Therapeutic Interventions for Severe OCD

Last year, Target released a sweatshirt emblazoned with the words “OCD: Obsessive Christmas Disorder.” As online debates raged about whether or not the sweatshirt was offensive, one thing was clear: obsessive-compulsive disorder (OCD) has made its way into our everyday vernacular in a way previously unimaginable. From meme-filled Buzzfeed articles like “19 Things That Will Drive Your OCD Self Insane” to Obsessive Compulsive Cosmetics, a high-end makeup brand, OCD has permeated popular culture and our collective consciousness.

“When people have this common usage or knowledge of a term; it creates what we call a ‘cultural script,’” says Yulia Chentsova-Dutton , a cultural psychologist and professor at Georgetown University. In this script, OCD is not a deeply distressing mental illness, but a set of personal habits and quirks that may range from mildly annoying to endearing. Rather than a pathology, OCD comes to act as a descriptor for benign qualities and preferences such as an appreciation for order and cleanliness.

“People may just be trying to relate [by focusing on] perceived commonality,” suggests Fatima Tipu, a writer for The Atlantic. The “de-pathologization” of OCD may, in some ways, speak to the way OCD symptoms do indeed exist on a spectrum of normal human thought and behavior; its symptoms appear to be relatable. But while the impetus behind this search of commonality and desire to make OCD legible to the common viewer may be benign or even positive in intent, the effect can be anything but. As Jeff Szymanski, executive director of the International OCD Foundation explains, “You’re now mixing a distressing psychological disorder with [arbitrary habits and preferences], and when you mix them, you lose the severity of the disorder.”

For people living with OCD, the erasure of OCD as an illness and its reframing as a mere personality trait is a disservice. Rather than acting as simple quirks, the obsessions and compulsions that define the illness can leave you in profound distress and prevent you from engaging in meaningful relationships, work, and everyday activities. Unfortunately, people with severe OCD often struggle to find effective therapeutic interventions in order to create relief from painful symptoms.

OCD is a serious mental health disorder that affects an estimated 1% of Americans, over half of whom experience severe articulations of the illness. OCD symptoms can profoundly interfere with emotional and practical function, greatly diminishing your overall quality of life and even putting you at risk of harm. Although the exact presentation of OCD can vary widely from person to person, severe versions share a common thread: they hurt.

Obsessions can be deeply painful, often making you afraid of who you are and what you will do, while compulsions can leave some people virtually housebound, unwilling or able to cope with exposure to the larger world. Dr. Jon E. Grant, a psychiatrist at the University of Chicago’s Pritzker School of Medicine, writes:

[I saw one young man who] washes his hands a hundred times a day, will not touch anything that has been touched by someone else without scrubbing it first, and has a fear of germs that left him isolated in his bedroom, unable to eat, and wishing he were dead.

Meanwhile, in a moving 2013 article, Olivia Loving describes her own experience with OCD:

When I had thoughts of hurting people I loved, I would kiss or press my tongue to the floor, recalling a ritual I’d seen in church. My loving God became a vengeful deity, one who would kill my family members before he would watch me disobey a compulsion. When I was 17 and living in Manhattan, this meant kissing dirty streets and subway floors. I would pretend to search for something under a seat on the train and peck the spotty ground with my lips. My OCD also involved thoughts of cleanliness, and this forced germ exposure seemed, to me, to serve as punishment for my thoughts.

Indeed, the reality of severe OCD is a far cry from what many imagine it to be, and serious therapeutic interventions are usually required to quell the intrusive thoughts and maladaptive behaviors that come to define your life.

OCD was once considered virtually untreatable, leaving people without hope of remission or recovery. Today, however, we know that effective therapeutic interventions exist that can minimize or eliminate both compulsions and obsessions, drastically changing how OCD is understood by both clinicians and sufferers.

There are currently two primary treatment modalities:

Pharmacotherapy

There are a number of medications currently used to treat OCD, the most prevalent of which are selective serotonin reuptake inhibitors (SSRIs). According to the Centre for Addiction and Mental Health (CAMH), these medications are estimated to “reduce the symptoms of OCD for about 70 per cent of people who take [them].” If SSRIs do not relieve symptoms, other medications such as Effoxor, monomine oxidase inhibitors, (MAOIs), antipsychotics, and mood stabilizers, may replace or be added to SSRI treatment. Benzodiazepines and Buspar may also be used to calm anxious symptoms, although these medications are generally considered to be short-term solutions. Unfortunately, finding the right medication may take multiple medication trials, particularly if a psychiatrist is not adept at treating OCD pharmacologically.

Psychotherapy

The most common form of psychotherapy for OCD is cognitive behavioral therapy (CBT), a goal-oriented modality that seeks to control symptoms and restore normal function via targeted therapeutic intervention. The two primary forms of CBT for OCD treatment are exposure therapy and response prevention (ERP) and cognitive therapy (CT), which are often used in combination. ERP therapy “involves direct or imagined controlled exposure to objects or situations that trigger obsessions that arouse anxiety. Over time, exposure to obsessional cues leads to less and less anxiety.” In other words, you are slowly exposed to distressing situations while learning how to effectively cope with your trigger in healthy ways in order to minimize their impact and is considered the gold standard in OCD treatment. Cognitive therapy, on the other hand, focuses on the thoughts and beliefs that drive obsession and seeks to change those thoughts and beliefs to eliminate negative associations with triggering scenarios. As CAMH points out, “CT helps participants identify and re-evaluate beliefs about the potential consequences of engaging or not engaging in compulsive behavior, and work toward eliminating this behavior.”

There are also a number of other therapies, such as eye movement desensitization reprocessing (EMDR) that are showing promise in the treatment of certain types of OCD, such as trauma-induced versions of the illness. In order to see the best results, pharmacotherapy and psychotherapy are often used in concert, allowing each to augment the other and provide a more complete relief of symptoms.

While effective therapeutic interventions exist for OCD, many people struggle to find treatment providers who can adequately implement them due to lack of knowledge and training. Dr. Grant says, “Only approximately one-third of patients with OCD receive appropriate pharmacotherapy, and fewer than 10 percent receive evidence-based psychotherapy.” According to some estimates, it takes the average OCD suffer 17 years to find effective treatment. As such, it’s imperative to find a treatment provider with the expertise and experience necessary to deliver evidence-based therapies.

For some, residential treatment programs adept at treating severe OCD offer the best option for finding meaningful relief from distress. In these environments, clinicians are able to offer personalized treatment plans targeted toward your specific symptoms by drawing on in-depth psychological assessments and clinical interviews. The immersive nature of these programs and constant monitoring afforded by residential environments means that medication plans can be rapidly implemented and continuously tailored to optimize efficacy while minimizing side effects. You also have the opportunity to engage in a holistic array of intensive psychotherapies that provides more treatment in a matter of weeks than would be possible in a year of outpatient care. Additionally, the group therapies and social setting of residential programs can be vital to breaking through the isolation so many people with severe OCD experience, providing you with the invaluable benefit of social support and a sense of belonging.

The suffering of people with severe OCD is profound and the lack of understanding displayed by general society as well as many clinicians can create feelings of deep hopelessness and resignation. But effective interventions do exist. Connecting with the right treatment provider can be a life-changing experience, allowing you to regain stability, self-determination, and your sense of joy.

Bridges to Recovery offers comprehensive residential treatment for people struggling with mental health disorders as well as co-occurring substance abuse and eating disorders. Contact us to learn more about our renowned Los Angeles programs and how we can help you or your loved one start on the path to lasting wellness.