Hi, I'm Dr. Tracey Marks,
and I make mental health videos every Wednesday.
Today I'm talking about obsessive-compulsive disorder
and how we treat it.
Today's topic is based on two viewer questions.
WTT says, my biggest compulsion was rumination.
I thought I was a pedophile, homosexual, I'm straight.
I always thought something bad was going to happen.
I wish I knew more about this disorder earlier.
It's taken me eight months just to try meds
due to my fear of doctors and medication.
Please do a video on OCD.
Then Inam says, I was diagnosed recently
with Pure O OCD and I have been dealing
with this distressing problem since last nine years.
Can you please do a video on Pure O OCD
since it's a widely misunderstood illness.
A lot of people are aware of that,
and it's not like normal OCD.
What causes it, how we can treat it,
and what are the symptoms, et cetera.
Thank you WTT and Iman for these questions.
Obsessive-compulsive disorder is an anxiety disorder
whereby you have either obsessions or compulsions or both.
Most people have both but you can have one or the other.
So this addresses Inam's question about Pre O OCD.
Pure O is not a separate diagnosis,
it's a descriptive term people have come to use.
Even though more people have both the obsessions
and compulsions I wouldn't go so far as to say
that that's normal OCD and then if you only have obsessions,
that you have a misunderstood illness.
People who treat OCD know that you can have either or.
But I think people believe that the compulsions are
their normal OCD because that part is observable.
You can see someone performing a compulsion,
but you can't tell what's going on in someone's head
if they don't tell you.
And for some people the obsessions can be
so disturbing that they don't tell anyone.
You may not even tell the doctor that you see
what obsessions that you're having.
You may go to see the doctor for anxiety or depression
and still not admit that you're having
these obsessional thoughts behind it.
The obsessional thought may be
that if you speak to something about something out loud
that your family's gonna be harmed.
So of course, you don't want to say anything.
Often times people with OCD will have dysfunctional beliefs.
You may put too much importance on a belief
as if having the belief makes it a fact.
Like WTT said, if you have a thought
about some taboo sexual act
in your head it can be as if you did it yourself.
People with OCD could have poor insight
into how realistic their thoughts really are.
An example of this would be to actually believe
that if you do not turn your faucet on and off 20 times,
the water will leak out and flood your home.
If you ask a person how can that really happen,
they can't give you an answer.
They may say, I don't know, I just I believe it
and I can't make myself not think that.
In this scenario, you if can't be convinced
that that outcome is not possible,
your belief would be considered a delusional belief.
But, this is one of the few instances
where you would not consider to have a psychotic illness.
In this case your diagnosis would be
obsessive-compulsive disorder with delusional beliefs.
The term delusional beliefs would be
considered a course specifier.
There are some common obsessional themes with OCD.
Contamination obsessions
with or without cleaning compulsions.
Symmetry obsessions.
This may come along with repeating,
ordering, and counting compulsions.
Forbidden taboo thoughts.
And, this is where you can get aggressive,
sexual, or religious obsessions.
- [Man] Nice.
- And then there's the harm obsessions.
And, this can be fears of harm to yourself or someone else.
Sometimes a woman can have a baby and have the thought pop
into her head that she may harm her baby.
And a really scary thing about OCD is
that it's not always thoughts.
Sometimes the obsessions are images.
So a new mom can have a flash of seeing herself hurt
her baby and be completely freaked out
thinking why am I thinking this?
Something must be seriously wrong with me.
Some people respond to the harm obsessions
by checking or hoarding.
Hoarding is its own disorder but it falls
under the category of obsessive-compulsive
and related disorders because it is similar.
But it's a separate disorder when it's not due to OCD.
I've talked about compulsions but what are they?
Compulsions are repetitive behaviors that you're drawn to do
because of an obsession or belief or a set of rules
that you feel like you have to follow.
An example of this would be needing to open
and close your car door five times before you can get in.
Or walking into a room that has tiles on the floor
and needing to count all of the tiles
before you can feel comfortable in the room.
The compulsions are hard to resist performing
and they typically give you a lot of anxiety
if you don't follow all the steps.
And for the diagnosis of OCD the compulsions
or obsessions need to be time-consuming,
taking more than an hour per day.
So if you're someone who tends to check your locked
your door twice before you leave the house every morning,
that is compulsive, but it's not a disorder.
There's a certain amount of normal compulsivity
and obsessionality that anyone can have.
With the compulsions, you can recognize
that it's something unreasonable but you have to do it
to relieve your anxiety.
So let's say you need to check to make sure
you turned off the oven before you can leave your home.
You go back in the house and check to see
if it's off and then you go back to your car.
But then you have the urge to check one more time.
So, you say to yourself you know it's off,
but you just can't feel satisfied
until you check that one more time.
If you try and force yourself not to check
you can leave with a lot of distress
and discomfort and maybe even at some point
in the day you may even question
whether you really turned it off.
It's like your memory of checking it changes
and now you're not sure sitting at work or school
and you've got a lot of distress about it.
Obsessions on the other hand can be something
that become hard to talk yourself down from.
For example let's say you fear getting HIV infection.
Intellectually you know that you get it
from human fluid exchange.
You can't get from touching a doorknob,
or shaking someone's hand
if you don't both have open sores.
But you go to a party where the room is thick with people.
And someone sneezes behind you.
You can feel the drops hitting your shirt
and you can even imagine the nasal drops
going through your shirt
and into a hair follicle on your back.
And now you have HIV.
You come to see me
and I tell you that's not a reasonable way to contract HIV.
You leave my office feeling somewhat reassured,
but you still may go get tested
anyway because just don't believe what I said.
The gold standard therapy for treatment for OCD is called
cognitive behavior therapy with exposure
and response prevention.
Essentially you're exposed to situations
that trigger your fears or urges to do the rituals,
and then you abstain from performing the ritual
or doing your usual coping mechanism.
This treatment can also help you if you only have
the obsessions or what people would call the Pure O OCD
because you probably have developed some avoiding behaviors.
And these avoiding behaviors could be
the focus of your treatment.
So instead of having an obsession and a performing
a compulsion, you have things that you don't do anymore
because you know they'll trigger your thoughts.
And you may be losing out on things because of the fact
that you're now avoiding certain activities.
Here's how the therapy goes.
You would create a list of feared situations
ranking them from least distressing to most distressing.
Then you would exposure yourself to the situations.
And, it can be an actual exposure which we call In Vivo
or it can be imagined.
An imagined exposure would involve creating a scene
in your mind of the triggering situation.
The therapist would help you create the exposure situations
based on the list of feared situations that you create.
Here's an example.
Suppose you fear being contaminated
by touching things that disgust you.
Here is what your list of exposure situations
might look like going from low to high.
Touching a doorknob, touching a gas station pump
with your full hand including the palm of your hand,
running your entire hand along the top
of a public toilet seat,
and then being unable to wash your hand for 10 minutes
Touching someone's sweaty back
and then touching your chest with that same hand.
Putting your finger inside someone's ear canal
and then continuing to use your hand
in a normal way that incorporates that ear finger.
I promise I'm not making this up.
Now these things might seem like extreme circumstances
that you probably wouldn't want to do
even if you didn't have OCD.
But when you don't have OCD, you're not consumed
with thinking about things like this.
It may gross you out if someone asked you to do it.
But they're not thoughts that you create in your head.
But these are the kinds of thoughts that people
with OCD can spend their time thinking or worrying about.
The exposure response prevention immerses
you into more extreme forms of your fear situation
to desensitize you from the things that you actually fear.
The goal of the treatment is to not only be able to stop
the behavior but to see that you can master your anxiety
and it doesn't have to consume you.
You also learn that the anxiety you feel
doesn't have to last forever and it actually goes away.
When you have the urge to perform a ritual,
at the time you think that's the only way
that you're going to feel better.
But, the treatment helps you break past that belief
by giving you the experience of having your anxiety
actually go away without doing the ritual.
And for those who have harm obsessions,
the exposure therapy can teach you that the consequence
you fear don't actually happen.
Sometimes you're too anxious to benefit
from the therapy or you don't have access
to a therapist who does this kind of CBT.
In this case the treatment for OCD would be medication.
And, we use the serotonin enhancing antidepressants.
The medications FDA approved for OCD are fluoxetine,
fluvoxamine, paroxetine, sertraline and clomipramine.
Clomipramine is a tricyclic antidepressant.
It's one of the older medications
and there's some data that suggest that
it's a better medication for OCD
then the selective serotonin reuptake inhibitors.
However it does come with a lot more side effects
including sedation, blurred vision,
weight gain and a host of other things.
If your obsessions rise to the delusional level,
you may need to take an antipsychotic medication
that would be added to your antidepressant.
Aripiprazole and risperidone are common medications
that we would use for this purpose.
There are also neuromodulation treatments
such as deep brain stimulation,
transcranial magnetic stimulation,
and Electroconvulsive therapy or ECT.
ECT would be used for OCD that comes along with depression
and usually not just for OCD alone.
But we do use TMS for OCD alone.
You can check out my video
I have on neuromodulation devices.
See you next time.