As you spend more time discussing goals and challenges with your Talkspace therapist, you may have questions or are interested in learning more about specific mental health topics and conditions. The Talkspace Bookshelf offers up-to-date mental health information directly from our behavioral health team to provide a better understanding of condition origins, diagnoses, various forms a condition may take, and different treatment options. Feel free to use this resource as a starting point to open up a dialogue and pose questions for your Talkspace therapist.

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Obsessive-Compulsive Disorder, commonly referred to as OCD, is a condition that affects just over 1% of the American population annually. It is experienced at similar rates around the world. While the number of people living with Obsessive-Compulsive Disorder might be small in relation to the total population, the impact on the individual may be profound.

Obsessive-Compulsive Disorder is a condition characterized by preoccupying thoughts, which are then paired with compulsions that one uses to try and cope with problematic thoughts. Clients with OCD may engage in rituals to manage their anxiety such as, but not limited to, “checking” behavior, cleaning rituals, and/or rigid organization.

Obsessions, in this context, are often experienced as recurrent, intrusive, problematic thoughts, images, or urges that an individual may experience chronically. These thoughts are paired with compulsions, which are repetitive behaviors that work in response to the preoccupying thoughts, or obsessions. These behaviors may be similar to those mentioned above, but also may be strictly mental acts, such as counting. Therefore, while some behavioral compulsions may be very noticeable, not all compulsions are apparent and not all look the same.

They can also manifest as avoidant behaviors, which may be difficult to discern without very close monitoring. In both instances, an individual living with Obsessive-Compulsive Disorder experiences these preoccupying thoughts and behaviors as nearly impossible to manage or control.

It is imperative that you work closely with a therapist if you think that you may be living with OCD, as there are similar mental illnesses that mimic and are related to Obsessive-Compulsive Disorder, but are not necessarily OCD.

There is a great amount of variability of manifestations of Obsessive-Compulsive Disorder. Some individuals may experience symptoms around harm and safety (such as fearful thoughts about safety leading to repeated checking to ensure a door is locked or closed); thoughts and behaviors centered around symmetry, order and counting; or taboo thoughts (such as sexual, aggressive, or otherwise violent urges that may lead to religious compulsions and preoccupation. Religious obsessions and compulsions may include, but not be limited to, using repetitive prayer due to perceived moral failings. One example may be receiving too much change from a cashier and fearing that one may be punished by God for the perceived wrongdoing. This may lead to compulsory prayer and preoccupying thoughts of committing a sin). However, most of the common understanding of OCD comes from mainstream depictions of preoccupation with cleanliness and avoiding perceived contamination, which may be accompanied by compulsive behaviors around cleaning.

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Symptoms

Those diagnosed with Obsessive-Compulsive Disorder meet certain diagnostic criteria including:

Obsessions

• Unwanted, intrusive, recurrent and persistent thoughts, images or urges that typically cause feelings of being distressed or otherwise anxious
• An attempt to ignore or otherwise minimize said thoughts with other thoughts or actions (compulsions)

Compulsions

• Performance of ritualistic and/or repetitive behaviors or thoughts in response to an obsession or according to specific, and often rigid, rules
• Thoughts and behaviors are made in an effort to lessen dread, anxiety, or stress-related to obsessions. These thoughts and behaviors, however, are clearly excessive and are not rationally connected to decreasing the dread or anxiety

The obsession and compulsions are experienced as incredibly time-consuming, which may result in disruptions in school, work, social, or other environments (e.g. Being routinely late for work, which leads to probation or termination, missing scheduled appointments entirely due to obsessive thoughts and compulsions, or truancy which leads to failing grades and expulsion)

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Additionally, those living with Obsessive-Compulsive Disorder can only be diagnosed with the condition if these symptoms can not be attributed solely to the use of substances or another medical or psychiatric condition.

Some individuals living with OCD may not know the extent of their condition, and as such, may not recognize the severity of their symptoms until they become quite severe. Clients may not be motivated to seek out professional support due to their perceived quirks or routines until they experience negative consequences such as problems with a romantic partner or negative reviews at the workplace. Even in treatment, it may be difficult to acknowledge that the obsessions may not cohere with objective reality.

While individuals with Obsessive-Compulsive Disorder must exhibit certain criteria, such as those symptoms listed above, the range in personal emotional experience can vary greatly. Some may experience intense fear or anxiety, which can lead to recurrent panic attacks. Others may predominantly experience disgust, fear, distress, or other emotions depending on their individual experience.

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Treatment

Like many mental illnesses, Obsessive-Compulsive Disorder is best managed by a combination of talk therapy (psychotherapy) and medication (pharmacotherapy).

Medication

Selective serotonin reuptake inhibitors (SSRIs) are the most recommended treatments for OCD and its accompanying symptoms. Mostly known as treatments for depression, SSRIs can be quite helpful in the management of OCD symptoms. In addition, they may be helpful in addressing symptoms of other conditions which might exist alongside OCD such as anxiety or depressive disorders. Other conditions, such as Panic Disorder or Major Depressive Disorder are commonly experienced alongside a diagnosis of OCD. In some instances, an antipsychotic medication, such as risperidone (brand name Risperdal), may be recommended to combat delusional thinking not remedied by selective serotonin reuptake inhibitors.

Therapy

Cognitive Therapy and Exposure and Response Prevention

Cognitive therapy is an effective tool in the treatment of Obsessive-Compulsive Disorder. Throughout treatment, a therapist will lead you through an exploration of the origins of your preoccupying thought patterns (obsessions) as well as new ways to approach thinking about the reported fears and anxieties. Treatment may often begin with the identification of obsessive thoughts and may, at some point, include an examination of the evidence in support or rejection of presented thoughts. Your therapist may assign homework that will encourage you to identify and explore these thoughts in-between sessions.

Exposure and Response Prevention is a specific type of therapy that includes both cognitive elements along with exposure to feared situations and response prevention. In ERP, a therapist will gradually invite you to be exposed over time, either directly or indirectly, to feared situations, starting with mild to moderate situations and then increasing intensity over time.

With the support of a professional therapist, this kind of treatment has been shown in research to be incredibly effective. It is, however, quite difficult, as it challenges an individual living with OCD to confront their biggest anxieties and fears. Therapists may use a combination of exposure strategies, such as talking about the preoccupying situation, showing pictures or other media, and being in close proximity to or actually being in feared situations. Examples may include things like being invited to touch a toilet seat or shaking hands.Through a process called habituation, those living with OCD will become desensitized to the scenarios and see their fear, disgust, or anxiety greatly diminish over time.

In combination with this exposure, you will also likely be encouraged to withhold utilizing previously used coping strategies (compulsions). Over time, an individual with OCD will be able to tolerate those situations or events without relying on compulsions. For most, this takes some time to achieve, therefore treatment should be approached with a lot of patience and intentional pacing. In some instances, a therapist will encourage you to use other healthier coping strategies.

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Therapeutic Note

Remember your therapist is here to help you figure out the best way to address your concerns. Therapy works best when it is a collaboration between you and your therapist. It is important to be open, honest, and an active participant in this process. Talk to your therapist about your goals for therapy so that together you can come up with the best plan to achieve your goals.

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Questions You Might Have For Your Talkspace Therapist

• Can you be cured of OCD?
• What if I don’t always wash my hands? Can I still have OCD?
• How long does treatment for OCD usually last?
• I think my partner may be OCD, how can I talk about this with them?
• What if I don’t want to be dependent on medication? Can I still control my OCD?

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Sources

American Psychiatric Association. (2013). Obsessive-Compulsive and Related Disorders. In Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.

Obsessive-Compulsive Disorder. (n.d.). Retrieved June 14, 2017

Treatments for OCD: Cognitive-behavioural therapy. (n.d.). Retrieved June 14, 2017