Obsessive-compulsive disorder (OCD) is a long-lasting psychiatric condition which causes impairment in a person’s overall functioning. OCD was once part of the Anxiety Disorders category within the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) however in the newest edition; DSM-5 OCD has been moved to its own category with other related disorders.
Two characteristics of OCD are:
- Obsessions: unwelcome thoughts/worries, urges, or images that are experienced as intrusive and cause anxiety
- Compulsions: behaviors or mental acts (rituals) that a person feels determined to perform, continually to decrease the anxiety experienced from obsessions
In addition to the presence of obsessions and/or compulsions other key factors of OCD are the amount of time a person is occupied by them and the level of impairment a person experiences.
The behaviors and the amount of difficulties are important to differentiate from a person that is highly organized, fixates over details or is perfectionistic in nature. A person with OCD will exhibit symptoms that are excessive or persistent causing challenges in their everyday routine and impact the quality of their life. This is different than a person who is successful or able to achieve due to their habits. Insight into symptoms varies from person to person.
Children can be impacted by OCD and their symptoms can often continue into adulthood. Children may also have a more difficult time recognizing their symptoms or expressing their troubles. The DSM5 states that females are more impacted than males in adulthood however males are more affected in childhood. Other psychiatric conditions likely may occur along with OCD, most commonly, depression, other anxiety disorders, or tic disorders.
Research shows that Cognitive-Behavioral Therapy (CBT) is the most valid and effective psychological treatment for OCD when symptoms are mild to moderate. CBT is appropriate in conjunction with medication when symptoms are more severe. If left untreated, OCD can significantly impact overall abilities to function easily. OCD cannot be cured however treatment is helpful.
Features for the treatment of OCD include:
- Psycho-education about the disorder provided by the clinician at the start of treatment.
- Exposure and response prevention using a gradual approach (hierarchy) to help a person face their fears and hold back from engaging in a behavior that typically lowers their anxiety (ritual or compulsion). A person learns to get used to the anxious feeling or the feeling is eliminated altogether (called habituation). Exposure exercises occur in and outside of sessions.
- With children incentive programs are useful to increase their motivation, preserve enthusiasm to engage in treatment and reward behaviors when completing exposures.
- Cognitive restructuring is taught to a person to help with changing their faulty thinking related to obsessions and increase useful self-talk.
- Parent training and family participation is important to recognize and reduce accepting or enabling OCD behaviors. Frequently, family members or parents help with behaviors (i.e., make changes in routines or participate in the behavior) in order to provide relief to their loved one.
- Relapse prevention is useful to help plan for bumps in the road after treatment ends. Symptoms may resurface which some people may interpret as a setback. Relapse preventions is to increase awareness for signs of relapse, organize a response and address the concerns before treatment has ended.
Lastly, booster sessions with the clinician, is a positive practice to help if OCD symptoms resurface. Booster sessions assist with reviewing skills and address any issues that arise.
American Psychiatric Association: Diagnostic and statistical manual of mental disorders. 5th Edition. Arlington: American Psychiatric Publishing; 2013.
Freeman,J., Garcia, A., Frank,H.., Benito, K., Conelea,C., Walther,M., & Edmonds (2014). Evidence Base Update for Psychosocial Treatments for Pediatric Obsessive-Compulsive Disorder. Journal of Clinical Child & Adolescent Psychology, 43:1, 7-26.
Mancuso,E., Faro,A., Joshi, G., & Geller, D. (2010). Treatment of Pediatric Obsessive-Compulsive Disorder: A Review. Journal of Child and Adolescent Psychopharmacology, 20, 299-309.
Wagner, A. (2003). Cognitive- Behavioral Therapy for Children and Adolescents with Obsessive-Compulsive Disorder. Brief Treatment and Crisis Intervention; 3:3, 291-306.
Written by Joshua Rosenthal, PsyD