How is Obsessive Compulsive Disorder treated?

There are two treatments for OCD that have proven to be effective: Behavior therapy and medications. The backbone of behavior therapy for OCD is Exposure and Response or Ritual Prevention (or ERP). The sufferer is exposed to what they are afraid of (which triggers the obsession and creates anxiety) and then does not perform the usual compulsion/ritual to reduce the anxiety. For example, to follow up on the example used above of the hand washer, the person would touch a door knob and then not wash their hands. Recall that the obsession is that their hands are now covered in germs and they or a loved one are surely going to die. It is easy to see how this belief could cause anxiety! In the past the sufferer has used washing their hands to relieve the anxiety, but now they have entered treatment and are not going to wash their hands. What they discover is that if they can wait long enough, the anxiety does eventually go away and no one gets sick and dies. The principle that ERP is based on is habituation. If you jump into a swimming pool of cold water, the water would feel very cold at first, but if you stayed in the water you would gradually get used to it and eventually the water would not feel so cold. Touching the doorknob and not washing you hands is equivalent to jumping into the cold water and staying there. In the same way that you "adjust" to the cold water, you also "adjust" to the idea of having touched the doorknob. You also, of course, notice that the feared outcome did not occur and that helps speed along the "getting used to it" process. While the general principles of ERP are somewhat easy to explain, it is often very difficult to do the exposures. Again, if you look at it from the perspective of the person with OCD and they truly believe they or a loved one are going to die if they don't wash their hands, not washing their hands would be extremely difficult.

Depending upon how severe the OCD is, you could consider trying to do Behavior Therapy on your own. There are a number of excellent self-help books available and some of the ones I recommend are listed on my recommended books page. If you decide to seek Behavior Therapy it will be important to find someone who is trained to do ERP. The Obsessive Compulsive Foundation (www.ocfoundation.org) provides a service you can use to locate a therapist in your area. Be aware that there somewhat of a national shortage of properly trained therapists who treat OCD (especially OCD in children) and so you may have difficulty finding someone.

Medication is the other validated treatment for OCD. The practice guidelines for treating OCD suggest that Behavior Therapy/ERP be tried first and if that is not successful, then try adding medication. Research outcome studies have shown that two-thirds of people benefit considerably from ERP alone without medication.