Obsessive Compulsive Disorder (OCD)
OCD is an anxiety disorder that can be extremely interfering in one’s life. Due to many subtypes of obsessions and compulsions, it can commonly be misdiagnosed as another type of anxiety and requires thorough assessment by a trained clinician. If you are experiencing any of the following obsessions or compulsions, further evaluation could be very useful.
Obsessions: unwanted thoughts, images, or urges. Obsessions cause significant distress and have consequences that the person fears (Ex: an obsessing over an illness and the fear is dying).
What are common obsessions: contamination, harm to self/others, rethinking the meaning of a thought or behavior, worry about forgetting, loss of a person or possession, misunderstanding or being misunderstood, experiencing anxiety, imperfection, attention to thoughts or body.
Compulsions: behaviors that are developed to decrease or neutralize the anxiety caused by obsessions. They may or may not be directly related to the obsession. Compulsions maintain the anxiety by creating short-term relief but the anxiety gets stronger in the long-term as the compulsions and avoidance continue. (Ex: a compulsion of hand washing to reduce both the obsession of an illness and the overall fear of dying). Compulsions take up a great deal of time and interfere in other activities and ways of functioning.
What are common compulsions: decontamination (hand washing, disinfecting), checking (doors, stove), perfectionistic (having symmetry, order), counting, touching, mental (rethinking, memorizing, repeating), body focused checking or grooming, hoarding.
Treatments OCD: The treatment that works for OCD is a type of Cognitive Behavior Therapy (CBT) called Exposure and Relapse Prevention (ERP).
How does Exposure and Response Prevention work: The exposure part of ERP involves gradually approaching specific thoughts, images, situations, and objects that are linked to obsessions (i.e., sitting with dirty hands when the obsessive thought is related to contamination).
The response prevention part of ERP is learning to avoid the compulsion that generally relieves the anxiety or discomfort (i.e., do not wash dirty hands in response to the contamination worry and instead tolerate the emotions while having dirty hands).
Effective OCD treatment uses both exposure and response prevention. The goal of exposure therapy in OCD is to disconfirm previous fears, create new learning that the feared situation is relatively safe, and anxiety is tolerable.
How to treat severe OCD?: The treatment approach is the same for severity of symptoms, as well as the type of OCD. A combination of medications and treatment can be more effective for more severe cases.
Body Dysmorphic Disorder (BDD)
BDD is considered an Obsessive Compulsive spectrum disorder, as there are both obsessions and compulsions present. The obsessions in BDD are unwanted, and persistent and the compulsions reduce the anxiety from obsessions (only in the short-term) -just the same as in OCD.
Obsessions in BDD: The obsessions in BDD are more specifically related to the body (often obsessed about one’s perceived or actual flaws). People with BDD have been found to have more attention to detail and overly focus on details of the body, especially facial features.
Compulsions in BDD: The compulsions in BDD are frequently related to mirrors (avoiding mirrors and/or repeatedly checking mirrors, binocular like focus at an identified flaw when looking in the mirror). Other compulsions in BDD can include covering up the flaws or one’s body in general, attempting to appear more muscular, rituals with clothing (avoiding, frequently changing) and assurance seeking related to appearance. Panic attacks related to the body can also occur, and common times are during showers or in front of mirrors. Symptoms interfere in social and emotional functioning – often in the form of avoiding or withdrawing.
What is the difference between OCD and BDD: Though the disorders and the treatments are very similar, there are also differences. People with BDD can experience increased concerns in the following areas: self-esteem, depression, and suicidality.
Treatment for BDD: Cognitive Behavior Therapy (CBT) is the main treatment for BDD. Mindfulness, self-compassion, and Behavior Activation strategies are helpful along side CBT to reduce overall depression, anxiety, and low self-esteem that is often co-occurring with BPD.
CBT for BDD includes:
- ERP (facing fears while at the same time refraining from rituals – i.e., going to a social gathering and avoiding repeated mirror checking, going into a store without disguising a part of the body that brings distress, over time developing an average relationship with mirrors).
- Increase effective thinking (challenge distorted thoughts, increase mindfulness to thoughts, and participate in behavior experiments to confirm or disconfirm body image beliefs).
- Increase attentional control (learn non-judgmental and more holistic attention to oneself instead of narrow attention only on the flaw).
Panic attack physical symptoms: A panic attack is an experience of intense fear and abrupt, short lasting changes in body symptoms. This may include any of the following: feeling short of breath, increased heart rate, sweating, and an urge to flee the situation you are in. Many can end up in the hospital believing they have a medical condition (such as a heart attack) but are actually experiencing panic. One can experience either a full blown panic attack or a limited symptom attack with less symptoms than a full attack.
Recurrent panic attacks can become panic disorder. Panic disorder can lead to Agoraphobia, especially when untreated for a duration of time. Agoraphobia includes either extreme dread or complete avoidance of situations that an escape is either difficult or unavailable (going in public, stores, crowds, using public transportation).
How to treat Panic Disorder: Exposure therapy is the most evidence-based therapy for panic. This includes facing situations that cause anxiety and panic as a way to regulate the anxiety. Breathing and thinking skills are taught to use during and after exposure situations. The goal is new learning that the situations can be tolerated.
What does it mean to be perfectionistic: Having high standards can be very healthy. It is important to distinguish between effective goal setting with high standards and perfectionism. A perfectionist sets unrealistic goals across areas of their life and commonly has extreme reactions to their perceived or actual failures (low sense of worth, judgments and self-criticisms, either avoiding or relentlessly persisting behaviors).
Treatment for Perfectionism: There can be a variety of approaches to reduce perfectionism. Cognitive Behavior Therapy teaches people how to practice high achieving or less than perfect behaviors, to challenge critical thinking, and to increase tolerance to imperfection.
Self-compassion therapy teaches mindfulness to reduce critical thinking and to offer oneself curious, kind, gentle, and accepting responses. It guides one in setting realistic expectations and self-validation. Reducing perfectionism does not mean eliminating goals or standards.
More Anxiety Disorders
General Anxiety Disorder (GAD) includes persistent and unrealistic worry about the unknown (future, school, work, money, and others). The worry can interfere in sleep, concentration, relationships, and life. Anxiety effects people physically with body tension and behaviorally with either avoiding situations or extra cautious behaviors when in situations.
Social Anxiety Disorder (SAD) includes worry specifically related to being around others. There may be extreme fears of embarrassment or humiliation around others and often avoidant behavior in social situations (avoiding eye contact, hanging back, worrying about perceptions of others).
Specific Phobias are fears that are persistent and/or the fear disrupts the person’s life. Common types of phobias can be dogs, spiders, blood, heights, small rooms or spaces.
The treatment for GAD, SAD, and Phobias is Cognitive Behavior Therapy (CBT). It is essential to combat anxiety with skills to regulate one’s body into a more relaxed and calm baseline and to challenge anxious thoughts. It is also important to stop avoiding and to approach anxious situations. Behavior Activation Therapy and Exposure Therapy are used to face fears and decrease anxiety.