OBSESSIVE-COMPULSIVE DISORDER

Obsessive-Compulsive Disorder is a diagnosis that is characterized by recurrent obsessions and/or compulsions that interfere substantially with daily functioning. Obsessions are "persistent ideas, thoughts, impulses or images that are experienced as intrusive and inappropriate". These obsessions tend to cause a great deal of anxiety and distress. Typical obsessions would include repetitive thoughts about contamination, causing harm to others, self-doubt (e.g. did I lock the door) or other unwanted thoughts that people battle to get out of their minds. Compulsions are "repetitive behaviours or mental acts that are aimed at preventing or reducing the anxiety or distress". Typical examples of compulsive behaviour would include hand washing, ritualistic prayer, checking and counting. Compulsions are often aimed at either preventing the distress brought on by obsessions or at preventing the proposed harm associated with them.

For example, an individual with a contamination obsession would worry a great deal about getting "dirt" or "germs" on his hands. As a result, he would tend to avoid touching a wide variety of "contaminated objects" (e.g. door handles, the floor, towels that have previously been used by themselves, restaurant cutlery, desks at college). He would tend to then frequently wash his hands in an attempt to reduce his anxiety associated with his perceived contamination. This behaviour would cause a great deal of distress and get in the way of his ability to function, firstly because of his avoidance and secondly because of the amount of time that may be taken by his hand washing behaviour.

The treatment of choice for OCD is referred to as prolonged exposure and response prevention (EX/RP) (Franklin & Foa, 2008). During exposure therapy, individuals are introduced to the idea of prolonged exposure to obsessions without the use of the associated compulsive behaviour as a coping mechanism. During prolonged exposure, individuals are encouraged to expose themselves to the very thoughts, images, ideas, situations or other stimuli that they have their obsessions about. This is done for a prolonged period of time until their anxiety begins to habituate or starts to come down without the use of the compulsion. This is a very powerful technique that helps the brain to rewire its circuitry that is involved with OCD symptoms. As with most other exposure-based interventions, most people feel a great deal of anxiety about this before beginning with exposure and a significant amount of psycho-education and cognitive therapy is often required before hand.