Obsessive-compulsive disorder is not simply being neat

How many times have you heard someone say, "I am obsessive-compulsive about keeping my house neat"? Yet, people with Obsessive-Compulsive Disorder (OCD) resent hearing this type of comment. OCD is not simply about being neat or clean. OCD is a serious mental illness characterized by anxiety and can be severely disabling. This week is OCD Awareness Week and I'd like to show you how OCD is much more than just a quirky character trait.

OCD can take many different forms. OCD can present itself in the woman who is terrified that she will harm her child even though she has no intention of doing so. It manifests in the child who repeatedly asks his mom if he has done things against the law even though he follows rules strictly. The man who avoids touching doorknobs because he believes he will get cancer if he does — he also probably has OCD.

The vast majority of individuals with OCD have both obsessions and compulsions. The DSM-5 defines obsessions as "recurrent and persistent thoughts, urges, or images that are experienced…as intrusive and unwanted." Any thought can become an obsession if it is associated with anxiety or distress. Classic obsessions are often related to contamination, making mistakes, and having unwanted impulses. However, the content of obsessions vary greatly across individuals with OCD. Other obsessions include distress about loss of identity, fear of accidentally performing a socially inappropriate behavior, or distress because something doesn't feel "just right."

Compulsions, as defined by DSM-5, are "behaviors or mental acts…that the individual feels driven to perform in response to an obsession." Any behavior could be a compulsion if it is being performed in an effort to reduce or avoid distress associated with an obsession. Typical compulsions are excessive washing, cleaning, counting, and reassurance seeking, but compulsions can vary. For example, a person with OCD may tap his fingers together to prevent poor grades on an exam. Another may silently repeat, "all will be OK" in response to an obsession.

OCD can also vary dramatically in severity. Some individuals with OCD can hide their obsessions and compulsions so well that others are unaware of any issues. On the other hand, some may spend an hour per day performing compulsions and others may spend up to eight hours performing their rituals.  It is also not uncommon for people with OCD to insist that their significant others perform compulsions in order to alleviate some distress.

As debilitating as this disorder can be, effective treatments are available. The therapeutic treatment with the most empirical support is called Exposure and Response Prevention (EX/RP). EX/RP is a short-term therapy that can be conducted once, twice, or five times per week depending on an individual's needs. Treatment involves systematically and repeatedly confronting situations that give rise to obsessions without engaging in compulsive or safety behaviors. Patients are frequently surprised at how quickly they improve from this type of therapy. The treatment usually takes approximately 17 sessions and is effective without medication. Long-term follow up has found that improvement is maintained even after therapy has ended.

Serotonergic medication is also used to treat OCD. It has been found to reduce 30-40 percent of OCD symptoms in patients taking the medication. In addition, EX/RP can be used to augment the effects of medication.

It is often difficult to find a therapist who is trained in conducting EX/RP.

Locally, the Center for the Treatment and Study of Anxiety (CTSA) at Penn Medicine has been conducting research on treatment of OCD for the past 30 years. The CTSA and its director, Edna B. Foa, Ph.D., are internationally known for their expertise in conducting EX/RP treatment with OCD patients. Currently CTSA is offering free treatment for individuals with OCD who participate in a therapeutic study that is being conducted in conjunction with Columbia University in New York City.

For information about free OCD treatment at the CTSA call (215) 746-3327 or at Columbia University call (646) 774-8062