How We Treat OCD
The Arroyos approaches the treatment of obsessive-compulsive disorders (OCD) from an interdisciplinary team approach. OCD is best understood as a spectrum of disorders. We start with a thorough evaluation of your OCD symptoms to make an accurate diagnosis. We also need to address your level of functioning and any suicidal feelings, if present, so that we can create a plan for safety.
We talk with you about your concerns and goals for treatment and then create a customized treatment plan together with you. We offer a variety of types of evidenced-based psychotherapy, and we may recommend adding medication management as well. Our staff is here to provide you with premier care to help you address your problems so that you can feel better and start enjoying life again.
Diagnosing Obsessive-Compulsive Disorder
As there are several types of disorders on the OCD spectrum, getting the right diagnosis is essential to providing you with the best treatment. Our doctors talk with you to better understand the problems and symptoms you are having. We will also have you complete some questionnaires, brief psychological tests, and sometimes have you participate in a specific type of interview developed for OCD disorders. We also want to make sure that your OCD symptoms are not caused by another psychological condition, drug and alcohol abuse, or a medical condition.
Many patients with OCD spectrum disorders also have other mental health conditions such as anxiety, depression, and substance abuse problems. In addition to diagnosing your OCD disorder, we ask about other symptoms that you might be experiencing to make a comprehensive diagnosis of all psychiatric disorders that you are coping with to develop a comprehensive treatment plan.
Types of Obsessive-Compulsive Disorder
Obsessive-compulsive disorders (OCD disorders) are a group of disorders that share the common features of an obsessive preoccupation or repetition with thoughts, behaviors, or activities. These disorders also have similar responses to approaches to treatment. The specific types of OCD spectrum disorders are described below:
Obsessive-Compulsive Disorder: The presence of obsessions (unwanted, repetitive thoughts) and/or compulsions (repeated behaviors designed to neutralize an obsession).
Body Dysmorphic Disorder: Excessive preoccupation with the perception of defects of flaws in one or more body parts that are not observable to others. The individual engages in a variety of repetitive behaviors such as checking, cleaning, grooming, avoiding, covering up, and/or assurance seeking related to these perceived defects.
Hoarding Disorder: Excessive difficulty discarding possessions, regardless of their value, because of an intense urge to save them and intense anxiety at discarding them. The hoarding behavior results in the accumulation of such a large amount of possessions that the person’s personal space becomes so congested and cluttered that their living area is compromised and may become hazardous.
Trichotillomania (Hair-Pulling Disorder): Compulsive hair-pulling resulting in hair loss, despite attempts to stop. In extreme cases, the individual has pulled out all the hair on their body.
Excoriation (Skin-Picking) Disorder: Compulsive picking at one’s skin resulting in skin lesions, despite attempts to stop.
Substance/Medication-Induced Obsessive-Compulsive Disorder: Obsessions and compulsions that develop soon after using substances or medications or withdrawing from substances or medications. These symptoms are not better understood by the presence of an anxiety disorder or other mental disorder or physical disorder.
Other Obsessive-Compulsive Disorders: Obsessive-compulsive disorders that do not fit the criteria for the above disorders.
Psychotherapy for OCD
Cognitive behavioral therapy (CBT) is a cornerstone for the treatment of OCD spectrum disorders. CBT is a type of therapy in which you work with your therapist to change your dysfunctional thoughts and cognitive distortions in order to improve the way you view the world and specifically the OCD symptoms that you have. A specific type of CBT used in many OCD disorders is exposure therapy. In exposure therapy, you and your therapist set a goal to slowly work your way through a hierarchy of exposure to stimuli that you are fearful, obsess about, or avoid. For example, if you have an obsession about your hands being dirty, you and your therapist may limit the number of times you can wash your hands (exposing you to nonharmful germs), and work on the negative thoughts (obsessions) that enter your mind as you avoid your compulsive behavior.
Another type of CBT is habit reversal training. In this treatment the patient is helped to become more aware of the circumstances in which unwanted behavior such as hair pulling or skin picking occurs. Competing response training involves substituting an alternate response for the undesirable behavior that you and your therapist are trying to decrease. Increasing social support is also very helpful to engage trusted loved ones and friends to provide support, understanding, and help in changing your OCD patterns.
Medications for OCD
Your psychiatrist will work closely with you and your psychologist to select the right medication program for you. Pharmacogenomic testing through The Arroyos laboratory service may be recommended to better match your medications with your genetic profile. While SSRI and SNRI medications are typically the gold standard for most OCD spectrum disorders, the choice of which class of medication, brand, and the dose is made between you and your psychiatrist.
Psychopharmacology is a complex process, and you may have to try more than one type of medication before you find the right prescription plan to treat your condition. While milder OCD spectrum disorders may be treated with psychotherapy alone, for more severe cases, the best outcomes are often achieved with a combination of medications and psychotherapy. Your treatment team will regularly consult to maximize the coordination of your psychiatric and psychological care at The Arroyos.
How to Help a Loved One
If you have a loved one who is suffering from an OCD spectrum disorder, it is important to talk with them right away about your concerns. They may be embarrassed about their condition, have difficulty putting their feelings into words, feel hopeless or worthless, or be preoccupied with feelings of guilt or even suicidal thoughts. Let them know that you care and that you are confident that they can feel better if they speak to a trained professional. Please call us if they are willing to schedule an intake appointment. If they are unwilling or unable to get help, they may need to be hospitalized. If they are expressing thoughts of hurting themselves or someone else, this is an emergency. Call 911 or take them to the nearest emergency room.