Although obsessive-compulsive disorder (OCD) is a serious and chronic disorder, there are impactful treatment options that offer positive outcomes. Both therapy (inpatient and outpatient) and medication can effectively reduce symptoms and improve the quality of life for those dealing with this disorder. Consider seeking help and treatment from a licensed therapist and psychiatrist.
OCD, an anxiety-related disorder characterized by obsessions and/or compulsions, can be treated with selective serotonin reuptake inhibitors (SSRIs) and/or cognitive behavioral therapy (CBT).1 Studies of both CBT and SSRIs show that in the long-term, a substantial number of patients with OCD (32%-70%) have experienced a reduction of symptoms.2 If traditional treatment methods don’t produce the desired result, some may require more intensive treatment.
What Is the Best Course of Treatment For OCD?
Generally, cognitive behavioral therapy (CBT) is the most effective type of treatment used to address OCD; however, the length of one’s illness, severity of symptoms, and treatment history all play a role in determining the best options.3 Other patients may choose to add medication management to their treatment plan to achieve greater impact on their progress.
Most often, OCD is treated with outpatient therapy. Positive results can be seen as soon as four to six months. There are instances in which clients will require longer outpatient treatment or a more intensive treatment setting depending on the severity of their condition.
Three CBT techniques used to manage OCD are:3,4
- Exposure & response therapy (ERP): In ERP therapy for OCD, the individual and therapist formulate a list of feared items (hierarchy of fears), then gradually expose the individual while avoiding the usual compulsive responses. This continues until they can manage the stimuli without the need to engage in the usual, ritualized behaviors.
- Cognitive restructuring: Individuals with OCD struggle with what are called cognitive distortions like all-or-nothing thinking, catastrophizing, and perfectionism. Cognitive restructuring is designed to help individuals identify OCD thoughts then challenge untruths with more rational, objective, evidence-based thinking.
- Mindfulness-based CBT: Mindfulness trains people to have an observational vs. judgmental stance regarding thoughts, feelings, urges, and physical sensations. Patients are taught that the uncomfortable sensations are not the problem, but rather their reactions to them/ They are encouraged to practice experiencing these sensations without engaging in rituals, avoidance, and reassurance-seeking behaviors.
Other Therapy Treatment Plans
For the patients who do not respond to the more traditional therapeutic approaches, there are several less common methods, including repetitive transcranial magnetic stimulation. Some of these approaches do not have as much evidence to support their success rates, but individuals and their teams may find them helpful.
Three other types of therapy and treatment plans for OCD are:5
- Repetitive transcranial magnetic stimulation: A non-invasive type of deep brain stimulation that is used to treat OCD and depression
- Cingulotomy: A type of brain surgery that is a last resort for those with OCD
- Electroconvulsive therapy (ECT): A brief electrical stimulation of the brain while the patient is under anesthesia
Medication
If necessary, your therapist will refer you or your loved one to a psychiatrist or psychiatric nurse practitioner who can prescribe appropriate medications. Individuals may make the decision to add medications due to continued struggles after several months of therapy with only moderate progress. Most individuals can self-refer to a PCP or psychiatrist to discuss medication. If not, your therapist or PCP can make a referral.
Medications that can be used to treat OCD include:*6
- Clomipramine (Anafranil)
- Fluoxetine (Prozac)
- Fluvoxamine (Luvox)
- Sertraline (Zoloft)
- Citalopram (Celexa)
*This is not a comprehensive list. You should talk with your doctor or psychiatrist about any medications you are prescribed or interested in taking.
SSRIs have side effects, but they are generally more manageable than clomipramine. Although all SSRIs appear to be equally effective, individuals may respond well to one and not another. In choosing among the SSRIs, the psychiatrist will consider the pros and cons, past treatment responses, and the presence of any other conditions.
The use of medication in children with OCD and adolescents with OCD is dependent upon the age of the child, the severity of their condition, and whether there are any co-occurring disorders such as depression that require treatment with a selective serotonin reuptake inhibitor (SSRI) as well. If the child or adolescent has no other conditions and is young, CBT is suggested as the first option prior to utilizing medication. Medication is only added after a trial of CBT has been attempted with less than desirable results.8
Treatment For Severe OCD
Occasionally a patient will require more intensive outpatient or inpatient treatment due to the severity of their condition or the presence of unmanageable co-occurring disorders. Intensive outpatient consists of up to 10 hours of care each week. Inpatient care is usually reserved for the most severe cases.3
Outpatient Care
Individuals usually meet with therapists, psychiatrists, and medical providers such as medical doctors or nurse practitioners who monitor their medications and health status. They will also participate in several hours of group therapy each week with other patients who have OCD. This allows them to hear from others dealing with the same condition. Family members may also participate in either group meetings or therapy appointments to learn how to support their loved ones.
Inpatient Care
In an inpatient setting, an individual receives care from medical professionals 24 hours a day, seven days a week. One example is that someone with OCD may be so afraid of germs and contamination that they refuse to eat and require medical intervention. OCD can also exacerbate conditions such as anxiety and depression to the point that an individual may become suicidal. Other times, the condition may be interfering with functioning to the point that intensive treatment is needed to break the cycle of the disorder.
Can OCD be Cured?
While OCD is likely genetic in origin, currently, we are not able to treat OCD at the genetic level to cure it.7 Consequently, the best option is therapy and/or medication for effectively managing the symptoms and achieving recovery and symptom management. OCD is a chronic condition, which means that without intervention the condition will not likely go away on its own. The severity of OCD varies greatly, yet with professional intervention, treatment outcomes are positive in most cases.8
Final Thoughts on Treatments for Obsessive-Compulsive Disorder
While OCD is a chronic disorder, there are many effective treatments. If you or someone you love is dealing with OCD, talk to a therapist who specializes in the treatment of OCD and anxiety disorders. Therapists are trained to utilize CBT and will make referrals as needed. Remember, you are not alone, and there are resources available to assist you and your family. Consider using an online directory to find the right therapist for you.
