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Drugs vs. Therapy When Treating OCD

Obsessive-compulsive disorder (OCD) is classified in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) as an anxiety disorder. It is characterized by habitual, recurrent and disturbing thoughts (also known as obsessions) and/ or repetitive behaviors (also known as compulsions). Research has indicated that OCD is rooted in a biochemical imbalance within one’s brain. It is most common for an individual with OCD to experience both obsessions and compulsions. In order for an individual with OCD to manage his or her obsessions, he or she will actively attempt to avoid any triggers, by way of avoiding situations, and/ or neutralizing obsessions by engaging in a related compulsion. Even in situations where an individual with OCD recognizes his or her thoughts and/ or behaviors to be excessive and/ or senseless, he or she will be unable to refrain from carrying them out. OCD can be a debilitating condition as it drastically affects one’s thoughts, actions, and behaviors. There are several common obsessions associated with OCD. They can include, but are not limited to the following examples:

  • Contamination (i.e. fear of germs, dirt, and/ or illness)
  • Safety 
  • Intrusive sexual thoughts 
  • Religiously preoccupied 
  • Unwanted acts of aggression 
  • A need for exactness and/ or symmetry
  • Superstitions 
  • Fear of losing or not having items one needs

The National Institute of Mental Health (NIH) provide examples of commonly reported compulsions in association with OCD, which include the following:

  • Habitually double checking things (i.e. door closed, appliance turned off, water faucet shut…etc.)
  • Constantly engaging in senseless behaviors in attempts to reduce stress (i.e. tapping, counting, repeating words…etc.)
  • Spending excessive amounts of time washing or cleaning (i.e. ritualized hand washing)
  • Consistently and continuously checking in on the safety of loved ones
  • Ordering and/ or arranging things symmetrically and/ or no flexibility regarding the placement of items
  • Unable to discard superfluous items (i.e. hoarding) 

It is not uncommon for an individual with OCD to struggle with several different types of obsession and compulsions simultaneously. Alternatively, some individuals may experience only one component of OCD (either compulsions or obsessions). The symptoms associated with OCD can be incredibly time consuming, and will undoubtedly impede an individual’s relationships as well as interfere with many aspects of his or her daily life. 

Treatment Options

Prior to seeking any type of professional treatment for OCD, an individual must be clinically diagnosed with the disorder. Much like any mental health disorder, it is best to obtain a diagnosis from a qualified mental health professional (i.e. psychiatrist, psychologist, clinical social worker…etc.). This typically includes a comprehensive psychological evaluation as well as a physical exam. Every individual is different and has nuanced needs when it comes to establishing a treatment plan for OCD. Each individual will respond distinctly to the various types of treatment methods available to those with OCD. The typical treatment options for OCD usually consist of medication and/ or psychotherapy. There are a variety of contributing factors when attempting to distinguish which is more effective. It is also not uncommon for both options to be integrated into an individual’s treatment plan.

  • Medication: while medications have not been identified as a sole treatment method for OCD, depending on the situation, there are several psychiatric medications that may be helpful to one’s treatment. For example, antidepressant medications such as SSRIs (selective serotonin reuptake inhibitors) are FDA-approved as an effective treatment option for adults with OCD.
  • Therapy: there are a variety of psychotherapeutic methods relied upon by mental health clinicians to help treat an individual with OCD. Many individuals with OCD will require tailored treatment plans, which often involve utilizing a combination of different therapy strategies. Specific types of therapy frequently used to treat OCD include various types of cognitive behavioral therapy (CBT) and behavior techniques, more specifically the behavioral treatment known as ERP therapy (exposure and response prevention). 

In addition to formalized psychotherapy, there are a myriad of relaxation techniques that can be helpful in managing one’s OCD symptoms. Furthermore, maintaining a healthy lifestyle (i.e. regular exercise, adequate sleep, and healthy eating habits) can contribute to reducing one’s anxieties and keeping OCD symptoms at bay. In situations where medication is deemed beneficial in assisting to regulate the manifestation of one’s OCD symptoms, it is usually done so as a supplementary component of one’s treatment plan that consists of one or more therapeutic modalities. According to the Mayo Clinic, a combination of psychotherapy and medication provide an individual with optimum chances for a successful outcome. Although each individual is different, with the proper treatment, an individual with OCD can generally begin to experience some relief from his or her symptoms within six months. 

OCD Signs in Children and Therapy Options

Obsessive-compulsive disorder (OCD) is a neurobiological illness, and is listed in the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, 5th Edition) as an anxiety disorder. It is characterized by excessive, intrusive thoughts (obsessions) that lead to repetitive behaviors (compulsions). While the exact cause of OCD remains unknown, certain research findings have indicated that a child diagnosed with OCD does not produce sufficient amounts of serotonin, alluding that the development of OCD may originate within one’s brain. The Obsessive Compulsive Foundation of Metropolitan Chicago asserts that OCD appears to be “at least partially genetic and, in some cases, may be activated by a strep infection.” For children that are genetically predisposed, the onset of OCD can occur as young as three years old. It is more common, however, for OCD symptoms to begin in children around age ten. While there are several overlaps, the signs and symptoms of OCD manifest and are exhibited differently in children than in adults. OCD affects the way a child is able to adequately filter and process information. This, in turn, leads the child to perseverate on thoughts that would be otherwise ignored or dismissed by a child without OCD. 

Signs and Symptoms

Adolescence is a challenging time in one’s life. It is a time of significant physical, emotional, educational and developmental growth. It is not uncommon for a child to exhibit a plethora of varying behaviors prior to and throughout his or her adolescence. The signs and symptoms that a child with OCD may present might appear similar to the neurotypical child, but for a child with OCD they will be debilitating. The International OCD Foundation provide the following examples of commonly reported obsessions and compulsions displayed by children with OCD:

  • Obsessions:
    • Religious fixations
    • Aggressive thoughts
    • Fear of contamination
    • A need for order, symmetry and/ or precision 
    • Sexual thoughts
    • Fear of germs and/ or dirt
    • Preoccupation with bodily waste
    • Intrusive sounds and/ or words
    • Preoccupation with household items
    • Fear of illness and/ or harm coming to oneself and/ or others
  • Compulsions:
    • Repeating rituals (i.e. entering and exiting doorways multiple times) 
    • Ordering and/ or arranging objects
    • Grooming rituals (i.e. showering, brushing teeth, hand washing, hair combing…etc.)
    • Counting rituals
    • Checking rituals (i.e. pushing repeatedly on doors to assure they are closed)
    • Touching rituals
    • Cleaning rituals (i.e. household items)
    • Hoarding 
    • Rituals to prevent self-harm and/ or harming others 

It is important to note that stress does not cause OCD, however it can exacerbate one’s symptoms. It is common for a child to attempt to hide his or her symptoms due to confusion and/ or embarrassment, depending on his or her age. 

PANDAS

Children are highly susceptible to contracting typical illnesses (i.e. strep, the flu, the common cold, conjunctivitis…etc.). Some studies have found that a strep infection may trigger the onset of OCD symptoms in children. When this occurs, it is known as Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcal infections (PANDAS). The studies indicate that strep antibodies attack certain parts of a child’s brain, which can manifest as OCD symptoms. Although this is possible, it is imperative to bear in mind that the majority of strep infections in children do not lead to the development of any obsessions nor compulsions. Furthermore, most reported childhood OCD is unrelated to infection.

Treatment Options

The most effective method of treatment for children with OCD is formalized psychotherapy. There are a variety of different types of therapy that can be combined to create the ideal treatment plan for a child. Cognitive behavioral therapy (CBT) is most commonly used when treating children with OCD, according to the Child Mind Institute. CBT is multifaceted and a form of psychological treatment that is used by many mental health professionals. One of the specific types of CBT that is used in a child’s treatment plan is known as Exposure and Response Prevention (ERP) therapy. Through ERP therapy a child learns techniques to not only confront his or her obsessions but also actively commit to not engage in the compulsive behavior. 

Depending on several contributing factors, supplementary treatment methods, such as medication, may be incorporated into a child’s treatment plan. Additionally, maintaining a healthy lifestyle by engaging in regular exercise, establishing healthy eating habits, and obtaining ample sleep can help reduce the severity and/ or frequency of a child’s OCD symptoms. With the proper treatment and support a child can learn to control his or her symptoms and implement healthy coping strategies for navigating and managing any subsequent recurrences. 

 

Dialectical Behavioral Therapy versus Cognitive Behavioral Therapy: What’s Best for Me?

Nowadays there are a variety of different types of therapy available for individuals in need. While many therapeutic methods can be utilized concurrently, certain therapeutic techniques can be especially beneficial for certain ailments. Any qualified mental health professional will be able to assist in deciding the best course of action regarding one’s therapy plan. Having a broad understanding of the similarities and differences of some of the therapeutic modalities that are frequently utilized in mental health treatment can be helpful for a client. Certain therapeutic methods have tangential methods that are widely used. For example, Psych Central indicates that dialectical behavioral therapy (DBT) is actually a form of cognitive behavioral therapy (CBT). 

Cognitive Behavioral Therapy

The American Psychological Association asserts that cognitive behavioral therapy (CBT) is a common form of psychological treatment. CBT can be an effective form of treatment for many health disorders, such as anxiety disorders, depression, Posttraumatic Stress Disorder (PTSD), phobias, eating disorders, obsessive-compulsive disorder (OCD), sleep disorders, bipolar disorders, substance use disorder, sexual disorders, and schizophrenia. It can also be helpful with managing situational emotional challenges. The Mayo Clinic provides various examples of these, which can include, but are not limited to, the following:

  • Overcoming emotional trauma related to abuse and/ or violence
  • Resolving relationship conflicts
  • Coping with grief and/ or loss
  • Coping with a medical illness
  • Managing chronic physical symptoms

Cognitive behavioral therapy uses tools to help teach healthy coping mechanisms for regulating emotional challenges. It focuses on helping people learn how thoughts affect feelings and behaviors. In shifting one’s thought patterns, an individual is more capable of releasing negative feelings and breaking unhealthy behavioral patterns. One of the goals of CBT is to help a client learn techniques to enable them to be their own therapist. Through various exercises (conducted both in and out of therapy sessions) a client develops coping skills to learn to change his or her own problematic emotions, damaging thinking patterns, and unhelpful thoughts. Mental health clinicians that integrate CBT into their treatment plans generally practice talk therapy that is reliant upon several guiding features. 

Dialectical Behavioral Therapy

The term “dialectical” derives from the idea that combining two opposites in therapy (acceptance and change) yields better results than either would on its own, as is described by WebMD. DBT was created out of a need to help diagnose individuals with borderline personality disorder (BPD). While DBT is housed under the larger umbrella of CBT as a form of mental health treatment, this type of specialized treatment has been known to be highly effective in helping clients that struggle with self-harming behaviors. It is also commonly used to help treat individuals struggling with the following ailments:

  • Sexual trauma survivors
  • Borderline personality disorder
  • Chronic suicidal ideations
  • High risk and/ or difficult to treat patients

Dialectical behavioral therapy (DBT) is a type of CBT that is tailored towards helping a client acknowledge the pain and discomfort he or she feels, while being empowered to choose healthy behaviors instead of engaging in harmful actions to simultaneously allow him or herself to feel and move through the uncomfortable emotions. The following four components make up DBT:

  • Individual therapy: focused on improving client motivation and helping clients apply and integrate skills learned to navigate specific life challenges.
  • Group skills training: focused on improving and teaching healthy client behavioral skills, as well as provide a forum to practicing integrating the skills.
  • If needed, distance/ phone coaching: in-the-moment coaching to assist in and provide crisis management support between sessions
  • Consultation team: this component is solely for the mental health provider treating the client. A consultation team serves as support for the clinician in treating clients with severe, complex, and/ or challenging to treat disorders. 

In DBT there is some emphasis placed on dealing with and navigating thoughts, however the primary focus is placed on helping clients learn to identify triggers outside of themselves and pair those triggers with healthy responses and coping mechanisms. 

What’s Best for Me?

Every individual is complex with nuanced needs and will respond to different forms of treatment for mental illness uniquely. With the wide variety of therapeutic modalities available, certain types have been proven more effective for certain mental health ailments. For example, a therapy technique that works well for individuals struggling with depression and/ or anxiety may exacerbate an individual struggling with an eating disorder. CBT focuses on rationale and reasoning, DBT heavily relies upon mindfulness skills to assist in effectively regulating emotions. Both types of therapy techniques can yield successful results. The best way to figure out which type of therapy treatment is best is to consult a mental health professional. Any qualified mental health professional will consider all symptoms, health history, and goals of a client when recommending the best course of action regarding his or her treatment plan.