Obsessive-Compulsive Disorder Part One: The Do Do Do, The Da Da Da

OCD is a very common diagnosis. It is extremely debilitating and interferes profoundly with relationships, accomplishments and personal happiness. It manifests itself with 2 profound elements. First is the obsessive, irrational thought. There is a perceived danger in the personal environment and it is magnified in the mind to the point that one can think of nothing else. These repetitive thoughts are cause for a compulsion to do something about that perceived danger and to act on removing or altering the magnitude of that danger and alleviating fear. When the urge to perform that task is insurmountable, it creates tremendous discomfort and interferes with important daily functions that must be performed to maintain one's well-being. These urges can be categorized into types. Some frequent recognized categories are Washers (obsessed with cleanliness), Checkers (consistently check on things they associate with danger), Counters (seek order, evenness and symmetry), Sinners (believe there will be severe consequences for a past action and seek to undue it), and Hoarders (take survivalist behavior to an irrational extreme).

OCD is commonly co morbid with other diagnoses. It is frequently diagnosed with depression and the inability to satisfy the compulsion feeds into the other hopeless feelings that fuel a low mood. It is also associated with other mood disorders, such as Bipolar and PTSD. In the case of ADHD, attention enhancing medicines are often cause for people to form "loops of thought," and a repetition of ideas that often lead to repetitive actions. Pharmacologically treated ADHD can often help manifest compulsive behavior as a side effect. Psychiatrists will commonly address this effect by prescribing an SSRI/antidepressant along with the attention enhancing drug. This patchwork approach is limited in its effectiveness.

Treatment of this illness focuses on interrupting the chain of thoughts and behavior associated with the idea and the action. It is generally conceded that the compulsive thoughts will exist at some level, but the OCD client can find ways to diminish the intensity of that thought and seek secondary cognitions and behaviors that diminish the urge to wash, go back, doubt or stack up. What helps reinforce the intensity of the obsession and compulsion is that it is positively reinforced. The hand washer does not catch the disease after repeated washing and the checker does not have his house broken into. The therapist is effective in supporting and validating the client's fears initially, but diminishing the intensity of those fears and helping the client find less intrusive behaviors to satisfy his now less intense fears. The hope is to find a new and viable chain of behavior. The compulsion to "do" will become the more comfortable, socially acceptable and less debilitating "da." Once the client is able to experience the contingency between the tone-downed thought and the less-profound action, this will be reinforced to the point that the old extreme thoughts and behaviors will fade away.

I am optimistically simplifying the course of treatment as described above. Alternative behaviors that are satisfying to the client are difficult to find and require allot of probing and problem solving with the therapist. OCD behaviors are often ingrained over a long period of time and are difficult to shake. In the next section I will get more specific about the treatment approaches that are taken to cure this illness.

Treating Anxiety Part 1: cycles and patterns

Anxiety is by far the most addressed issue in clinical therapy. It is the big kahuna of psychiatric treatment. The 3 largest selling prescription drugs in the U.S. for all ailments of body and mind are approved to treat anxiety. These drugs usually produce moderate to excellent initial success, but are known for profound side-effects and increased tolerance. That's why learning to manage it on your own is so important.

Although anxiety manifests itself in many ways, there are some common elements we can identify that help us gain an understand of the cause-effect relationship and behavior chains that make it an obstacle to enjoy and function in our daily lives. Here are a few commonalities:

The Tension Mounts: Anxiety accumulates through stress. Most people report anxiety heightening by the end of the day. Panic attacks occur far more often in the PM then AM. It is therefore very important for sufferers to take stress breaks during the day. If you have an anxiety problem and you are spending your lunch or coffee break surfing the net, calling family or friends or some other activity that requires significant attention and concentration, then you are making poor use of your time. Take a few minutes periodically during the day implement a stress reduction technique (much more on them later). This will at least slow the accumulation of stress during the day and make it more manageable as it peaks.

Domino Effect: When we are under stress, we often make hasty and impulsive decisions. The consequences of these decisions are often cause for more stress and anxiety. Like a bad lie made from a politician, things start to unravel and we experience chaos and a loss of control. The saying or song "one thing leads to another," probably alludes to this phenomena. This dynamic once again points to the need to keep stress at a minimum and reset periodically during the day.

The Mind-Body Relationship: There are several measurable physical response directly associated with anxiety: increased and variable heart rate, adrenalin being dumped in the blood stream, increased muscle tension to name a few. These will be further addressed in the discussion of biofeedback in part 2. When we experience uncomfortable physical sensations the result is generally, you guessed it, more anxiety. Someone's heartbeat increases and palpitates and they wonder if they need to go to ER. Or someone begins to perspire in a social setting and they become more self-conscious and less confident.

The common theme between these 3 elements of anxiety disorders is one of mounting and accumulating stress. We see a chain of events and behaviors that help feed the anxiety. The preventive or proactive element of treating this disorder is vital. The onus is on you to identify these maladaptive trends as they happen and try to subvert them. Then the therapist or other resource can give you a repertoire of techniques to help you tame this debilitating beast.

up next: Treating Anxiety Part 2: relaxation techniques