Treatment for the Symptoms of Obsessive-Compulsive Disorder (OCD)
OCD is best treated with therapy or medication. However, some lifestyle changes can help patients cope with the disorder as well. This treatment overview covers all popular options for patients with OCD.
Like most mental health disorders, OCD is nearly impossible to “cure” — meaning symptoms may never go away completely. However, it is highly treatable, and many patients can reduce symptoms to tolerable levels where they no longer interfere with day-to-day activities and relationships.
The earlier treatment begins, the more likely it is to make a difference. Experts in obsessive compulsive disorder emphasize the importance of early symptom detection and evaluation. If ignored, OCD symptoms can grow stronger and interfere more and more with daily life. The following treatments help many patients with OCD to control and live healthier with their symptoms.
Treating OCD with Therapy
OCD is most commonly treated with a specific type of psychotherapy known as Exposure and Response Prevention therapy, or ERP. In most cases — but not all — ERP has been found to be more effective than medication. ERP is a specific type of therapy that forces patients to confront the obsessive thoughts, images, objects, or situations that make them anxious. In an uncontrolled environment, the patient would temporarily alleviate the anxiety caused by the obsession with the corresponding compulsive behavior. In ERP, the therapist stops them from carrying out the compulsion.
A common example of this relates to contamination obsessions. Someone obsessed with the idea of germs, for example, may wash their hands repeatedly. An ERP therapist may start their treatment by asking them to touch the bottom of a dirty shoe, and then continue by prohibiting them from washing their hands for an hour. Once that milestone is conquered, the therapist may work up to having the person touch a dirty toilet seat or something else far outside their comfort zone.
During ERP therapy, a patient’s anxiety typically rises — and then, eventually, it goes back down. The human body isn’t designed to maintain a high level of anxiety for a long period of time, so over time the person adjusts to the anxiety and it feels less and less severe.
When a person with OCD carries out their compulsion, they think they’re reducing their anxiety, but in reality they’re actually just pushing it back down. And if it’s simply pushed under the surface, it will resurface — in most cases, stronger than before. But when the patient is compelled to sit with an uncomfortable level of anxiety, and resist the temptation to push it back under the surface, they learn to confront it and see that their anxiety can be controlled in a healthy way.
Many ERP therapists get creative when addresses patients’ obsessions. If a patient is obsessed with her mother developing breast cancer — and avoids anything with the word “cancer” in it as a result — the therapist might ask her to write a short play where her mother develops breast cancer. While writing and acting out this play with her therapist, she would be unable to avoid her taboo word. With time, the patient would become habituated to the level of anxiety that the obsession creates, and learn how to deal with it in a healthy way.
“ERP works on the notion that what goes up must come down,” says Roberto Olivardia, Ph.D., a clinical psychologist who specializes in the treatment of OCD at McLean Hospital in Boston. “The purpose is to raise one’s level of anxiety, and engage it, without avoidance, until the body eventually tolerates it.”
Cognitive behavioral therapy (CBT) has also been used to treat OCD, though the results are far less promising than are those for ERP. Essentially, CBT works to confront the thoughts behind the OCD and identify where they’re irrational. This can be especially useful in cases where the person is unsure whether his or her fears and anxieties related to OCD are, in fact, irrational. However, for CBT to be successful, it often needs to be combined with the behavioral component of ERP.
Treating OCD with Medication
Since ERP results take time — and not all symptoms can be fully controlled with therapy — many doctors also prescribe medication to help keep OCD symptoms at tolerable levels.
Obsessive-compulsive disorder is thought to be linked to deficiencies in serotonin, so the psychopharmacological treatment of choice is often an antidepressant. While doctors usually start with a Selective Serotonin Reuptake Inhibitor (SSRI) like fluvoxamine (Luvox), fluoxetine (Prozac), paroxetine (Paxil, Pexeva), or sertraline (Zoloft), they can also try a tricyclic antidepressant like clomipramine (Anafranil). Both types of antidepressants have shown to be effective in treating OCD symptoms like rigid thoughts and repetitive behaviors.
Like all psychiatric medications, OCD medications have potential side effects that include:
- Upset stomach
- Sleep disturbance
- Decreased libido
- Increased risk of suicidal thoughts. Though rare, this side effect is serious — particularly for teenagers and young adults. If suicidal thoughts occur, contact a doctor immediately.
A word of warning: Stimulant medications used to treat ADHD have been shown to make OCD symptoms worse — particularly if the patient suffers from compulsive hair and skin picking. If ADHD is a possibility, it’s important to tease out both diagnoses before prescribing medication — in these cases, it may be best to treat the OCD with antidepressants and focus on behavioral therapy for the ADHD.
Treating OCD with Dietary Changes
Though no formal research exists, some dietitians hypothesize that eating foods heavy in tryptophan — an amino acid linked to serotonin production — can have positive effects on OCD symptoms. Foods that are rich in tryptophan include turkey, milk, eggs, cottage cheese, beans and legumes, pumpkin, sunflower seeds, and other nuts.
Aside from that, eating an all-around balanced diet can help manage your blood sugar levels — decreasing stress and reducing the possibility that you’ll fall back in to a compulsion. Don’t skip meals, and work to make mealtimes calm and relaxed. This means no eating on the go, or eating hastily over the kitchen sink. Set aside some time each day to calmly enjoy a healthy meal — just sit and relax, reflect on your progress, and work on managing your stress levels.
Other dietary tips for patients with OCD:
- Avoid or limit caffeine
- Drink alcohol in moderation
- Don’t use food as comfort or stress relief. Guilt-induced overeating can be especially damaging to someone with OCD, who may be more likely to suffer from body dysmorphic disorder and have an unrealistic body image. If overeating is a problem for you, try finding an alternative like walking the dog or taking a warm bath.
- Exercise regularly
Treating OCD with Lifestyle Changes
One hallmark of OCD is crippling stress — the anxiety caused by obsessions and compulsions can easily bleed in to other areas of your life. Perhaps a fear of contamination is causing you to blow off friends and leading to increased social isolation, or maybe your need to check the stove 14 times each morning is making you frequently late for work. Even after treatment starts, these side effects of anxiety can be hard to handle. That’s where lifestyle changes like meditation and support groups come in.
Setting up a meditation routine can help you calm the obsessive chatter in your brain, while giving you the space to look at your disorder from a non-judgmental place — helping you accept that it’s not your fault.
If you’re new to meditation, work with a teacher or a guided meditation video until you feel comfortable forging out on your own. To successfully meditate on your own, try following these simple tips:
1. Find a mantra to repeat to yourself. This can be about your OCD (“I am more than this disorder”) — or not.
2. Get comfortable. Some meditation experts prefer sitting, but you may feel most comfortable lying down. If you’re worried about falling asleep, set an alarm.
3. Take slow, even breaths, and focus on the sensation of breathing. Every time you feel your attention start to drift — whether it’s toward an obsession or not — gently refocus yourself on your breath.
4. Stick with it! Meditation will get easier the more you do it, and the further you progress in your OCD treatment will make it even easier still.
Another powerful source of treatment for anyone with OCD is the love and support of friends and family. Depending on the nature of your obsessions, your therapist may ask your family members or close friends to participate in therapy sessions. Being open and honest with them about your condition — and acknowledging how OCD has strained your relationships — can help loved ones come to terms with the role they can play.
Make sure you schedule time for fun, too! OCD can feel like it has taken over your life at times. If you stay close to friends and family, and take care of your body and mind, you’ll find it easier to cope with your OCD and get back on track.
When you’re feeling particularly stressed, give yourself permission to try these things:
- Take a warm bath
- Get a massage
- Drink a warm, non-alcoholic beverage
- Take a walk
- Try a yoga class
- Listen to soothing music