Obsessive Compulsive Disorder (OCD)
About OCD
What is OCD?
Obsessive Compulsive Disorder (OCD) is a psychiatric disorder characterized by the persistent presence of unwanted thoughts, images, or urges, known as obsessions, and/or repetitive behaviors, referred to as compulsions, which can severely interfere with daily life activities.
People living with OCD often experience considerable emotional distress and challenges in their day to day lives.
Symptoms of OCD usually emerge gradually during adolescence or young adulthood. Unfortunately, OCD often goes unrecognized for many years in adults. It is not uncommon for diagnosis to be delayed for a decade or longer!
How common is OCD?
If you are living with OCD, you are not alone.
OCD is a common mental health condition that impacts about one in forty adults. That means that over 8 million adults in the United States are estimated to struggle with OCD during their lifetime.
How is OCD Diagnosed?
OCD must be diagnosed by a mental health professional, such as a psychiatrist or a psychologist. The diagnosis is a clinical one, meaning that there is no blood test or imaging that can determine if someone has OCD. The diagnostic process for OCD usually involves a comprehensive psychiatric evaluation as well as the use of specific instruments and scales.
How is OCD Treated?
The good news: there are multiple effective, evidence-based treatment options available for OCD. Specialized forms of therapy, such as Exposure Response Prevention, or “ERP”, can help to break the cycle of obsessive thoughts and compulsive behaviors. Prescription medications are also available, and are frequently prescribed in combination with therapy.
Obsessions
Unwanted, persistent and intrusive thoughts, urges, or images which repeatedly enter one’s mind
Obsessions create anxiety and distress
Obsessions may lead to attempts to ignore or neutralize with another thought or action (i.e., performing a compulsion), which may temporarily relieve the anxiety and distress.
Common Obsessions
Fear of contamination/germs/dirt
Fear of harming yourself or others
Fear of losing control
Need for order/ “just right”
Difficulty with uncertainty
Unpleasant aggressive, sexual, or religious thoughts
Compulsions
Repetitive behaviors (i.e., hand washing, ordering, checking)
Mental acts (i.e., counting, repeating words silently, praying)
One may feel driven to perform the mental acts and repetitive behaviors in an attempt to prevent or reduce the anxiety and distress associated with an obsession
Mental acts and repetitive behaviors are not connected in a realistic way with that which they are designed to prevent. They may be clearly excessive.
Common Compulsions
Excessive handwashing and cleaning
Excessive counting, checking, or ordering
Excessive reassurance seeking
Thinking “neutralizing” thoughts
Strict, rigid routines
The Cycle of OCD
How does the Cycle of OCD work?
Obsessions involve intrusive, unwanted thoughts, images, or urges. They often bring up feelings of distress and anxiety. We may seek to relieve these negative feelings by performing a compulsion. The compulsion may provide some temporary relief from anxiety and distress, but this reprieve is short-lived, and with time, the obsessions return.
When we engage in compulsions, we train our brains to believe that the obsession and its associated discomfort are dangerous, intolerable, and must be dealt with immediately. This strengthens the connection and reinforces the need to engage in the compulsion the next time that the obsession arises, ultimately perpetuating the vicious cycle.
How do we break the Cycle of OCD?
Exposure and Response Prevention, also known as “ERP”, is a specialized form of therapy used to treat OCD. ERP involves facing the obsessions and their associated distress head-on, resisting the urge to engage in compulsions to alleviate feelings of anxiety.
ERP helps to teach our brains that with time, our anxiety will subside on its own, and that the feared outcomes associated with the obsession are unlikely to occur. It can help us to learn to tolerate uncertainty. ERP is conducted by a trained mental health professional, such as a psychologist.
Medications for OCD
There are many different medication options available for the treatment of Obsessive Compulsive Disorder. A discussion with a board-certified psychiatrist can help you to determine whether medications may be an option for you and your personal health circumstances.
The following information is provided for educational purposes only. It is not intended to substitute for professional medical advice. Always reach out to your doctor with questions about your health.
Selective Serotonin Reuptake Inhibitors (SSRIs)
What is an SSRI?
SSRIs are a category of medications that are often used as a first-line medication option in the treatment of OCD. They are also frequently used in depression and anxiety- you may hear them referred to as “antidepressants” (although not all antidepressants are SSRIs!).
SSRIs often come in an oral tablet form, and are available in the United States by prescription only. This means that they cannot be purchased over the counter, and should only be taken under the careful supervision of a physician. Psychiatrists are medical doctors who specialize in the treatment of mental health conditions, with extensive expertise in working with these types of medications.
How do SSRIs work?
SSRIs get their name from their mechanism of action- in other words, how they work. SSRIs selectively inhibit the reuptake of serotonin. But what does that mean, exactly? Let’s break it down.
Serotonin is a neurotransmitter- you can think of it as a chemical messenger in your brain. Serotonin plays many roles, and is involved in mood, emotion, and sleep.
These chemical messengers are involved in the transmission of signals between the cells in your brain, called neurons. You can think of this signal transmission as a method by which the neurons communicate with one another.
To send a chemical message to its neighbor, a neuron releases serotonin into the space between the neurons called the “synaptic cleft”. Once this chemical message has been transmitted to the other neuron, the serotonin is reabsorbed in a process called “reuptake”.
SSRIs work by preventing, or blocking, the reuptake process. This means that rather than being reabsorbed back into the neuron, the serotonin stays put in the synaptic cleft.
Which SSRIs are used in OCD?
In the United States, the Food and Drug Administration (FDA) has approved four different SSRI medications for the treatment of Obsessive Compulsive Disorder in adults. These medications include:
Sertraline
Fluoxetine
Paroxetine
Fluvoxamine
The medications are listed above by their generic names, however, you may also see these medications referred to by their brand names.
The SSRI category also includes other medications that are not listed above which may be used on an “off-label” basis for OCD. This means that they have not been approved by the FDA specifically for use in OCD.
How quickly do SSRIs work?
Medications vary significantly in terms of how long they take to work. Some medications get to work right away, and may have you feeling better almost immediately. Unfortunately, this is not the case with SSRIs, which are generally much slower to take effect. Some people may begin to feel better after a couple of weeks of taking SSRIs, but for others, this time frame may be closer to six weeks.
Do SSRIs have side effects?
Like all medications, SSRIs can cause side effects. While some people experience side effects while taking SSRIs, others don’t- people vary significantly in terms of how they respond to a medication.
SSRIs are often better tolerated than other medications used to treat OCD, which is why they are frequently selected as a first-line option.
A board-certified psychiatrist can provide education about the potential risks and benefits of a specific medication to help you make an informed decision about whether it would be an appropriate choice for you as a unique individual.
SSRIs vary amongst themselves in terms of potential side effects- no two are exactly alike. It is important to review the prescribing information specific to the particular medication. With that said, some side effects that are commonly seen across the SSRI class of medications are listed below.
Some common side effects of SSRIs include (but are not limited to):
Gastrointestinal upset (such as nausea, upset stomach, or diarrhea)
Jitteriness, agitation or increased anxiety
Headache
Dizziness
Changes in sleep
Changes in appetite, leading to changes in weight
Sexual dysfunction
Discontinuation Syndrome (after the SSRI is stopped)
Some less common side effects of SSRIs include (but are not limited to):
Increased risk of bleeding/bruising
Suicidal thoughts or behaviors
Serotonin Syndrome
Seizures
Blurred vision
Sweating
Confusion
If you are struggling with OCD,
reach out to discuss treatment options.
Dr. Holly Betterly, MD is a Board-Certified Psychiatrist and member of the International OCD Foundation (IOCDF). She specializes in helping patients to overcome OCD through evidence-based psychiatric care. She considers your unique needs and preferences to develop a treatment plan that is personalized to you as an individual.
Dr. Betterly is currently accepting new patients. She offers telehealth for patients across Florida, as well as in-person appointments at her office in Weston, FL.
Learn more about OCD
Dr. Holly Betterly is committed to educating her patients about their mental health, encouraging them to play an active role in their psychiatric care. She empowers her patients by sharing the knowledge and expertise that she has gained through over a decade of training.
She maintains a mental health education blog, Better Together, which features articles on timely topics in psychiatry, as well as answers to your mental health questions- straight from a trusted psychiatrist!
Check out some of Dr. Betterly’s latest articles about OCD:
