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Obsessive-Compulsive Disorder (OCD) – Overview

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What is OCD? Obsessive-compulsive disorder (OCD) is a debilitating mental illness that affects nearly 2.5% of the population (American Psychiatric Association, 2000).  The primary features of the disorder include obsessions, which are recurrent and persistent thoughts, impulses, or images that cause severe anxiety and distress; and compulsions, repetitive behaviors or mental acts performed in response to an obsession.  Compulsions frequently are performed to reduce distress or prevent a dreaded event or situation from occurring.  Because individuals with OCD often spend many hours each day experiencing obsessive-compulsive symptoms, the disorder severely impairs functioning across a variety of domains. According to Rasmussen (2005), individuals with OCD tend to adhere to highly rigid and disciplined notions about how to do things properly, “sacrificing opportunities for positive, pleasurable activities to maintain a position of disciplined appropriateness” .  Consistent with this view, cognitive rigidity...

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Parenting Kids & Teens with OCD: Don’t Feed the Reassurance Monster…and Other Quick Tips

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Many excellent parents struggle with how to appropriately parent their child/teen with obsessive-compulsive disorder (OCD). Unfortunately, this process is rarely straightforward and is often counter-intuitive, which leaves many parents feeling anxious and confused. As a psychologist in Palm Beach County, Florida, I work closely with kids, teens, and parents throughout the greater Palm Beach, Fort Lauderdale, and Miami areas on strategies for recovering from OCD. I also run a free support group for kids/teens with OCD. Consider the following set of ground rules for parenting your child with OCD.  The strategies you adopt as a parent can mean the difference between reducing your child’s symptoms or giving these symptoms room to grow. 1. Remind yourself that OCD is based on emotion rather than logic. Many parents get tripped up and frustrated by the many illogical forms that OCD takes....

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ERP therapy for OCD: Shifting from destructive to constructive to gestalt notions

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Here’s a question for you: Is exposure and response prevention (ERP) fundamentally a destructive or constructive process? I think that many people naturally conceptualize it as more of the former than the latter. They conceive of ERP as being the process by which we can “unlearn” or “weaken” maladaptive associations. We learn, through repetition, to no longer be afraid of those things that previously incited fear. On the surface, this appears to be a notion predicated on destruction. In actuality, it is not. If you ever take the time to refer back to the basic animal literature on fear learning and fear “unlearning”, you’ll find that associations appear to be weakened largely as a consequence of new learning taking place. This new learning competes with (and weakens the expression of) previous learning. It is this process that accounts for...

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OCD and DSM-V: Taking the “anxiety” out of OCD

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Psychiatrists and psychologists continue to debate the fundamental nature of OCD, trying to decide whether or not OCD should continue to be classified as an “anxiety disorder.”  In some ways, OCD overlaps with other anxiety-related conditions, such as panic disorder, phobias, social anxiety disorder, generalized anxiety disorder, and post-traumatic stress disorder (PTSD).  In other ways, OCD is unique unto itself. Although the current version of the Diagnostic and Statistical Manual (the book that psychologists and psychiatrists use when making diagnoses) classifies OCD as an anxiety disorder, the next revision is likely to give OCD its own category of related conditions (see here). Regardless of your position on the conceptual issues involved in this change, there are many pragmatic benefits that arise from treating OCD-related conditions as distinct from the anxiety disorders.  For example, it is likely that this change will ultimately...

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OCD guilt, shame, disgust, anxiety & depression: Why treatment sometimes fails (and what to do about it)

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OCD isn’t just about anxiety. Although anxiety is certainly a prominent feature of the disorder, clinicians who only attend to anxious symptoms can easily overlook some of its other core features. As a psychologist in Palm Beach, Florida, I work closely with kids, teens, and adults throughout the greater Palm Beach, Fort Lauderdale, and Miami areas on strategies for recovering from OCD. In the patients I treat, anxiety is often accompanied by significant guilt, shame, disgust, and depression. These features are not necessarily related to, or caused by, anxiety; they can be distinct processes. If you (or your psychologist) conceptualize exposure and response prevention (ERP) as only a means to habituate to anxiety but fail to consider how treatment must also address these other features, you are likely to have a suboptimal treatment response and will continue to experience significant...

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OCD, ERP, & doubt sensitivity: Shattering the illusion of certainty

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Many individuals with OCD hunger for certainty. It’s a craving that often can’t be easily sated. Early conceptions of OCD from the 19th century acknowledged this issue directly, in that OCD was often termed the “doubting disease.” It is this need for certainty, the need to eliminate doubt, that leads many people with OCD to perform repetitive behaviors, which are known as rituals. For example, it is doubt about whether one’s hands are sufficiently clean that leads one to engage in repetitive hand-washing rituals. Likewise, uncertainty about whether a stove has been turned off (and worry about potentially dire consequences) can underlie checking rituals. Many different types of rituals involve reassurance-seeking behaviors. For people with OCD who have intrusive bad thoughts (e.g., What if I secretly want to hurt a family member? What if I don’t believe in God...

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