Stephanie Burchell, PhD, LMFTA
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As its name implies, the symptoms of OCD involve obsessions that lead to compulsions. Obsessions are recurrent and
persistent ideas, thoughts, images, or impulses that may cause a great deal of anxiety or distress. People experiencing these
obsessions typically find them to be disturbing and intrusive, and usually recognize that they don't make a lot of sense. In
response to obsessions, people with OCD try to get rid of them by way of compulsions-acts that are done over and over again,
and often according to certain personal rules. Also called rituals, compulsions are usually aimed at preventing or reducing
distress and anxiety, or preventing some feared event or situation.

Obsessions and compulsions can take many forms. A few examples include: drivers who fear that they've hit a person every time
they run over a pothole or bump on the road. In response to such an obsession, these persons may resort to compulsions such
as retracing their routes to be sure no harm was done, or avoid the particular road altogether in the future. Individuals who fear or
are obsessed with germs may wash their hands repeatedly throughout the day after touching any potentially "germy" objects,
such as door handles, money, or newspapers. Often, their hands are sore and raw from repeated washing, but they can't seem
to stop washing. Others who might be obsessed with order and cleanliness may compulsively arrange items in a particular
order, or clean their home floors many times a day. Those who fear burglary, fires, or floods may repeatedly check door locks,
stove burners, and taps to ensure that their homes are safe. Over time, such repetitive actions work less and less effectively, and
the persons may experience anxiety and often depression in response to the increasing obsessions and compulsions.

Besides causing a great deal of stress, OCD symptoms may take up a lot of time (more than an hour a day for some diagnosed
people) and may significantly interfere with a person's work, social life, or relationships. OCD can be a challenging problem but
fortunately, very effective treatments for OCD are now available to help individuals and families lead a more satisfying life.
What causes OCD?

There is no single, proven cause for OCD. There is, however, growing evidence that biological factors are a primary contributor to
the disorder. Research suggests that OCD involves problems in communication between the front part of the brain (the orbital
cortex) and deeper structures (the basal ganglia). These brain structures communicate with each other by using serotonin, a
chemical messenger. It is possible that serotonin plays a significant role in the development or maintenance of OCD. Other
psychological, familial, social and cultural factors may contribute to OCD, but it is not clear whether they cause the disorder.
What is the effect of OCD on family members?

Family members often feel confused and frustrated by the symptoms of OCD. They may have difficulty understanding the
exaggerated behaviors seen in a person with OCD, and they may think that the person is behaving oddly on purpose or that
he/she has simply "lost their mind." Understandably, the family may find it difficult to cope with the behaviors seen in the member
with OCD and they may not know how to handle the situation. The family may react negatively to the person, possibly causing a
lot of family and marital stress. In order to avoid and/or deal appropriately with family reactions, it is very important for family
members to learn about OCD, including its symptoms, causes, and treatment. Families who educate themselves about the
disorder can contribute to the successful treatment of the individual with OCD.

What treatments are available for OCD?

There are several types of effective treatments for individuals with OCD and their families. The most common types of treatments
are the following:

Cognitive Behavioral Therapy (CBT)-This treatment has two parts: behavioral therapy and cognitive therapy. Behavioral therapy
involves exposure and response prevention. Exposure is designed to reduce the negative emotions (anxiety and guilt) brought on
by obsessions. It is based on the idea that anxiety usually decreases after lengthy contact with something feared. For example,
people with obsessions about germs will be advised to stay in contact with "germy" objects, such as money. In order for
exposure to be most helpful, it needs to be combined with response prevention (RP). In RP, the person's rituals (or
compulsions) are blocked. For example, those who worry a lot about germs will be advised to stay in contact with "germy"
objects, but avoid the compulsion to wash their hands excessively. This repeated exposure without rituals assists individuals to
understand that coming into contact with certain objects or situations will not lead to the initial fear-in this case, becoming ill from
the germs found on common objects.
CBT's second part is cognitive therapy (CT). It is often combined with behavioral therapy to help reduce the catastrophic thinking
and exaggerated sense of responsibility often seen in OCD. In cognitive therapy, the therapist asks the client a series of
questions to help him/her identify and evaluate the interpretations and beliefs that lead to typical OCD behavior. Once these
beliefs are identified, the therapist will use a variety of strategies to assist the client in challenging the faulty assumptions that are
seen in OCD.
Behavioral Family Treatment- Whenever possible, it is helpful for family members to participate in the treatment of OCD. Family
members and persons with OCD both tend to benefit when the family members participate in psychoeducational groups. These
groups educate family members about OCD and provide strategies that the family can use to assist and support the member
with OCD.

Medication- Research shows that the use of medication, specifically serotonin reuptake inhibitors (SRIs), is beneficial for the
treatment of OCD. Most research shows that medication alone does not get rid of OCD, but it reduces the force of obsessions
and urges to engage in rituals (for example, excessive hand washing), thereby allowing the person with OCD to have more
control over their thoughts and behaviors.

How can a family therapist help?

Family therapists are trained to assist individuals, couples, and families with a variety of clinical issues, including OCD. A family
therapist will carefully assess a person's condition and assist him/her in determining which of the above treatments will be most
appropriate and beneficial. A family therapist will also encourage the family to actively participate in the treatment of OCD in a
variety of ways, including participation in a psychoeducational group. If medication is necessary, the therapist will refer the client
to a physician who can guide the person in determining which medication is the most appropriate to take. Often, the family
therapist and physician will work together to coordinate and carry out the treatment of the person with OCD. This will ensure that
the person receives the best possible treatment. ?

Consumer Resources:

Organizations

Obsessive Compulsive Foundation, Inc.
Phone: 203.315.2190
Website: www.ocfoundation.org

This national organization provides information and referral services for those seeking help for OCD. An annual conference on
OCD and related topics is held during the summer and provides an excellent forum for clinical training and for sufferers to meet
each other and the experts. The OCF also has an extensive publication list of books, articles and videos available for sale.
Books

Van Noppen, B., Pato, M., & Rasmussen, S. (2003).
Learning to live with OCD: Help for Families. New Haven, CT: Obsessive
Compulsive Foundation. This booklet is a mainstay for family members trying to understand OCD and how to deal with these
symptoms in the family environment.

Baer, L. (2000)
The Importance of the Mind. New York: Little, Brown & Co. An excellent book describing how obsessions
become embedded in the psyche. This is a useful resource for patients and therapists.
The information in this brochure was provided by Gail Steketee, Ph.D. and the Obsessive Compulsive Foundation, Inc.,
www.ocfoundation.org.
Dallas, TX ?75237
(214) 534 - 6177
Obsessive Compulsive Disorder