the symptoms of OCD. However, symptoms were only reduced for as long as the medication was taken, indicating that no lasting change was taking place. Some practitioners suggest using medication alongside EX/RP therapy, although results on whether this approach is any more effective than EX/RP alone are mixed.
Conclusion and Areas for Future Research
OCD is a condition that causes severe distress and diminished quality of life for many people around the world. However, due to advances in our understanding of the condition, OCD treatment is now highly effective in reducing symptoms in the majority of patients.
Further research into OCD treatment should focus on the following areas:
- Examining how treatment varies according to different OCD symptoms and subtypes.
- Developing OCD treatments which target factors that can complicate OCD, such as family dysfunction and the presence of other disorders.
- Improving access to care so that patients around the world can have access to the same high quality OCD treatment.