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Obsessive-compulsive disorder (OCD) assessment and therapy techniques

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Obsessive-compulsive disorder (OCD) assessment and therapy techniques

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What is obsessive-compulsive disorder (OCD)? 

OCD is often, incorrectly, used in common language to describe tendencies toward perfectionism and organization. While these traits might be present in those with OCD, it’s important to remember that this is a very real condition that is a class of mental illness (i.e diagnosable by licensed psychiatrists and psychologists as a health condition). 

People with obsessive-compulsive disorder (OCD) will experience patterns of unwanted and intrusive thoughts and fears (obsessions) that trigger feelings of stress, and that stress can lead to repetitive behaviours (compulsions) in an attempt to decrease or alleviate those distressing thoughts.

Symptoms

Many people spend some time thinking over-and-over again about stressful situations, or fall into bouts of cleaning and organizing when they’re stressed or worried. So how do you know if your symptoms are severe enough to be classified as OCD? 

When these thoughts and behaviours persist, you recognize them to be excessive, and they start to interfere with your ability to socialize, work or rest, it’s time to talk with someone. 

Some common obsessive thought patterns:

  • Fear of dirt or contamination
  • Fear of intentionally or unintentionally harming yourself or others through your actions
  • Assuming or fearing you’ll say something offensive in public
  • Constant fear and believe you will become sick with an illness like cancer
  • Having intrusive thoughts that could be violent or disturbing, including unpleasant sexual thoughts 

Some examples of compulsions include:

  • Washing hands excessively, even to the point of chapping
  • Counting objects of actions until you achieve a “safe” or “correct” number
  • Checking in with others constantly that you did not offend or harm them
  • Needing constant reassurance you didn’t do anything wrong
  • Fear of touching objects like doorknobs or shaking hands
  • Checking repeatedly to make sure doors are locked and the stove is off
  • Repeating words or phrases to yourself 
  • Having a prohibitively strict routine

You might notice some of these symptoms yourself and seek a professional opinion, or your primary care physician may recognize some symptoms and conduct an assessment.

Assessment

Risk factors and causes for OCD can include a family history of the illness, physical and biological factors (brain chemistry), experiencing a traumatic life event or being in prolonged stressful situations, or it can be a symptom of other mental health disorders. 

A therapist will work to understand the severity and nature of your obsessions and compulsions by asking you screening questions, such as:

  • Do you experience unwanted thoughts or images, repeatedly, despite trying to move past them? For example, worrying about germs?
  • Do you try to get rid of these thoughts? How?
  • Do you have habits or rituals that are repeated every day, and that take up a lot of time in the day?
  • Do you feel driven to repeat acts, or repeat thoughts in your mind to feel better?
  • Do these behaviours trouble you?

If your diagnosis is OCD, you may be guided to seek treatment from a licensed mental health professional like a psychologist, psychotherapist or social worker.

Treatment

While people with OCD might benefit from prescribed medications, many can have their symptoms treated effectively through psychotherapy.

Certain cognitive therapies work to shift beliefs and negative thought cycles that could be contributing to OCD symptoms. Cognitive behaviour therapy (CBT) is a modality (technique) in psychotherapy. CBT guides you through understanding your thought patterns and how those contribute to your behaviours and emotions. By building new skill sets around managing your thoughts and understanding if they’re tied to reality, you can alleviate some of the anxieties that lead to obsessions and compulsions.

There is a subset of CBT called exposure and response prevention (ERP) or exposure and ritual prevention (ExRP). These are proven through professional research to be effective for treating OCD. These therapies involve guided exposures to the fears that drive obsessions and compulsions—physical exposures like sitting on a dirty floor, or exposing yourself mentally to a particular obsessive thought. This teaches us that the repercussions we fear are not inevitable. 

If OCD is present as a result of a traumatic event, it may be worthwhile to seek a therapist who specializes in trauma therapy. They’ll be more careful not to have patients relive distressing events too early with techniques like exposure therapy, for example. 

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