Tag Archives: obsessive compulsive disorder

OCD: Not Just About Handwashing

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OCD - Not Just About Handwashing

Obsessive-compulsive disorder (OCD) has been portrayed in the popular media as primarily a problem of checking or washing.

The lay public has accepted OCD as one many people claim, in an ad hoc way, to have given the virtuous qualities associated with it, such as fastidiousness, cleanliness or being well organized. Unfortunately, when individuals actually suffer from this condition, these qualities could not be further from the truth. No one would want to claim they have OCD if they were cognizant of the full range of symptoms.

Most people with OCD suffer greatly and experience incredible emotional pain. Their families struggle with how to best help them. OCD is a severe and debilitating psychological condition affecting 1 percent to 3 percent of the population. The World Health Organization ranks it among the top 10 disabling conditions.

Research suggests it is comprised of subtypes that generally fall in the following categories: symmetry obsessions with symmetry compulsions; obsessions (such as aggressive, sexual, religious or somatic concerns), checking compulsions and contamination obsessions and cleaning compulsions.

Epidemiology research suggests that approximately half of all OCD sufferers report contamination fears associated with washing rituals. Therefore, if you treat individuals with OCD, there is a very high likelihood that the sufferer will have this variant of the disorder.

Many practitioners are aware that the treatment with the greatest level of scientific support for OCD is exposure with response prevention (ERP), which is a component of a broader program of cognitive-behavior therapy (CBT). ERP is said to work through a process of teaching clients that experiencing situations that are avoided do not result in the consequences that they are expecting.

In the case of treating individuals with contamination fears and washing rituals, here are a few helpful tips:

Exposure is Not Harmful

Many therapists are reluctant to practice exposure therapy. The concerns typically involve fears (by the therapist) that the client will drop out, get worse or that the practice will increase the risk of litigation.

Research has shown that dropout among individuals with OCD is comparably high regardless of intervention employed but that ERP is of the highest likelihood in producing good outcome and that clients rarely worsen with its application.

There are no documented cases of litigation to therapists that came about solely due to the application of exposure therapy. This is particularly true in contamination fear with washing rituals, which is one of the most readily treated of the subtypes of OCD.

Emotional Reaction to Exposure is Not Always Fear

The stereotype of OCD sufferers with washing rituals is that they are fearful of contracting an illness. Research over the past 15 years suggests that at least as much of the avoidance in contamination fear is due to much higher disgust reactivity. Many therapists are less familiar with disgust, so here are a few important points to know about this understudied emotion. Disgust is a transmittable emotion

Certain substances and objects lead to disgust reactions. Among the most disgusting things we can encounter are certain body products (i.e., feces, urine, mucus), rotting food and certain types of insects (i.e., spiders) or animals (i.e., rodents). However, experimental findings have shown that disgust operates based on two principles. The first is called the Law of Contagion.

This principle operates when an otherwise neutral object comes in contact with a disgusting object, transferring disgust onto that neutral object. For example, if a clean pen came in contact with mucus, the pen would acquire the disgusting properties. In the case of OCD with washing rituals, the problem is compounded. If that pen were to come in contact with another object such as a cell phone, now the cell phone is also contaminated. This contagion problem can persist across objects multiple times over.

The second principle is a bit less relevant in OCD, called the Law of Similarity. This is when an object that is neutral, but is shaped like a disgusting object leads to a disgust reaction. For example, if one were to serve soup in a bowl shaped like a miniature toilet, this would be evocative of disgust.

Disgust Can Be Treated with Exposure

It may require a bit more intestinal fortitude for the therapist, but ERP for washing rituals where disgust is evoked can still be effective. Be aware that it may take a bit longer than exposure in other circumstances.

When conducting ERP and the primary emotion is fear, there is a consequence that the client is concerned about, but which will not come to pass with the exposure exercise. So the learning is that there is nothing to fear. With disgust, there is typically no consequence except the client offering statements such as “it feels yucky” or “this looks gross.”

These are reactions that are slower to respond to treatment, since it is more a matter of simply getting accustomed to the emotional experience and not recognition of reduced risk. It may be necessary to schedule more frequent sessions in order to ensure a good outcome, such as two or three sessions a week, or longer duration sessions (i.e., up to 90 minutes).

Exposure with response prevention is widely sought out among OCD sufferers. Online forums and professional organizations that have consumer-oriented materials (such as the International Obsessive Compulsive Foundation or the Anxiety and Depression Association of America) have promoted ERP as an empirically supported approach.

As a result providers are often asked to deliver this treatment. In doing so, awareness of the full range of typical emotional reactions that might be provoked is essential for producing better outcomes for clients.

Course excerpt from:

Therapy Tidbits – September/October 2017 is a 1-hour online continuing education (CE) course comprised of select articles from the September/October 2017 issue of The National Psychologist, a private, independent bi-monthly newspaper intended to keep mental health professionals informed about practice issues. Course #11-12 | 2017 | 17 pages | 10 posttest questions

Related Online Continuing Education (CE) Course:

Obsessive-Compulsive Disorder (OCD)Obsessive-Compulsive Disorder (OCD) is a 3-hour online continuing education (CE/CEU) course that reviews the diagnosis, assessment and treatment strategies for OCD.

Obsessive-Compulsive Disorder (OCD) is characterized by intrusive, unwanted, and anxiety-provoking thoughts, images, impulses and rituals that are performed to alleviate the accompanying distress. Because OCD is a heterogeneous disorder with several subtypes, assessing, diagnosing, and treating it can be challenging. Further, the presentation of varying symptoms may be considered to be OC Related Disorders. Being able to make differential diagnoses and treatment recommendations are essential in clinical work with the many patients that present with the spectrum of OC problems. Specific behavioral strategies have been developed and validated in the literature that target the various manifestations of OCD and related disorders.

The first part of the course offers information on the neurobiology, diagnosis and assessment tools, including the various subtypes, and highlights important topics to be taken into consideration during the process. Emotional and cognitive factors are outlined that seem to play important roles in the diagnosis and the course of episodes. The next section is dedicated to describing the clinical factors of and differential aspects of the OC Related Disorders and their prevalence. A case study follows that outlines the precipitating events, assessment, and behavioral treatment of a college student who is struggling to maintain and overcome her OCD. The final section describes effective treatment and coping strategies and augmentations that help to maintain treatment gains. Course #30-95 | 2017 | 60 pages | 20 posttest questions

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This online course provides instant access to the course materials (PDF download) and CE test. After enrolling, click on My Account and scroll down to My Active Courses. From here you’ll see links to download/print the course materials and take the CE test (you can print the test to mark your answers on it while reading the course document).

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Professional Development Resources is approved to sponsor continuing education by the American Psychological Association (APA); the National Board of Certified Counselors (NBCC ACEP #5590); the Association of Social Work Boards (ASWB Provider #1046, ACE Program); the American Occupational Therapy Association (AOTA Provider #3159); the Commission on Dietetic Registration (CDR Provider #PR001); the Alabama State Board of Occupational Therapy; the Florida Boards of Social Work, Mental Health Counseling and Marriage and Family Therapy (#BAP346), Psychology & School Psychology (#50-1635), Dietetics & Nutrition (#50-1635), and Occupational Therapy Practice (#34); the New York State Education Department’s State Board for Mental Health Practitioners as an approved provider of continuing education for licensed mental health counselors (#MHC-0135); the Ohio Counselor, Social Worker & MFT Board (#RCST100501); the South Carolina Board of Professional Counselors & MFTs (#193); the Texas Board of Examiners of Marriage & Family Therapists (#114) and State Board of Social Worker Examiners (#5678); and is CE Broker compliant (all courses are reported within a few days of completion).

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OCD: What Clinicians Need To Know

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OCD

Obsessive Compulsive Disorder (OCD) can present in many forms. It can trigger a cascade of behaviors that result in washing, checking, and a variety of routinized behaviors. It can also drive perfectionism and rigidity, as well as intrusive, and disruptive thoughts. Many patients often feel lost, trapped, and without recourse.

And while there can be many factors that contribute to the development of OCD, a fascinating new study done by Kai Schuh from the Institute of Physiology at the Julius-Maximilians-Universität (JMU) Würzburg (Germany) in collaboration with the JMU’s Departments of Psychiatry and Neurology found that one underlying cause may be the absence of the protein SPRED2. In mouse models, Schuh and his team were able to show that without this protein, excessive grooming behavior was triggered (Schuh, 2017).

Occurring in all cells of the body, the protein SPRED2 is found in particularly high concentrations in regions of the brain, namely in the basal ganglia and the amygdala. Normally, the protein inhibits an important signal pathway of the cell, the so-called Ras/ERK-MAP kinase cascade. When it is missing, this signal pathway is more active than usual. When the mice in Schuh’s study were given an inhibitor to attenuate the overactive signal cascade the obsessive-compulsive symptoms improved (Schih, 2017).

This recently discovered link between OCDs and the Ras/ERK-MAP kinase cascade, offers a new way to look at OCD. OCD patients could be responding not just to intrusive thoughts, but an overactive amygdala that results in elevated hypervigilance. Moreover, this study represents just one of the many things we are learning about a diagnosis that has been notoriously hard to identify, and perhaps even harder to treat.

OCD has many subtypes that can often appear similar to many other disorders, such as generalized anxiety, acute stress disorder, PTSD, adjustment disorder, and a variety of phobias, and understanding the etiology as well as the clinical presentation is the foundation of effective treatment. When clinicians use accurate assessment tools to diagnose OCD, as well as its various subtypes, they can then isolate the treatment strategy that will be most helpful to the patient. Further, knowledge of the related emotional, cognitive, and clinical factors that influence the progression of OCD will help clinicians adjust treatment to the patient’s specific needs and augment treatment gains.

While OCD can be difficult to detect and treat – and often the source of much distress for the patients who experience it – through a solid understanding of the most recent research on the etiology and treatment, clinicians can help patients with OCD find ways to live productive, meaningful, and healthy lives.

Related Online Continuing Education (CE) Course:

Obsessive-Compulsive Disorder (OCD)Obsessive-Compulsive Disorder (OCD) is a 3-hour online continuing education (CE/CEU) course that reviews the diagnosis, assessment and treatment strategies for OCD. Obsessive-Compulsive Disorder (OCD) is characterized by intrusive, unwanted, and anxiety-provoking thoughts, images, impulses and rituals that are performed to alleviate the accompanying distress. Because OCD is a heterogeneous disorder with several subtypes, assessing, diagnosing, and treating it can be challenging. Further, the presentation of varying symptoms may be considered to be OC Related Disorders. Being able to make differential diagnoses and treatment recommendations are essential in clinical work with the many patients that present with the spectrum of OC problems. Specific behavioral strategies have been developed and validated in the literature that target the various manifestations of OCD and related disorders. The first part of the course offers information on the neurobiology, diagnosis and assessment tools, including the various subtypes, and highlights important topics to be taken into consideration during the process. Emotional and cognitive factors are outlined that seem to play important roles in the diagnosis and the course of episodes. The next section is dedicated to describing the clinical factors of and differential aspects of the OC Related Disorders and their prevalence. A case study follows that outlines the precipitating events, assessment, and behavioral treatment of a college student who is struggling to maintain and overcome her OCD. The final section describes effective treatment and coping strategies and augmentations that help to maintain treatment gains. Course #30-95 | 2017 | 60 pages | 20 posttest questions

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Professional Development Resources is a nonprofit educational corporation 501(c)(3) organized in 1992. We are approved to sponsor continuing education by the American Psychological Association (APA); the National Board of Certified Counselors (NBCC); the Association of Social Work Boards (ASWB); the American Occupational Therapy Association (AOTA); the American Speech-Language-Hearing Association (ASHA); the Commission on Dietetic Registration (CDR); the Alabama State Board of Occupational Therapy; the Florida Boards of Social Work, Mental Health Counseling and Marriage and Family Therapy, Psychology & School Psychology, Dietetics & Nutrition, Speech-Language Pathology and Audiology, and Occupational Therapy Practice; the Ohio Counselor, Social Worker & MFT Board and Board of Speech-Language Pathology and Audiology; the South Carolina Board of Professional Counselors & MFTs; the Texas Board of Examiners of Marriage & Family Therapists and State Board of Social Worker Examiners; and are CE Broker compliant (all courses are reported within a few days of completion).

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Life with Obsessive Compulsive Disorder

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Living with Obsessive Compulsive Disorder

 

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Between the ages of 12 and 14 I was afflicted with obsessive compulsive disorder, though I didn’t fully know it at the time. It wasn’t until years later in college when I was actually given time to think and reflect on it did I realize that it was, in fact, f̶u̶l̶l̶-̶s̶c̶a̶l̶e̶ c̶o̶m̶p̶l̶e̶t̶e̶ t̶o̶t̶a̶l̶ full-blown OCD.

When I came to this realization, I can’t even begin to describe to you the feeling I had. Living with OCD was a lonely, frustrating, and hopeless experience for me, especially at such a young age. When I was going through it at the time, I didn’t know what was wrong with me. I thought I was fully alone in my weird habits and thoughts and rituals and I was afraid that nobody could possibly understand what I was s̶u̶f̶f̶e̶r̶i̶n̶g̶ e̶n̶d̶u̶r̶i̶n̶g̶ b̶e̶a̶r̶i̶n̶g̶ going through. So while it was happening, I felt truly alone in the world, an isolation that was amplified by the already cosmic loneliness that comes naturally only as a teenager. So when I read about OCD in my intro to psychology textbook, my vast teenage loneliness in one fell swoop became reconciled, my fears and alienation documented meticulously, and my psyche prodded and laid bare for all to see. The darkness of those years was finally given a name for what it was: a mental illness.

And that’s exactly what it was: an illness.
 
Most people have this t̶w̶i̶s̶t̶e̶d̶ m̶i̶s̶g̶u̶i̶d̶e̶d̶ i̶g̶n̶o̶r̶a̶n̶t̶ i̶n̶a̶c̶c̶u̶r̶a̶t̶e̶ warped idea of what OCD really is. Most people think that it’s this innocuous thing, like a personality tic or flair or choice or something. I would bet that at least at one time in your life you’ve heard someone proudly proclaim something along the lines of, “That picture is slightly crooked, I need to fix it! I’m so OCD!” or, “That floor tile isn’t facing the right way! I’m SO” etc. etc.

OCD, real OCD, isn’t like that at all. It’s much, much more i̶n̶s̶i̶d̶i̶o̶u̶s̶ p̶e̶r̶v̶a̶s̶i̶v̶e̶ sinister than that. The best description that I can come up with is that it’s like a parasite that attaches itself to your mind and grows and grows and slowly infects every aspect of your life. It’s like a slow, unceasing progression. It starts in your thoughts, then your behavior, then your personality, and soon, it messes up your relationships with other people. It creeps like an invisible force that compels you to do things you don’t want to do, hate doing, and make you hate yourself for doing.

Sure the picture is crooked, and you feel compelled to fix it — but would you take the time to stand there and fix it 25 times, adjusting it at every single angle between 45 and 90 degrees, three times over while your hand shakes and your skin feels like it’s m̶e̶l̶t̶i̶n̶g̶ c̶r̶a̶w̶l̶i̶n̶g̶ r̶i̶p̶p̶i̶n̶g̶ peeling off? And the worst part of it all is knowing that you feed this force, this fear, and that you are responsible for all of your pain and misery… but all the time you’re powerless in the face of this immovable, immutable fear.

You feel like you’re going to die. Sometimes you feel that death would be a release. Your daily life becomes so unnatural that you may as well be dead. No human being could ever live like this, you think. But that’s the thing about OCD. Its worst trick is that it swallows you whole but doesn’t let you die.

My specific condition was called scrupulosity, a form of OCD that preys upon a person’s moral and religious fears. The fears of being an evil person, of going to hell and of divine retribution for one’s sins, are the main reasons why people with this condition do the obsessive rituals they do. Raised a Roman Catholic, the fear of God was instilled in me at a very young age.

And so, as a big-headed and lonely 12-year-old, I aimed an entire religious machine directly onto myself. I was born with original sin. I had to cleanse myself, and this manifested itself in the form of u̶n̶c̶o̶n̶t̶r̶o̶l̶l̶a̶b̶l̶e̶ i̶r̶r̶e̶s̶i̶s̶t̶i̶b̶l̶e̶ compulsive hand washing. Not only was I dirty, but everything else was too, as if everything was infected with a disease. So a floor with toys strewn about it turned into a field littered with mines. I had to carefully tip-toe across the room avoiding each object like death. And if a tiny bit of me even so much as grazed a toy, I’d have to stop in the middle of the room and touch the thing a certain number of times, then run into the bathroom and then scrub my hands x amount of times.

I had these other C̶r̶a̶z̶y̶ c̶r̶a̶z̶Y̶ c̶r̶A̶z̶y̶ c̶r̶a̶Z̶y̶ c̶R̶a̶z̶y̶ crazy rituals that I had to do every single day without fail. Everyday when I came home I made myself run up and down the stairs at least half a dozen times, and I wouldn’t let myself stop unless I had done it perfectly. I had to count the seconds I stood in the shower, and until I counted them perfectly, I couldn’t get out even after the water had long become frigid. Everything was my cross to bear, and mine alone.

Try living life like that, d̶a̶y̶ ̶i̶n̶ ̶a̶n̶d̶ ̶d̶a̶y̶ ̶o̶u̶t̶ ̶d̶a̶y̶ ̶i̶n̶ ̶a̶n̶d̶ ̶d̶a̶y̶ ̶o̶u̶t̶ ̶d̶a̶y̶ ̶i̶n̶ ̶a̶n̶d̶ ̶d̶a̶y̶ ̶o̶u̶t̶ day in and day out.

Life becomes artificial, constructed, stilted. Everything could kill you if you didn’t do things perfectly. Doing even the most menial things became an exercise in extreme patience, willpower, and mental-sometimes physical-effort.

You try to live your life one way but your mind and body have different plans. Life is a round hole, but your mind’s a square peg and your body’s a triangle. Everybody else lives on an x-y graph, but you try to live on the z axis. They work and conspire against you, and don’t let you do the things you want to do-which is to just live normally and naturally without fear. Nothing you do is right. Everything you do is wrong and your rituals barely help. Every thought, every action, becomes toxic.

Obsessive compulsive disorder doesn’t make sense by any system of logic and reason except your own. But it’s under the false banner of “logic” and “reason” that you do these things. I think at the heart of it all is fear. You’re afraid of everything — of the world, of the unknown, of the unstructured, of the chaotic, of the unpredictable, of what will happen if you stop doing these things-so you construct these arbitrary rules and schema and logic systems so that the world can start to even make a bit of sense. It keeps the tragedy away. It gives you whatever comfort you think you need.

I got out of it eventually. It wasn’t through any medication or therapy, but by sheer force of will: I used my own OCD’s system against itself (but that’s a story for another time). But remnants of this behavior still manifest themselves even today. It’s part of who I am and it’s not something I can change. I often find myself editing a post that I wrote over and over again, removing an errant period or comma here or there, saving it, and then going back and adding it and removing it all over again. Sometimes I force myself to re-read something over and over again just to make sure I know exactly what it was saying, even though I got the general gist of it five readings ago. I’m still obsessive and particular about my word choice, which, I suppose, helps as a writer. It isn’t as drastic or as life-stopping as before, but it’s always there, just creeping in the back of my head.

There are always those thoughts. I always wonder what I would be like if I didn’t lose two years of my life to OCD. If my entire life didn’t just come to a complete standstill. Would I still be the same person I am today? Was it inevitable? If it didn’t happen when I was 12, would it have hit me sooner or later?

Maybe it was the person I was meant to be all along. What an even scarier thought. How can you even think of mental illness without being fatalistic? That there was nothing I could have done to stop it, nothing I could have done to prevent it. Maybe it was always just lurking in the dark corners of my mind, waiting for the perfect time for something to trigger it, strike, and c̶o̶n̶s̶u̶m̶e̶ d̶e̶v̶o̶u̶r̶ T̶a̶k̶e̶ ̶o̶v̶e̶r̶ T̶a̶k̶e̶ ̶O̶v̶e̶r̶ t̶a̶k̶e̶ ̶O̶v̶e̶r̶ T̶A̶K̶E̶ ̶O̶V̶E̶R̶ take over.

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If you or someone you know has OCD or exhibits obsessive compulsive behavior, don’t be afraid to get help. There are many options available for you to get help, or you contact your doctor. You are not alone.

Original Article: http://www.huffingtonpost.com/dan-truong/living-with-obsessive-compulsive-disorder_b_7925514.html

Related CE Course

Psychological Treatment of Obsessive-Compulsive Disorder: Fundamentals and Beyond is an 8-hour test-only course. This CE test is based on the book “Psychological Treatment of Obsessive-Compulsive Disorder: Fundamentals and Beyond” (2006, 328 pages). The chapters in this practical and insightful guide for helping individuals with this troubling disorder, written by prominent specialists, provide practical, step-by-step descriptions of psychological approaches to treating OCD. After explicating the general, underlying features of the disorder, the contributors to this volume describe evidence-based behavioral and cognitive approaches, such as exposure and ritual prevention and cognitive restructuring. Subsequent chapters discuss how to apply these strategies with particular presentations of OCD, including fears of contamination; doubting and checking; incompleteness concerns; religious, sexual, and aggressive obsessions; and compulsive hoarding. Also included are discussions of more advanced issues, including dealing with treatment resistance and comorbidity and treating OCD in special populations.

Professional Development Resources is approved by the American Psychological Association (APA) to sponsor continuing education for psychologists; by the National Board of Certified Counselors (NBCC) to offer home study continuing education for NCCs (#5590); the Association of Social Work Boards (ASWB #1046, ACE Program); the California Board of Behavioral Sciences (#PCE1625); the Florida Boards of Clinical Social Work, Marriage & Family Therapy, and Mental Health Counseling (#BAP346) and Psychology & School Psychology (#50-1635); the Ohio Counselor, Social Worker & MFT Board (#RCST100501); the South Carolina Board of Professional Counselors & MFTs (#193); and the Texas Board of Examiners of Marriage & Family Therapists (#114) and State Board of Social Worker Examiners (#5678).