Obsessive Compulsive Disorder (OCD)
Obsessive-compulsive disorder (OCD) is characterized by two hallmark features: obsessions and compulsions. Those living with OCD have recurring, intrusive thoughts (obsessions) that trigger distressing feelings such as anxiety, and are often accompanied by a strong urge/ drive to do something repetitively in response to the compulsion.
Interested in group therapy? Try WeOCD
We offer a monthly group therapy for those with OCD. This group of like minded individuals come together to share their experiencing and learn from each other.
The compulsions are intended to relieve the distressing feeling but unfortunately any relief is very temporary and ensures the person continues to engage in compulsions as their primary strategy to relieve anxiety, hence forming “the cycle” of obsessions and compulsions that those living with the disorder can become ‘stuck’ in.
OCD shows up very differently from person to person, the ranges of fears and variations in rituals are limited only by the human mind. Despite these differences, there is often one major feature shared, the fear of uncertainty.
Most people have some obsessive thoughts and/or compulsive behavior tendencies, however this does not necessarily mean they have OCD. You may hear others make use of OCD as an adjective “I’m so OCD right now” (cringe).
For a formal diagnosis of obsessive compulsive disorder to be made, this cycle of obsessions and compulsions becomes so extreme that it consumes a lot of time and gets in the way of important activities that the person values. The diagnosis must be given by a qualified professional such as your family doctor, a psychologist, psychiatrist, or Nurse Practitioner.
Common Obsessions in OCD
OCD has a knack for “hitting you where it hurts” and creating fear and doubt about important aspects of your life. The particular content varies from person to person and this list is not exhaustive, but here are some examples of the “themes” of obsessions that often (but not always) show up for people:
Responsibility for harm or mistakes
Contamination
Order & Symmetry
Violence & Aggression
Sex
Religious & Morality (scrupulosity)
Somatic ( physical illness, disease, or an aspect of your appearance)
Miscellaneous
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OCD does not discriminate, it equally affects all genders, races, ethnicities and backgrounds. OCD is estimated to affect approximately 1% of the population.
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While the exact cause remains unknown, research suggests that there is both a neurological and biological component to OCD. There is much to be learnt about this complex disorder, however another important component to the development and maintenance of OCD is found within learning theory.
Learned responses can be very powerful and difficult to change, particularly when they are fueled by intense anxiety. These components have important implications to the treatment of this disorder.
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Most people have some obsessive thoughts and/or compulsive behavior tendencies, however this does not necessarily mean they have OCD. The word ‘obsession’ is often used quite casually in everyday conversation and can result in a minimization towards what this word means in terms of the disorder. In fact, being ‘obsessed’ with something in everyday terms is often equated to liking or being very interested in the thing you are describing. This can help us understand why you may even hear others using this diagnosis as an adjective, “I’m so OCD about…”. Although those statements often make those of us living with or treating the disorder cringe, more often than not it’s a lack of information and not meant to minimize the experience of those living with this incredibly impactful disorder.
For a formal diagnosis of obsessive compulsive disorder to be made, the cycle of obsessions and compulsions becomes so extreme that it consumes a lot of time and gets in the way of important activities that the person values. The diagnosis must be given by a qualified professional such as your family doctor, a psychologist, psychiatrist, or Nurse Practitioner.
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OCD is commonly treated through behavioural therapy (Exposure and Response Prevention) and/or a class of medications called SSRI (Select Serotonin Reuptake Inhibitors) medications. As mentioned before in the what causes OCD section, it is important to consider both the biological and learned aspects of the disorder in order for treatment to be successful.
Everyone’s treatment journey is unique. While some people are able to treat OCD purely from therapy, others will benefit from starting medications in order to be able to participate effectively in therapy. It is estimated that about 70% of people will benefit from ERP and/or medication for their OCD.
Common Compulsion in OCD
Despite the differences in how rituals look for individuals, their main purpose is to make the person feel safe, certain, and in control. Most compulsive rituals generally fall into the following categories, however this list is simply an attempt to summarize common themes and it too is not exhaustive..:
Reassurance Seeking (asking others, google)
Mental Rituals
Checking
Decontamination
Repeating
Ordering, Arranging & Counting
Monitoring Outcomes
Alongside therapy, we use symptom monitoring tools designed to ensure therapy is heading in the right direction. The Y-BOCS, a 10-item scale, has become the most widely used rating scale for OCD. The Y-BOCS is designed to rate symptom severity, not to establish a diagnosis.
We will complete the Y-BOCS symptoms checklist at your first appointment and review it together to establish a starting point. We will repeat this scale several times throughout treatment to monitor your symptoms and how they are responding to the treatment.
Medications may be a helpful part of your treatment, we will encourage you to connect with your family physician or psychiatrist to have this conversation as we do not prescribe medication here at Lotus.
ERP Basics
Exposure and Response Prevention (ERP) has the strongest evidence supporting its use in the treatment of OCD. Generally, clients will attend sessions 1-2 times per week and begin building up an independent home practice. Sometimes we extend sessions to 90 minutes during exposure practice. Overtime, we gradually reduce the frequency of in session practice and encourage you to take the new learning into everyday life.
The ‘exposure’ in ERP is quite literal, meaning over time you will purposefully be exposing yourself to the thoughts, objects, and situations that make you feel anxious. The ‘response prevention’ entails making changes, reducing or ideally eliminating the compulsive behaviour you do in response to the anxiety trigger (exposure). Doing this in a therapeutic manner will allow for the process of habituation (which is a fancy way of saying 'getting used to') to take place. This may sound terrifying or even hard to believe. You have likely worked very hard to avoid the things that make you anxious and trigger the OCD cycle, in fact you may notice a strong urge to close this website right now but please, stay with me here so I can illustrate this process through an example.
Imagine watching the scariest movie you have ever seen and because it’s very important for you to be able to watch this movie without feeling so scared, you agreed that you would watch it 3 times a day, every day, for at least two weeks (so 42 times).
What do you predict will happen each time you watch?
Do you think your fear will be different the 3rd time .vs. the 20th time?
What new things might eventually happen as you re-watch the movie?
You may be starting to pick up what I’m putting down, which is that over time, and with frequent exposure, something that is really scary can become less distressing the more you do it.
Managing OCD
Unfortunately there is no cure for OCD and so the importance of developing long term management skills is a very important aspect to treatment. This therapy aims to help you identify when OCD is 'calling the shots' and unveil connections that you may or may not have noticed before so you can recognize them if they show up again in a different context in the future. Simply put - by eliminating behaviours that 'OCD' (not you) designed to keep you safe, you are able to test their value and make choices based on your values instead of being bossed around.
We are thrilled to offer ‘WeOCD’, a therapeutic support group open to clients who are completing or have completed ERP. This group is designed to augment therapy, offer supportive connections to others living with the disorder and become a source of ongoing support after treatment.
