How Do Psychiatrists Treat Obsessive-Compulsive Disorder (OCD)?

Addressing the Stigma (New Section)

If you suffer from Obsessive Compulsive Disorder (OCD) or know somebody who suffers from it, you might know that people with OCD are often tagged “Too Clean”, “Too panicky” or “Too repetitive

While this is a part of the public stigma, there is personal stigma too. A person might feel guilt or ashamed of their behaviors and might refrain from being themselves completely. It also prevents them from seeking treatment.

One must understand that OCD can be disabling if not addressed on time. Addressing your issues related to OCD and looking after your well-being is extremely important. After all, your mind is like the CPU for your body. You must maintain it before it starts to affect the functions of your body. Before you go into self-repair mode, you must know that it is always better to rely on a professional for such matters. In the case of OCD, mental health professionals can guide you through the treatment process.

This article covers how psychiatrists diagnose and treat obsessive-compulsive disorder.

What is Obsessive-Compulsive Disorder (OCD)?

Obsessive-compulsive disorder (OCD) is a mental disorder in which a person experiences recurring and persistent thoughts, ideas, or sensations (obsessions) and engages in compulsive behaviors to seek relief from them.

The obsessive thoughts are persistent, intrusive, and cause significant distress to the individual. Usually, the content of the obsessive thoughts falls within the five overlapping categories:

Contamination obsessions
Rumination and unwanted thoughts
Symmetry obsessions
Hoarding
Checking (1)

Compulsions are repetitive mental or physical actions that an individual is compelled to engage in according to their stereotyped manner. Here are some of the common compulsions reported by the National Institute for Health and Clinical Excellence (NICE):

Cleaning and washing
Repetitive checking (eg: Is the bedroom door locked)
Counting
Maintaining symmetry or exactness
Repeating words silently

When to See a Psychiatrist for OCD

Many think that people with OCD are just more anxious than others and it is to overcome by having strong willpower. The most important thing to understand here is that though behaviors of OCD are easily recognizable, it can be very difficult for people to control them.

Stressful situations might also trigger anxiety or other mood disorders in people with OCD. It might interest you to know that OCD is common in patients with bipolar disorder, depression, and anxiety disorders. (2) Apart from the comorbid symptoms, people with OCD might also accompany a tic disorder. Tics are repetitive movements or sounds. It can be as simple as eye movements, or shoulder shrugging or as serious as abdominal tensing or assuming a difficult posture. (3)

When such symptoms of OCD start to affect your psychosocial functioning and cause you significant distress, you might want to consider seeing a psychiatrist.

What to Expect During Your First Visit to a Psychiatrist for OCD

If you've decided to see a psychiatrist for OCD, it is advised to keep an updated medical history. The psychiatrist might conduct a detailed evaluation which includes an inquiry about your family and personal background. The assessment might also include questions about substance use, and alcohol consumption The evaluation typically involves a comprehensive interview and the use of assessment tools to gauge the presence and severity of OCD symptoms.

Additionally, the psychiatrist will screen for other mental health conditions such as anxiety or depression during the assessment. Upon finishing the evaluation, the psychiatrist might create a personalized treatment plan tailored to align with recovery. This plan involves therapy and if necessary, medication too. Once the assessment is finished, the psychiatrist will collaborate with you to create a personalized treatment plan tailored to your specific needs and goals. This plan may involve therapy and, if necessary, medication.

If medications are prescribed, it's important to adhere to the treatment regimen as instructed by your psychiatrist and continue taking the medications for the recommended duration. As symptoms improve, your psychiatrist may gradually reduce the dosage of medications.

How Can Psychiatrists Help in Treating OCD?

A psychiatrist plays a significant role in diagnosing OCD. In most cases, it involves a combination of psychotherapy and medications.

Once the medications are started, the psychiatrist tracks the patient’s symptoms throughout the course of treatment and makes adjustments as necessary.

1.OCD treatment Using tDCS

While a lot of psychological and pharmacological interventions are helping individuals cope with OCD, transcranial direct current stimulation (tDCS) is gaining popularity in treating the resistant symptoms of OCD and comorbid symptoms of anxiety and depression.

tDCS is a non-invasive brain stimulation technique with a mild current (1-2 mA) applied between electrodes attached to the subject's scalp. Applying weak current improves cognitive functioning by increasing the signaling between the neurons (brain cells). The placement of the electrode depends upon the affected area of the brain. Many psychiatrists are now suggesting the use of tDCS for the treatment of OCD. (9)

Mave Health uses the ARC-tDCS, which follows the same principle but with more ease. ARC-tDCS is a wearable self-managed brain stimulation device that can be used at home easily with the help of medical guidance and supervision.

2.Medications to Treat OCD

For many OCD patients, medications have long been a crucial component of treatment with a high efficacy rate. Effective management of obsessive-compulsive behavior involves determining the right dosage and duration of treatment.

A. Selective serotonin reuptake inhibitors (SSRIs):

SSRIs are recognized as the cornerstone of pharmacological treatment for OCD, serving as the first-line therapy. They work by increasing the uptake of serotonin, which plays a crucial role in mood stabilization. Some commonly used SSRIs with their brand names are mentioned below:

Fluoxetine (Prozac)
Sertraline (Zoloft)
Escitalopram (Lexapro)
Paroxetine (Paxil)
Citalopram (Celexa)
Fluvoxamine (Luvox)

B. Clomipramine:

Certain tricyclic anti-depressants like Clomipramine are used as a second line of treatment for OCD. It increases serotonin and norepinephrine levels, neurotransmitters that are responsible for mood regulation. A research study finds that clomipramine improved symptom scores by 37% for participants aged ten and older. (5)

Certain tricyclic anti-depressants are also useful for treating OCD. Clomipramine is one such drug that has been extensively used to manage the symptoms of OCD. Though more efficacious than SSRIs, Clomipramine is used as a second life of defense. It increases Serotonin and norepinephrine - chemical messengers that help to regulate the mood. The researchers found clomipramine improved Children's Yale-Brown Obsessive-Compulsive Scale (CY-BOCS) by 37% in children and adolescents. (5)

3. Psychotherapy Treatments for OCD:

Psychotherapy is used as the first line of treatment for mild to moderately ill patients. For patients with severe symptoms, a combination of psychotherapy and SSRIs is used. Currently, there are multiple therapies available. They are:

Acceptance and Commitment Therapy
Mindfulness-based cognitive therapy
Family inclusive treatments
Stress management and relaxation training

While these therapies have shown results, Cognitive Behavioral Therapy, and Exposure and Response Prevention have shown consistently efficacious results. (6)

A. Cognitive Behavioral Therapy:

Cognitive behavioral therapy is an approach that addresses a person’s behaviors and thinking. It helps a person understand how their obsessive thoughts can influence their compulsive actions. During the course of the therapy, the therapist provides the patient with a set of techniques that can help them manage their symptoms.

Following these techniques might help a person distinguish between routine and intrusive thoughts and tag them as unwanted or obsessive. Over time, a person may learn how to challenge their obsessive thoughts and approach them with logic.

B. Exposure and Response Prevention Therapy:

Exposure and response prevention (ERP) is a type of cognitive behavioral therapy (CBT) that aims to help the patient confront their fears/discomfort related to their obsessional thoughts (exposure) instead of performing their compulsions (prevention) once the anxiety or obsession is triggered. Exposure can be of any type - in vivo (actual), imaginal, or physical sensations that are associated with anxiety.

4. Psychoeducation

Psychoeducation in terms of OCD involves educating the patient about the nature of the disorder in detail. It usually consists of a description of:

Education about the symptoms of OCD
Causes and triggers of OCD
Treatment options.

Doing this cultivates a better understanding of the disorder and addresses the stigma around OCD. It also encourages individuals to make better decisions and actively participate in the recovery process.

5. Lifestyle Changes:

Exercise:

Maintaining a healthy lifestyle can help OCD patients to improve their mood. In fact, research shows that doing aerobic exercise can help to reduce compulsions significantly. Patients can use their bouts of physical activity to fight against the urge to perform the compulsions. (7) If you cannot exercise regularly, move your body in any way that seems accessible to you.

Maintaining Sleep Hygiene:

Apart from regular exercise, maintaining healthy sleep habits can also help to manage the symptoms of OCD. if you are suffering from OCD, make sure that you maintain a fixed sleep schedule. A sleep cycle of 7-8 hours daily is important. Waking up and sleeping around the same time is equally important.

For better quality of sleep, you can make the environment suitable enough for you to sleep. A quiet dark room with a temperature that is suitable for you might help you sleep soundly. If it is possible, try to avoid screen time in the hours leading to sleep.

Meditation:

Meditation and mindfulness can be used alongside routine therapy and pharmacological treatment to manage OCD symptoms. A study comprising 16 clinical trials showed that combined therapy of meditation and medication was effective in reducing the symptoms of OCD effectively. (8) With the help of guided meditations, OCD-induced anxiety can be managed thus helping the person to resist their obsessive thoughts and compulsions.

6. Building an Emotional Support System

Constantly having intrusive thoughts or acting on compulsions can be mentally exhausting. At such times, emotional support from family and friends can be really helpful in providing comfort and encouragement.

You can talk about their thoughts and their urges to them. Sharing worries with your close ones helps to develop trust and break the taboo around OCD. You can also join support groups where you find other people suffering from similar situations. Listening to their stories can make one realize that they are not alone in this battle. Nowadays, support groups can be contacted online as well. You can choose anything that you are comfortable with.

If you feel that you can benefit from becoming a part of a group that shares a similar outlook toward your problem, there is always an option to join therapy communities or online forums. Here, you can learn about the emotional and social aspects of OCD along with other behavior management tips.

Know ways to overcome OCD?

Conclusion:

OCD is a serious mental health disorder that can severely impact your life, but fortunately, it is treatable with professional support. Psychiatrists are crucial for guiding patients through the treatment process and constructing a tailored treatment plan for every individual.

If you or someone you know feel that they are experiencing similar symptoms, you can always seek professional help. With the right help, people suffering from OCD can overcome their stigma and lead a better quality of life.