Thursday, February 21, 2008

Psych 101: OCD

Obsessive-Compulsive Disorder causes a lot of discomfort for people. In the DSM-IV obsessions are described as "persistent ideas, thoughts, impulses, or images that are experienced as intrusive and inappropriate and that cause marked anxiety and distress." The person experiences these obsessions as being not under their control, though is aware that they have created them (not like "hearing" voices). Common obsessions are about being contaminated by germs, repeated doubts (for example, having left a door unlocked), a need to have things in a particular order (people refer to a milder form of this as being "anal"), aggressive impulses (eg. hurting someone), and disturbing sexual images. People suffering from OCD try to neutralize the persistent thoughts with compulsive behaviors. For example, the concern about germs may trigger compulsive hand washing. "Compulsions are repetitive behaviors or mental acts (e.g. praying, counting, repeating words silently) the goal of which is to prevent or reduce anxiety or distress." These compulsions feel like things that you HAVE to do. Go back and check the door over and over to make sure it's locked before you can go out; or checking the stove repeatedly long after you should be in bed because you're obsessing about the house burning down; or spending hours washing your hands (obsessing about germs); being in a meeting and counting the ceiling tiles (or the dots on the speaker's tie).



There are a lot of theories about how we get OCD. I don't think people are born with it. They may be prone to it (ie. the "in-the-genes" theory), but mostly people learn it. We're effected by the influences of the care taking people close to us as children, as well as by traumatizing events. And we typically get a lot of practice with the thinking and behavior patterns. I've discussed my theory about habits before (see my blog posting of 9/14/07, on Anger Management).


To treat people with OCD is interesting for me, and enjoyable to see the client's progress, to see the reduction in suffering. It requires a lot of work. My primary goal is to teach the person to interrupt the chain of events (including thoughts and feelings) that trigger the obsessions and/or compulsions, and retrain the part of the brain that's responsible to respond differently. Dr. Jeffery Schwartz and Sharon Begley in The Mind and The Brain: Neuroplasticity and the Power of Mental Force, explain the "plasticity" (changeability) of the brain. I train the client in self-hypnosis, in order for them to learn to replace the anxiety with relaxation. And a lot of practice, first in their head (imagining the situations), then "in vivo" (in real life). We also discuss the early childhood family dynamics that helped lay the foundation for developing this illness . So there are definitely solutions to the conditions of our lives that distress us. It is up to you to find those answers, and with it (hopefully) the happiness that you deserve.


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