If OCD is untreated, it is usually a chronic mental illness. Without treatment, most people do not get better (Skoog and Skoog 1999).
There are effective treatments available which can help people with OCD manage symptoms or even experience a complete recovery.
There are two main treatments for OCD.
- Exposure Response Prevention Therapy
Exposure Response Prevention Therapy (ERP)
ERP is a particular type of Cognitive Behavioural Therapy (CBT) which is used to treat OCD.
Exposure: This part of the treatment requires you to expose yourself to the thoughts, images, objects and situations that make you anxious and/or start your obsessions.
Response: This part of the treatment requires you to make a choice not to do the compulsive behaviour once the anxiety or obsessions have been “triggered.”
All of this is done under the guidance of a therapist at the beginning — though you will eventually learn to do your own ERP exercises to help manage your symptoms.
For instance, the thought may be that you left the stove on. You are asked to expose yourself to that thought by thinking about the thought but not acting on it. You prevent yourself from checking as you usually do.
This strategy of purposefully exposing yourself to things that make you anxious may not sound quite right to you. If you have OCD, you have probably tried to confront your obsessions and anxiety many times only to see your anxiety skyrocket. With ERP, the difference is that when you make the choice to confront your anxiety and obsessions you must also make a commitment to not give in and engage in the compulsive behaviour. When you don’t do the compulsive behaviours, over time you will actually feel a drop in your anxiety level. This natural drop in anxiety that happens when you stay “exposed” and “prevent” the compulsive “response” is called habituation.
The International OCD Foundation explains ERP like this:
Think of your anxiety as an alarm system. If an alarm goes off, what does it mean? The alarm is there to get your attention. If an intruder is trying to break into your house, the alarm goes off, wakes you up, gets you to act. To do something. To protect yourself and your family. But, what if the alarm system went off when a bird landed on the roof instead? Your body would respond to that alarm the same way it would if there were an actual threat such as an intruder.
OCD takes over your body’s alarm system, a system that should be there to protect you. But instead of only warning you of real danger, that alarm system begins to respond to any trigger (no matter how small) as an absolute, terrifying, catastrophic threat.
When your anxiety “goes off” like an alarm system, it communicates information that you are in danger, rather than “pay attention, you might be in danger.”
Unfortunately, with OCD, your brain tells you that you are in danger a lot, even in situations where you “know” that there is a very small likelihood that something bad might happen. This is one of the cruellest parts of this disorder.
Now consider that your compulsive behaviours are your attempts to keep yourself safe when that alarm goes off. But, what does that mean you are telling your brain when you engage in these behaviours? You are reinforcing the brain’s idea that you must be in danger. A bird on the roof is the same as a real intruder breaking into your home.
In other words, your compulsive behaviour fuels that part of your brain that gives out these many unwarranted alarm signals. The bottom line is that in order to reduce your anxiety and your obsessions, you have to make a decision to stop the compulsive behaviours.
However, starting Exposure and Response Prevention therapy can be a difficult decision to make. It may feel like you are choosing to put yourself in danger. It is important to know that Exposure and Response Prevention changes your OCD and changes your brain. You begin to challenge and bring your alarm system (your anxiety) more in line with what is actually happening to you.
ERP deals with an OCD-ridden person’s worst nightmare, facing their anxiety-producing obsessions without engaging in the comfort of tedious compulsions. I spent six days staring my worst thoughts in the face, re-writing narratives over and over and listening to my voice on a tape recorder until my obsessions no longer scared me. It was pure pain, but I’ve never done anything that was so worth it.
Serotonin reuptake inhibitors (SRIs) and selective serotonin reuptake inhibitors (SSRIs) are used to help reduce OCD symptoms.
The following antidepressants have been found to work well for OCD in research studies:
- Fluvoxamine (Luvox®)
- Fluoxetine (Prozac®)
- Sertraline (Zoloft®)
- Paroxetine (Paxil®)
- Citalopram (Celexa®)*
- Clomipramine (Anafranil®)
- Escitalopram (Lexapro®)
- Venlafaxine (Effexor®)
Whenever any of the above drugs have been studied head to head, there seems to be no significant difference in how well they work. However, for any given patient, one drug may be very effective, and the others may not. The only way to tell which drug will be the most helpful with the least side effects is to try each drug for about 3 months. Remember! It is important not to give up after failing one or two drugs. Drugs work very differently for each person.
Most patients will experience one or more side effects from all of the medications listed above.
The patient and doctor must weigh the benefits of the drug against the side effects. It is important for the patient to be open about problems that may be caused by the medication. Sometimes an adjustment in dose or a switch in the time of day it is taken is all that is needed.
ALWAYS be sure to talk to your doctor before making any changes to the way you take your medications!
Although any licensed physician can legally prescribe these drugs, it is probably best to deal directly with a licensed psychiatrist who understands OCD.
- American Psychiatric Association, & American Psychiatric Association. DSM-5 Task Force.(2013). Diagnostic and statistical manual of mental disorders: DSM-5™. Arlington, VA: American Psychiatric Publishing.