Obsessive Compulsive Disorder (OCD)

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Treatment

Treatment of OCD includes the following:

• Behavior therapy, e.g., exposure and response prevention
• Antidepressant medication
• Surgical severing of the cingulum (in extremely rare cases)

There is good clinical support for the efficacy of behavior treatment, especially when combined with medication.

Goals of behavior therapy include desensitization and relearning. The method with the most certainty is exposure and response prevention therapy. This method exposes the patient to the objects or situations that trigger obsessions, fear, and anxiety, but then prohibits him or her from engaging in the usual compulsive response.

A therapist works with the person to identify his or her unreasonable obsessions and helps him or her realize that the effects of their thoughts are not catastrophic. The aim is to teach people to control their anxiety without relying on ritualized behavior. The patient will often feel intense anxiety, which he or she eventually learns to manage until it subsides. For example, a person who obsesses about contamination and germs prohibits him or herself from washing after shaking hands or coming into contact with public places.

Moreover, the person realizes that their obsessions, when not catered to, eventually disappear along with their anxiety. Success rates are determined by dedication and time. Usually, it takes at least 10 to 20 hours of therapist-controlled practice to see results.

Countless studies have documented the efficacy of exposure and response prevention therapy. It is effective in over 80% of people. In fact, the success rate of exposure and response prevention has led to its use in telephone-access therapy for people with OCD. One program allows people to phone in and get computer-generated response-prevention therapy and also allows them to track their progress.

Relaxation techniques or cognitive techniques, such as self-talk, are occasionally used to relieve OCD symptoms. Some studies report that as many as 60% to 70% of people benefit from this type of therapy. However, evidence for their efficacy is lacking, and these therapies have not been shown to have long-term benefits. They may be beneficial when used in conjunction with exposure and response prevention therapy.

Antidepressant Medication
Antidepressants (e.g., selective serotonin reuptake inhibitors [SSRIs], tricyclic antidepressants [TCAs]) may be used to treat OCD. These medications (e.g., Prozac®, Zoloft®, Anafranil®) influence serotonin levels.

High doses of SSRIs may be required to treat OCD and it can take 10 to 12 weeks to experience beneficial effects of these medications. This can be frustrating, but with time, SSRIs significantly help people with their obsessive-compulsive behavior.

About 70% of people with OCD respond notably to antidepressant medication, and about 40% experience a partial reduction of symptoms. However, only about 10% to 15% have a full remission of symptoms, so the disease is chronic for most people even with treatment. Most take medication indefinitely, and about 85% of people relapse within 1 or 2 months after discontinuing it.

For more information about common side effects associated with these medications, see treatment of major depressive disorder.

Cingulotomy
Occasionally, surgical treatment of the cingulum may be beneficial to people who have severe symptoms and who do not respond to treatment. A cut is made between certain nerve fibers that trigger emotional arousal (cingulate gyrus) and the limbic system, which is involved in mood and intense emotion. About 30% of cingulotomies result in improvement. The procedure is relatively uncomplicated and is not thought to negatively affect memory, cognition, or intellect.

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