OCD Treatment: Understanding Symptoms, Stigma, and Therapy Options
Obsessive Compulsive Disorder, or OCD, is a mental health condition that has received increasing attention on social media, often portrayed as a disorder marked by being a “clean freak” or someone who cares excessively about organization and tidiness. While OCD can include symptoms related to cleanliness and symmetry, it often presents in many other ways that individuals with OCD may not openly discuss due to shame and misunderstanding.
The truth about OCD is that it can be an incredibly debilitating mental health disorder, often interfering with even the simplest daily tasks and significantly impacting quality of life.
However, the good news is that OCD is highly treatable, and remission of symptoms is possible with the right support and evidence-based therapy.
What does OCD Actually Look Like?
Before diving into one of the most misunderstood components of OCD, it’s important to understand what the disorder actually looks like on a day-to-day basis. OCD symptoms are generally made up of two core parts: intrusive thoughts and compulsions.
An intrusive thought is any unwanted thought, image, or urge that involuntarily pops into your mind. These thoughts are different from regular thinking or ego-syntonic thoughts (thoughts aligned with your morals and values) because they are ego-dystonic, meaning they go against a person’s inner beliefs and values.
For example, someone might randomly have an intrusive thought about jumping in front of a subway train and immediately feel intense anxiety. Why? Because they value their life and have no desire for it to end, yet the thought appears anyway, unwanted and distressing. This is a common example of OCD intrusive thoughts.
The other major component of OCD is compulsions, which are behaviors or mental actions used to reduce or neutralize the anxiety caused by intrusive thoughts. In OCD, these compulsions are often used as a way to temporarily relieve distress, even though they can reinforce the cycle of anxiety over time. In the same example, the person might respond by trying not to look at the train, distracting themselves with other thoughts, or even avoiding the subway altogether as a way to manage OCD-related anxiety.
The functional relationship between an intrusive thought and a compulsion is that the compulsion is used to temporarily neutralize the anxiety caused by an intrusive thought. However, in OCD, this relief is often short-lived. The tricky part of this relationship is that relying on compulsions can actually make the anxiety worse over time and strengthen the OCD cycle.
OCD is often paradoxical in this way: the more a person tries to avoid or suppress intrusive thoughts, the more intense and persistent they can become. This is a key part of the OCD anxiety cycle, where attempts to control thoughts end up reinforcing them instead.
Understanding Intrusive Thoughts and OCD Themes
When we talk about intrusive thoughts, it’s important to understand that they can show up in a variety of ways, often referred to as OCD themes. These themes have been widely identified among people with OCD and can vary greatly from person to person. This is where OCD stigma often comes in.
Because intrusive thoughts are ego-dystonic, they can cause significant distress, anxiety, shame, guilt, and sadness. Some common OCD intrusive thought themes include thoughts of harming oneself or others, thoughts related to sexual violence, doubts about sexual identity, fears of contamination or illness, and fears of punishment by God, among many other difficult or taboo topics.
Why OCD Stigma Keeps People from Getting Help
When someone with OCD experiences an intrusive thought that feels completely out of character, it can be very difficult to share it with others, especially if the thought involves something socially sensitive or misunderstood. As a result, many people with OCD hide their symptoms, avoid seeking treatment, or go undiagnosed for years.
Additionally, individuals without OCD may sometimes misunderstand intrusive thoughts, assuming they are ego-syntonic rather than ego-dystonic. This misunderstanding can lead to stigma, judgment, or shame directed toward those experiencing OCD symptoms.
In thinking about OCD, it’s important to remember that individuals with OCD do not want to think about the content their intrusive thoughts brings up for them, which is part of what makes the disorder so distressing and debilitating.
OCD often targets what a person cares about most, such as their life, family, friends, faith, identity, values, and morals. Because of this, OCD symptoms can feel deeply personal and overwhelming. Individuals with OCD often spend a significant amount of time and mental energy trying to get rid of these intrusive thoughts or prevent them from coming back in order to feel a sense of peace. However, this effort to control or suppress thoughts is often what keeps the OCD cycle going.
The Best Evidence-Based Therapies for OCD (ERP and ACT)
Though OCD is often misunderstood and can be incredibly difficult to deal with, it does not mean that healing is impossible. In fact, with the right approach to therapy, individuals with OCD can go on to live fulfilling and meaningful lives. Current research shows that Exposure and Response Prevention (ERP) is considered the gold standard treatment for OCD.
ERP therapy involves gradually exposing a person to feared thoughts, images, or situations while preventing the use of compulsions. Over time, this helps reduce the fear response associated with OCD intrusive thoughts and breaks the cycle of compulsions.
Another commonly used treatment is Acceptance and Commitment Therapy (ACT), which helps individuals with OCD learn to accept the presence of intrusive thoughts without engaging with their content. Instead of trying to eliminate thoughts, ACT focuses on building a life based on personal values rather than fear and avoidance.
It can also be extremely helpful to work with a clinician who has specific training and experience in treating OCD. General talk therapy, while helpful for many conditions, can sometimes unintentionally reinforce OCD patterns if it does not address compulsions directly.
Finding an OCD Specialist in NYC
At our Chelsea, NYC practice, Vida Sana Psychology & Wellness, we have an intimate understanding of what it means to live with OCD and the unique challenges it can present. Our clinical team regularly works with individuals experiencing OCD to help them move toward a life based on their own values, rather than fear and compulsions.
OCD is highly treatable, and symptoms can significantly improve with the right support. Wherever you seek treatment, it’s important to work with a clinician who understands the paradoxical nature of OCD and uses evidence-based approaches.
