I do not have OCD. I just need to work on my middos...
Many people are familiar with the publicized symptoms of OCD (Obsessive Compulsive Disorder). These stereotyped symptoms generally include excessive hand washing and turning lights on and off multiple times. Although this is correct, these are not the only ways that OCD can manifest itself.
Bracha entered into my office reluctantly, stating that she came because she needed to work on her middos. When asked to elaborate, she explained that she was always worried that she was not as popular as her sisters, and that her children will not be as well-liked either. She described these thoughts as bothersome, and difficult to accept. She reported that she found it very difficult to distract herself when these thoughts began, and when she tried to think of a diversion, she became increasingly uncomfortable. She found herself counting all of her friends’ names in her head in order to count how many people "liked" her. If she said a name out of order, she had to start over. In order to deal with these thoughts, she began to learn Pirkei Avos (Ethics of our Fathers), and concluded that she needed to be happy with who she is, as "one who is rich is happy with what he has." She decided to seek treatment when she became increasingly frustrated with her inability to "become a better person." She began to lose sleep because of these thoughts, and food began to lose its appeal. Concentration suffered as these worries became increasingly overwhelming.
After careful questioning and explanations, she was able to understand that this was not indicative of a character flaw. Rather, this was a symptom of a psychiatric condition on the anxiety disorder spectrum. Obsessive Compulsive Disorder consists of obsessions, defined as "unwanted intrusive thoughts," and compulsions, which are "actions performed to ward off the obsessions." These obsessive thoughts could range from the thought to physically hurt somebody, (voiced by a mild mannered, docile older female), to the fear of contamination and germs which was thought to lead to immediate death if a doorknob was touched by the bare hand. These thoughts usually cause great distress to the person, which may further confound the diagnosis, as secondary depression (with the associated symptoms of change in sleep, appetite, energy level, and concentration), may occur.
Compulsions are usually bothersome as well, as the person feels that they cannot control these actions and they do not make sense, yet they cause a significant feeling of discomfort and anxiety when they are not immediately indulged upon. They often are linked directly to the obsession, such as hand washing excessively when the obsession involves germs, but at times they do not correlate directly, such as the need to put on the right sock six times.
Treatment for OCD can consist of both therapy and medication management. Both can be helpful if done properly. The mainstay of medication management consists of using an antidepressant, such as Zoloft, Prozac, Paxil, Celexa or Lexapro. The most efficacious of this category includes the lesser known Luvox and Anafranil. Usually the dosages effective for OCD are higher than utilized for depression or anxiety.
Therapy for OCD is often cognitive-behavioral, which includes exposure and response prevention. The premise of response prevention is exposing the person to the feared stimulus for increasingly longer periods of time, before the compulsion is allowed to be performed. The cognitive portion includes recognizing and dealing with the catastrophic thoughts and/or exaggerated sense of responsibility. Usually this therapy is short-term, and is often very successful. Education regarding the origins of anxiety and OCD is often very beneficial as the stigma and fear can be overwhelming. It is imperative to understand that this is a medical/psychiatric condition that does not reflect on one's character traits and value/worth as a person. Rather, it needs to be treated as one would any medical anomaly, so as to restore, a happy, healthy and productive lifestyle.
Pamela P. Siller, MD is a Board Certified Child, Adolescent and Adult Psychiatrist who provides medication management as well as individual and family therapy to children and adults. She maintains a private practice in Great Neck, New York. Dr. Siller is also an Assistant Professor of Psychiatry at Westchester Medical Center, where she is the Division Chief of the Child and Adolescent Psychiatry Division and is a staff psychiatrist at Interborough's mental health center in Brooklyn.