Obsessive compulsive disorder

What is obsessive compulsive disorder?

Obsessive compulsive disorder (OCD) is characterised by obsessions, i.e. intrusive, unwanted and repetitive images/thoughts/impulses that generate anxiety, and by compulsions as mental behaviours/actions/avoidances that are carried out in order to reduce and neutralise the anxiety experienced.

OCD is characterised by a vicious circle whereby symptoms normally intensify with time. In fact, if at the beginning one benefits from performing the compulsions because the discomfort caused by the obsessions is reduced. In the long run, performing these behaviours reinforces and worsens the disorder and, although the sufferer is able to recognise its irrationality, he is unable to resist it.

While the specific thoughts and behaviours of OCD may vary from individual to individual, this circular process is identical for everyone.

Symptoms of obsessive compulsive disorder

Some common symptom dimensions can be distinguished:

• CLEANING: fear of contamination. Generates, usually, compulsions of frequent hand-washing.
• CHECK: repeated checks on objects (oven switched off, locked doors) considered potential sources of danger.
• SCETTICI OR PECCATORS: fear that if everything is not perfect or done in a certain way, something terrible might happen to them or their loved ones.
• CALCULATION: obsession with order and symmetry, superstitions in relation to certain numbers-colours-positions.
• COLLECTION: compulsive accumulation and storage of unnecessary objects.

Just because one has obsessive thoughts or engages in ritual behaviour does not mean that one has OCD. Many people have minor obsessions or compulsions but are able to cope with life without major problems.

Those suffering from obsessive compulsive disorder are subjected to tremendous stress, which can significantly interfere with daily life routines, work and social relationships.

 

 

How can we help you?

Numerous studies, as attested by the American Psychological Association, have definitively confirmed that cognitive behavioural therapy (CCT), with or without medication, is the most effective in the treatment of obsessive compulsive disorder.

This form of psychotherapy involves two types of intervention in the treatment of OCD: behavioural and cognitive.

The behavioural technique of choice used is theexposure with response prevention (ERP), in which the patient, together with the therapist, repeatedly and gradually exposes himself or herself to obsessive thoughts, learning that anxiety is reduced spontaneously, through habituation, even without emitting the compulsive ritual. The prevention of the response implies the suspension or postponement of the compulsive behaviour.

The patient is, therefore, taught how to tolerate and manage the anxiogenic response generated by the obsessions so as to resist performing the compulsive behaviours and break the OCD vicious circle.

Cognitive intervention, on the other hand, focuses on dysfunctional thoughts, the exaggerated sense of responsibility, the overestimation of danger, the inability to accept risk and tolerate uncertainty.

Therefore, the patient is taught to:

• REDEFINE: recognising the obsessive compulsive thoughts, images and impulses resulting from OCD.
• REACT: realising that the intensity and intrusiveness of the thought/impulse/image is caused by OCD and is linked to a brain biochemical imbalance.
• REFOCUS: get around obsessive thoughts by focusing attention on something else at least for a few minutes by doing something else.
• REVIEW: consider that obsessive thinking has no meaning in itself and recognise that it has no meaning or value.

Cognitive behavioural psychotherapy can also be combined with other forms of treatment, such as:

DRUG THERAPY: The most commonly used drugs in the treatment of the disorder are antidepressants and selective serotonin reuptake inhibitors. A percentage of OCD patients, however, do not respond or responds incompletely to drug treatment. Medications, therefore, can be helpful but are not in themselves sufficient to alleviate the symptoms of OCD and, as recommended, should always be accompanied by cognitive-behavioural psychotherapy.

FAMILY THERAPY: OCD is often the cause of problems in family life, breaking the balance and hindering family functioning. For this reason, it is often suggested to opt for family therapy in order to foster understanding of the disorder and reduce intra-family conflicts.

GROUP THERAPY: interaction between different OCD sufferers reduces the feeling of isolation, provides support and encouragement.