The Circle of OCD
A ritual seen in obsessive compulsive disorder is goal-directed but has no rational justification. For example, washing oneself has an appropriate end-point – that is, to feel clean. However, going to inordinate lengths in washing oneself to feel cleansed (the ritual) will never be satisfied, meaning the end-point can never be reached. Similarly, checking that the doors and windows are locked before going to bed has a purpose, which is that the house has been made secure. Yet, checking repeatedly to “prevent” harm only serves to relieve anxiety in the short term; thus, the end-point will never be arrived at.
All obsessions are fear related; and all corresponding compulsions to “correct” the problem are of no use in the long term. Obsessions might relate to harm, sexual, cleanliness, moral or other; and resultant behaviours include reassurance, checking, confessing, cleansing, praying, and so on. The uncertainty of what has, is or will happen creates disagreement to rational persuasion. This is why re-occurring doubts and repeated responses to remedy the problem, albeit unsuccessfully, continue in a circle. In other words no amount of checking (or other ritual) ever takes away the grain of doubt.
The way to break the circle of OCD is with cognitive therapy (CT) and exposure response prevention (ERP) and sometimes medication.
The first helps to correct errors in thinking linked to faulty beliefs. For example, assuming your feelings are evidence of a fact – e.g., “I feel anxious, therefore the situation must be dangerous” or “I feel guilty, so I must have done something wrong”; or “I felt a groinal response, therefore I must be gay” are thinking errors. These thinking errors are linked to faulty beliefs such as catastrophising and overimportance of thoughts.
The second (ERP) assists in building distress tolerance by encouraging the resistance of pursuing purposeless goals. ERP is the gold standard intervention known to actively alter brain chemistry to reduce obsessional behaviours. Subsequently a person is able to better manage uncertainty and doubt which strengthens their resilience to OCD and resisting negative reinforcing behaviours (compulsions).
Whilst medication is not a replacement for reducing symptoms overall, it is often required in moderate-severe cases to allow for cognitive improvement, and in which a person is then more able to actively engage in ERP. Selective Serotonin Reuptake Inhibitors (SSRIs) such as Sertraline (Zoloft) are the medicines usually prescribed and are known to passively alter brain chemistry to reduce obsessions, usually by up to 60%. Just to note: an old class of tricyclic antidepressants – commonly clomipramine which works well for OCD – might be prescribed if a person cannot take to a SSRI.
Want the chance to win a prize?! Have a go at the quiz below!
One-two word answers are all that is required… The first five correct answers out of the bag gets a copy of my 3-part ERP educational document and a personal invitation to join my OCD Study Group (on Facebook)! If you’ve already joined my OCD Study Group, you can invite a person of your choice.
- What emotion drives a person to pursue goal-directed behaviours that have no rational justification?
- What makes rational persuasion a challenge for a person who has OCD?
- It can be seen that rituals do not change the course of events; yet, no amount of checking, washing or other ritual ever takes away what?
- Cognitive therapy can help a person alter thinking errors linked to faulty beliefs. True/False?
- Which therapy can (a) actively alter brain chemistry to reduce obsessive-compulsive behaviours and (b) which treatment intervention is able to passively alter brain chemistry to reduce obsessions?
Closing Date: 31st January 2018
Winners revealed on or before 10th February 2018
© Carol Edwards – Jan. 6th 2018
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