Conditions We Treat

Obsessive-compulsive disorder (OCD) is a mental disorder that usually begins in childhood or adolescence and may affect people throughout their lives, varying from mild to severely disabling. The signs and symptoms vary from person to person, but all people with OCD have either obsessions or compulsions or both.

Obsessions

These are recurrent and persistent thoughts, impulses, or images that are experienced as intrusive and inappropriate and that cause anxiety or distress. They are not simply excessive worries about real-life problems. The person attempts to ignore or suppress the thoughts, impulses, or images, or to neutralize them with some other thought or action. Common obsessions include:

• Repeated thoughts about contamination (e.g., becoming contaminated by shaking hands)
• Repeated doubts (e.g., wondering whether one has performed some act as having left a door unlocked)
• A need to have things in a particular order (e.g., distress when objects are disordered or asymmetrical)
• Aggressive or horrific impulses or images (e.g., physically hurt someone or to blurt out obscenities in public)
• Sexual imagery (e.g., recurrent images with sexual content)

Compulsions

These are repetitive behaviors or mental acts that the person feels driven to perform in response to an obsession, or according to rules that must be applied rigidly. The behaviors or mental acts are aimed at preventing or reducing distress or preventing some dreaded event or situation; however, they are not connected in a realistic way with what they are designed to neutralize or prevent or, they are clearly excessive. Common compulsions include:

• Washing and cleaning
• Counting
• Checking
• Requesting or demanding re-assurances
• Repeating Actions
• Ordering/Arranging (e.g., dressing in a set order or arranging things symmetrically)

The OCD Clinic at Johns Hopkins Hospital provides comprehensive outpatient assessments and treatment for individuals suffering from OCD and related disorders. It is directed by Gerald Nestadt, MD, MPH. Dr. Nestadt is a psychiatrist experienced in the clinical management of OCD and is actively involved in research into the causes of the disorder.

For additional information about the clinic, or to schedule an appointment, please call 410-955-5212.

General OCD Treatment Information

Effective treatments for each person with OCD varies just as the symptoms of OCD vary from person to person. The individual affected by OCD and their family members and friends can benefit from learning all they can about the disorder. Treatments can include one or more of the following:

Medications

Finding the most effective medication is important and useful. A series of trials on different medications is not uncommon. Psychiatrists can prescribe medications for OCD. It is important to discuss your symptoms honestly and openly and report any side effects you experience when taking medications. Although medications may have side effects, they can be very effective in reducing the symptoms of OCD with minimal adverse side effects. It is important to learn as much about the medication as possible, given that some medications do adversely interact with alcohol, other medications, sunlight, certain foods, etc. Medications commonly prescribed for OCD include Anafrinal, Luvox, Paxil, Prozac, Lexapro, Celexa, Cymbalta, Zoloft, and Effexor. There are additional ‘second-line’ treatments that may be prescribed.

Cognitive-Behavior Therapy

Behavior therapy is currently the non-pharmacological treatment of choice in the treatment of OCD. A clinical psychologist trained in behavioral therapy techniques can work with you to effectively reduce symptoms of OCD. Behavior therapy (specifically, exposure with response prevention) is often as effective as medication alone, but the most successful treatment usually is a combination of medication and behavioral therapy.

The behavioral model proposes that obsessions give rise to anxiety, and this anxiety is then reduced by compulsive behaviors. That is, compulsive rituals are strengthened and maintained because they decrease the anxiety by terminating the event that gives rise to it. For example, some event, such as touching a doorknob, activates an obsessive thought, such as that of contamination. The obsessive thought next generates feelings of anxiety and discomfort, which are relieved by performance of a compulsive ritual, such as hand washing. Successful behavior therapy first breaks the connection between the obsessive thought and the anxiety it produces and then breaks the connection between the performance of a ritual and the reduction in anxiety that follows. The former is accomplished by exposure and the latter by response prevention. Thus, the behavioral treatment of OCD based on this model is called exposure and response prevention. In exposure, patients confront (expose themselves to) the object, thought, or situation that frightens them. Exposure can consist of real contact with the feared object (in vivo exposure) or only in the patient’s imagination (imaginary exposure). In response prevention, compulsive rituals that function to decrease the distress brought on by obsessive thoughts are delayed or prevented entirely. Habituation is the process by which exposure therapy is thought to work. Obsessive thoughts or images produce feelings of anxiety or distress that continue to increase to very uncomfortable levels. In the absence of a neutralizing ritual, this distress will eventually decrease to levels that are tolerable or vanish almost entirely. At this point the rituals will disappear because there is nothing left to escape from and they are no longer reinforced by reductions in anxiety.

Hospitalization

As with any psychiatric disorder, OCD can cause a range of impairment. In rare cases, psychiatric inpatient hospitalization is necessary for individuals with severe OCD symptoms. OCD can become debilitating at times and significantly affect one’s functioning.