Obsessive-compulsive disorder is a complex and destructive mental condition centered around repeated and unavoidable encounters with anxiety-inducing obsessions, followed by the need to soothe these anxieties through specific compulsions. OCD can range from mild to severe, with debilitating symptoms potentially leaving a person disabled and incapable of functioning alone. Obsessions can range from specific fears and paranoia to some form of discomfort experienced when confronted with a certain trigger. Compulsions range from simple repeated behavior to complex rituals.
Treating such a disorder requires understanding how it was triggered to begin with, and then testing a patient’s response to different treatment methods. While OCD presents with unique symptoms and a clear connection between obsessive anxieties and soothing-yet-dysfunctional compulsions, a diagnosis must still be met with caution and after much deliberation. Some of the symptoms present in OCD can also be present in obsessive-compulsive personality disorder, schizophrenia, and certain other anxiety disorders.
However, treatment for OCD does exist. While we have not identified an effective cure for the condition, there are various techniques and medications that have proven largely effective in reducing symptoms, and even sending some aspects of the disorder into a total remission. Once a patient is successfully diagnosed with OCD, treatment begins immediately.
Treatment Programs & Partial Hospitalization
Treatment programs for OCD exist, typically consisting of a set number of weeks spent helping a patient with their given diagnosis, with treatments set up according to a patient’s needs.
Treatment frequency depends on the nature of the program, as different clinics offer outpatient programs (wherein a patient visits the treatment center regularly for scheduled treatment), inpatient/residential treatment (wherein patients live within the facility, often helpful for more severe forms of OCD), and day programs/partial hospitalization (more intensive outpatient programming, wherein a patient still lives at home, but attends treatment sessions daily, often spending six to eight hours at the center/hospital).
A form of cognitive behavioral therapy (CBT) used to help a person deal with severe anxieties related to their obsessions without the use of compulsions or more explicit triggers (often used in exposure therapy), imaginal therapy may involve the use of audio cues, narration, and discussion to help a patient picture a distressing situation or scene rather than physically enduring said scene, or viewing it through a picture.
Imaginal therapy is sometimes the first step to complete exposure and response therapy and utilizes the same basic structure as CBT wherein a patient is taught to identify erroneous thinking and tackle it on their basis through a slow and steady approach. Much like exposure therapy, imaginal therapy is about helping a patient slowing bring approach an uncomfortable place mentally, without triggering their anxieties.
Exposure therapy is not as extreme or mentally invasive as it might sound, and it is never a specialist’s intention to explicitly place their client under distress during exposure therapy. Neither is a patient ever asked to do something they do not want to do. Like any therapy, exposure and response therapy (ERT) is completely voluntary, and a patient can stop the process the second they feel they need to.
The basics of exposure therapy rely on helping a patient understand that, even in the face of their compulsions, they can learn to rely on healthier coping mechanisms, and not their unnatural and potentially destructive obsessions. In more severe forms of OCD, this kind of behavioral therapy is accompanied by medication, lifestyle changes, as well as other potential treatments, but in milder forms of OCD it can help a patient take charge over their condition and learn to successfully overcome their anxieties without the use of these compulsions.
Exposure therapy is a step-by-step process and can be highly effective for various anxiety disorders. The exposure starts at a very low level, and gradually progresses as a patient begins to become more comfortable with the previous level. For example, in patients with OCD who are germophobic, one way to help them would be to help them overcome their fear of coming in contact with the door handle to their office, without wearing gloves or immediately washing their hand.
For the treatment of OCD, doctors often first prescribe antidepressants. These seem to be the most effective overall yet come in a wide variety of different forms and shapes. Antidepressants all target the brain in the same way – reducing the reuptake of certain neurotransmitters involved in the development of depression – yet individuals react to them differently, making some drugs more effective for a given patient than others.
Most first line antidepressants are selective serotonin reuptake inhibitors (SSRIs). These have the least number of side effects, and a relatively high rate of success. If they fail, a doctor may prescribe other medication, eventually moving on towards alternative treatments if several different drugs elicit no positive response.
Invasive Brain Stimulation
Neuro modulation, brain stimulation, and neurotherapy – there are several different names for these procedures, but they are largely the same thing in concept. You take a small device that emits a very faint electric pulse, and you surgically implant that device near the brain or near a major nerve. The pulses will change the way your brain cells work, either by affecting neurotransmission and neuroendocrinology, or by affecting neural ‘pathways’ or ‘networks’ – these are cell clusters that communicate to facilitate certain thoughts and functions in the mind, and several of them have been identified to specifically improve symptoms of OCD.
These procedures are increasingly effective, especially as the technology improves, but they don’t come without their fair share of risk. Surgery is always risky, and aside from the chance of a complication during the procedure, there is also the risk of infection later on in the post-op phase. Nevertheless, invasive brain stimulation is not the only kind of effective neuromodulation for OCD.
Transcranial Magnetic Stimulation
Recently approved by the FDA for OCD treatment, transcranial magnetic stimulation (TMS) is a completely painless and non-invasive treatment used to affect the brain and reduce symptoms of OCD, particularly in patients who don’t react to psychotherapy (CBT, ERT, etc.) or medication.
Rather than sending pulses to certain parts of the brain throughout the day, TMS is a treatment that involves roughly five to six treatment sessions per week, at about 20-40 minutes per session. Each session consists of a non-invasive application of magnetic pulses, which target portions of the brain related to a patient’s OCD. Commonly targeted areas include the dorsolateral prefrontal cortex, the orbitofrontal cortex, and the pre-supplementary motor area. TMS has also been applied to affect the limbic system of the brain.
TMS has proven quite effective in patients with ‘treatment resistant’ OCD and carries much less risk than many other more invasive alternatives. Protocols are still being studied that may drastically reduce treatment time down to less than ten minutes per session, and new breakthroughs may yet occur.