Delaware Valley OCD Clinic

Obsessive-Compulsive Disorder

Obsessive-compulsive disorder (OCD) is a psychiatric anxiety disorder that includes distressing, intrusive thoughts and related compulsions (tasks or "rituals") to neutralize the obsessions. Obsessions are usually upsetting and the compulsions lead to temporary feelings of relief.

To be diagnosed with obsessive-compulsive disorder, one must have either obsessions or compulsions alone, or obsessions and compulsions together. Most people with OCD have both.

Obsessions are:

  1. Recurrent and persistent thoughts, impulses, or images that are intrusive and inappropriate. The thoughts cause severe anxiety or distress.
  2. The thoughts, impulses, or images are not just excessive worries about real-life problems.
  3. The person tries to ignore or suppress the thoughts, impulses, or images, or to neutralize them with some other thought or action.
  4. The person recognizes that the obsessional thoughts, impulses, or images are a product of his or her own mind, and are not based in reality.

Compulsions are:

  1. Repetitive behaviors or mental acts that the person feels they must perform in response to an obsession, or according to rigid rules.
  2. The behaviors or mental acts to prevent or reduce distress or prevent some dreaded event or situation; however, these behaviors or mental acts either are not connected in a realistic way with what they are supposed to neutralize or prevent or are clearly excessive.

In addition, at some point during the course of the disorder, the person must realize that his/her obsessions or compulsions are unreasonable or excessive. The obsessions or compulsions must be time-consuming (taking up more than one hour per day), cause distress, or cause difficulty in social, work, or school functioning. Having OCD is stressful and can lead to feelings of depression.

Prevalence

Community studies have estimated a lifetime prevalence of 2.5% and a 1-year prevalence of 0.5%-2.1% in adults. Research shows that prevalence rates of obsessive-compulsive disorder are similar in many different cultures around the world.

Onset of OCD

OCD usually begins in adolescence or early adulthood, but it may begin in childhood. Most people with OCD have a chronic waxing and waning course, with worsening of symptoms that may be related to stress.

The phrase "obsessive-compulsive" has worked its way into the wider English language, and is often used in an off-hand manner to describe someone who is meticulous or absorbed in a cause (i.e. "anal retentive"). It is also important to distinguish OCD from other types of anxiety, including the routine tension and stress that appear throughout life. Although these signs are often present in OCD, a person who shows signs of infatuation or fixation with a subject/object, or displays traits such as perfectionism, does not necessarily have OCD.

OCD has Many Faces

Symptoms of Obsessive-Compulsive Disorder

  • The most common problem experienced by people with OCD is excessive doubt leading to repeated checking.
  • A quarter have contamination concerns, leading to repeated washing and avoiding items felt to be dirty.
  • Many OCD patients save or collect too many items , and these hoarded items can cause a shortage of living space. (more about hoarding)
  • Over half are concerned about symmetry and order.
  • Many worry excessively about right and wrong, a condition called scrupulosity.
  • Almost a third have sexual obsessions or worry about religious issues. This includes people with worries about being gay or violating a religious ritual.
  • The next most common concern is about harming others or self accidentally or on purpose.
  • A few worry that they have contracted a dreadful illness, like cancer or AIDS.
  • Almost one in five have other concerns not described here.

Source: Ruscio, A. M., Stein, D. J., Chiu, W. T., & Kessler, R. C. (2010). The epidemiology of obsessive-compulsive disorder in the National Comorbidity Survey Replication. Molecular Psychiatry.

National Organizations with Information about OCD

Our therapists are members of these important organizations:

Treatment of OCD

There are many effective treatments for obsessive-compulsive disorder, including medication and therapy. The type of treatment you select may vary based on severity of your OCD, the recommendation of your clinician, and what type of treatment makes you feel the most comfortable.

OCD Treatment by Therapy

Cognitive-behavior therapy (CBT) is a type of psychotherapy that has been shown to be highly effective for OCD. The goal of CBT is two-fold: to change thoughts and behaviors. The cognitive portion involves the identification and analysis of unhelpful and unrealistic thoughts, which are then challenged. In the behavioral portion, the therapist and client work together to change the compulsive behaviors. This typically includes techniques such as Exposure and Response Prevention, also called Exposure and Ritual Prevention (EX/RP). In the exposure piece of the treatment, patients repeatedly expose themselves to their fears. By facing their obsessions in a systematic order, without performing compulsions, the person learns that there is nothing to fear and the obsessions begin to fade away.

Treatment of obsessive-compulsive disorder is typically completed in about twenty, 90-minute individual sessions with a therapist. This treatment emphasizes a behavioral approach to this disorder called Exposure and Ritual Prevention (Ex/RP). These sessions involve gradual exposure to one's feared thoughts and situations, while the patient learns to control compulsive behaviors such as washing and checking. Most patients complete treatment for their OCD over the course of 10 weeks. Medications may be recommended in addition to cognitive-behavioral therapy.

Please contact us if you would like to work with one of our expert therapists to get effective treatment for your OCD.

Medication for OCD

Antidepressant Medications: SSRIs

The main medication treatment for OCD is a class of antidepressants called selective serotonin reuptake inhibitors (SSRIs) that block the re-absorption of serotonin in the brain. Although SSRIs are commonly given for depression, research has shown they can also be effective for the treatment of anxiety and OCD. Common side effects may include, headaches, nausea, sexual dysfunction, and diarrhea, but usually these side effects are minor and temporary. The most commonly prescribed SSRIs for OCD are listed below.

Approved Medication

  • Selective serotonin reuptake inhibitors (SSRIs):
    • Paxil (paroxetine)
    • Luvox (fluvoxamine)
    • Prozac (fluoxetine)
    • Zoloft (sertraline)
    • Celexa (citralopram)
    • Lexapro (escitalopram)
  • Serotonin reuptake inhibitor (SRI):
    • Anafranil (clomipramine)

There is some evidence that anafranil may be slightly more effective in treating OCD, however it also tends to have more unwanted side effects, thus the trend toward prescribing SSRIs. Unfortunately, many people only find partial relief of their OCD symptoms from these medications, highlighting the importance of effective therapy strategies. Please contact us if you would like to be evaluated by our psychiatrist for medication for OCD.

Want to Get Better Fast?

Adding medications that improve memory can improve the effectiveness of exposure-based OCD treatment. This growing class of drugs is referred to as “cognitive enhancers," including the safe medication known as D-cycloserine (DCS). Research shows that DCS results in improved memory. Unfortunately, people develop rapid tolerance to the positive memory effects of DCS. Thus, DCS is not useful for long-term administration to improve memory. Rather, DCS can be used for discrete learning episodes for material that is important to remember. One randomized controlled trial conducted by researchers at Harvard and Yale found that patients given DCS with their Ex/RP therapy improved 2.3 times faster than those given a placebo. Although promising, DCS is still not in widespread use in clinical practice. Nonetheless, for many people DCS may help reduce costs, drop-out rates, and speed up therapeutic progress in Ex/RP. Please contact us if you would like to be evaluated by our psychiatrist for medication for OCD, including D-cycloserine.

Contact Us & Directions

Behavioral Wellness Clinic &
Delaware Valley OCD Clinic
225 Wilmington West Chester Pike
Chadds Ford, PA 19317
Phone: (484) 324-2749

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Clinical Director: Monnica Williams, PhD
Office Manager: Jasmine Terwilliger
Business Manager: Matthew Jahn