How to Manage OCD

Obsessive-compulsive disorder (OCD) is characterized by obsessive thoughts, fears, and the compulsive behaviors that arise with these thoughts and fears. Though one may have only either obsessive thoughts or compulsive behaviors, the two normally present together, as the behavior emerges as an irrational way of coping with the scary thoughts. [1] While OCD cannot be removed as there is no cure, the good news is this disorder can be well-managed through a combination of therapy, medication, understanding, and self-help methods (including overall lifestyle changes).

Part 1
Part 1 of 4:

Managing OCD

  1. To treat OCD, you'll need help from a mental health expert. Who you should visit largely depends on your needs. If your OCD is very problematic, as in causing you distress every day and holding you back from being able to live a normal life, you will likely need to see a psychiatrist because you might need medication to change the chemicals in your brain. However, this remains entirely your decision. Make sure that this is a person you feel comfortable with and has the credentials required to meet your needs.
    • If you would like to begin with therapy, find a therapist that has experience treating OCD or related disorders. You can also visit a psychologist who can diagnose and treat mental disorders through talk therapy. In most cases, you will not need a referral to simply see a therapist or a psychologist, but some areas may require a referral. Search by either asking your regular physician, getting a referral from family or friends, or try using this handy psychologist locator from the American Psychological Association. [2]
    • If you believe you might need medication, you must visit your doctor to get a referral to see a psychiatrist. Psychiatrists are medical doctors specializing in mental health who can prescribe medicine (unlike therapists and psychologists who cannot prescribe medicine). If you don't know which psychiatrist to see, your doctor can recommend someone for you. In many cases, you can treat OCD with both therapy and medication.
  2. It is important to see a professional for diagnosis, as there are other problems that have similar symptoms to OCD. Begin by paying a visit to your primary care provider. Doctors have training in mental health. Your doctor will most likely ask you a series of questions to be on the lookout for any abnormal behavior related to OCD. When giving responses, be honest. [3] [4] Doctors can diagnose OCD, but most of them tend to refer their patients to a mental health professional for further evaluation and confirm if you have OCD. If they believe you may have OCD, they'll refer you to a psychiatrist but if you prefer to see a therapist or a psychologist, tell them. There are two groups of OCD symptoms, obsessions and compulsions. Obsessive symptoms are constant, tenacious and undesirable thoughts, impulses or images that trigger feelings of anguish or apprehension. You may feel thoughts or images keep popping up even though you try to avoid them or shut them down. Compulsion symptoms are the behaviors that you perform in order to cope with the concern linked to obsessions. These are the behaviors that supposedly prevent the fear from coming true, and they often appear as rules or rituals. Together, obsessions and compulsions create characteristic patterns like the following: [5]
    • Those who fear contamination and the spread of dirt, usually have cleaning or hand-washing compulsions.
    • Others repeatedly check things (that the door is locked, or the oven is turned off, etc.) that they associate with potential danger.
    • Some fear that if everything isn't done just right that something terrible will happen to themselves or loved ones.
    • Many become obsessed with order and symmetry. They frequently have superstitions about certain orders and arrangements.
    • Then, there are those who are afraid that bad things will come if they throw anything away. This makes them compulsively keep things around that they do not need (like broken objects or old newspapers). This condition is called Compulsive Hoarding.
    • To be diagnosed with OCD, you must have obsessions and compulsions on most days for at least two weeks. Alternately, you may be diagnosed with OCD if your obsessions and compulsions have a significant impact on your daily life (for example, you are so afraid of germs that you wash your hands so often they bleed and you cannot touch anything that is outside your house).
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  3. This sort of therapy focuses on exposure and response prevention (ERP), which means that your therapist will expose you to the things that you fear or obsess over, and then will help you to come up with healthy ways to cope with these anxieties. [6]
    • Therapy sessions may consist of one-on-one sessions, family therapy sessions, or group sessions.
  4. This may be a process of trial and error, and in some cases, you may find that a combination of drugs are more effective at combating your symptoms than one drug by itself. [7]
    • A commonly prescribed type of drug is a selective serotonin reuptake inhibitor (SSRI), like citalopram (Celexa), fluoxetine (Prozac), paroxetine (Paxil), and escitalopram (Lexapro). These drugs increase the activity of the neurotransmitter that helps balance mood and lower stress (serotonin). [8]
    • Another regularly prescribed drug is the tricyclic antidepressant (TCA) clomipramine, which has been approved by the FDA for treating OCD. SSRIs are usually prescribed over clomipramine because they have fewer adverse side effects. [9] [10]
    • Never stop taking any medication without consulting the prescribing doctor. This can cause a relapse of your symptoms and withdrawal-like side effects. [11]
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Part 2
Part 2 of 4:

Using Exposure and Response Prevention (ERP)

  1. [12] OCD occurs when an unpleasant thought (for example, a thought of spreading disease to your loved ones) happens to pop up in your mind, and an extreme interpretation of that thought follows (maybe having this thought says to you that you are an evil person who can harm others through carelessness). This thought/meaning pair will create a lot of anxiety.
    • Because anxiety is very uncomfortable, you act to make sure that the thought won't come true. In this example, you may wash your hands every time you touch something and say a prayer for your loved ones while washing.
    • While performing this ritual briefly relieves anxiety, the bad thought arises more and more frequently (from trying too hard not to think it). This is the vicious cycle of OCD.
    • The main points of ERP are exposing yourself to situations that bring on obsessions and then not engaging in the unhelpful coping strategy (the compulsive behavior).
    • If your OCD is very severe, you should try ERP under professional guidance.
  2. [13] Whatever brings on obsessions and compulsions (situations, objects, people, or other thoughts) are called "triggers" because they activate the cycle of OCD. Knowing what triggers you is crucial since they will be what you expose yourself to in order to practice resisting doing the behavior eases anxiety. [14]
    • Use this form to help you spend a week keeping track of what triggers you.
  3. [15] Once you have tracked your obsessions and compulsions for a week, rank all of the situations that you fear from least to most scary.
    • For instance, if you fear contamination, being at your parent's house might be low on the hierarchy. Going there only gives you a fear level of 1/10. Using a public restroom, on the other hand, may rank very high on the hierarchy and cause you an 8 or 9 level fear.
    • Use different fear hierarchies if you have different groups of triggers. For example, all of the situations you fear relating to a fear of disease would go in one hierarchy and fears relating to preventing a disaster would go in another.
  4. [16] In order for exposure to work, it is important that you try to resist carrying out your compulsions during or after the exposure (to the extent possible). This is because ERP teaches you to face your fear without the compulsions that go along with it.
    • Then, ask someone you trust to show you how to perform the task that your OCD effects. Learning from their behavior is helpful because chances are good that you have been performing compulsions for some time and don't remember how to face a feared situation without doing it. For example, compulsive hand-washers might ask relatives about their hand washing habits to get a more common perspective on how and when to wash.
    • If completely resisting a compulsion proves too difficult (especially early on), try to delay acting on the compulsion rather than not doing it at all. [17] For example, after leaving the house (exposure), wait for 5 minutes before going back to check your appliances, and only check 2 appliances instead of 5. Gradually prolonging the delay will help you to eventually leave the action behind altogether.
    • If you do end up performing a compulsion, try to re-expose yourself to the same feared situation immediately, and repeat the practice until your fear decreases by half. So, leave the house again immediately after going through the process above, and continue this repetition until your fear drops from an "8" out of 10 to just a "4". [18]
  5. [19] Once you experience only a little anxiety when completing an exercise, you can move on to the next one. Say after several practices you only feel very slight anxiety when you wait 5 minutes before checking your appliances after leaving the house. You can then challenge yourself to wait 8 minutes.
    • Remember that even when you feel very intense anxiety, your fear will spike and then slowly level off. If you do not respond to the fear, it will go away on its own.
    • Exposure can be a very trying experience, and you should not hesitate to ask for help from people in your life if you need some additional support.
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Part 3
Part 3 of 4:

Learning to Cope with Obsessive Thoughts

  1. [20] In order to challenge some of the unhelpful interpretations you give to your obsessions, you have to know what they are first. The best way to do this is to start tracking two things: (1) your obsessions, and (2) the meanings or interpretations you have given to those obsessions.
    • Use this form to help you record three obsessions (and your interpretations of them) per day for a week.
    • Record the situation that brings on your obsessions and the obsessive thoughts you had in the specific situation. When did you first have this thought? What was happening when you first experienced it? Also, record all the emotions you had when the obsession happened. Rate the intensity of your emotions at the time of the obsession on a scale from 0 (no emotion) to 10 (as intense as you can imagine).
  2. Along with tracking thoughts, track your interpretations or the meanings you give to these thoughts. To figure out your interpretations (since this can be difficult) ask yourself the following questions: [21]
    • What is so upsetting about this obsession?
    • What does this obsession say about me or my personality?
    • What kind of person do I think I'd be if I didn't act on this obsession?
    • What might happen if I don't act on this thought?
  3. Challenging these interpretations will help you see that, for many reasons, your knee-jerk thoughts are not realistic. Not only that, but your interpretations are not helpful in guiding you toward resolving the problems these thoughts pose. Ask yourself the following questions to prove yourself wrong: [22]
    • What evidence do I really have for and against this interpretation?
    • What are the advantages and disadvantages of this type of thinking?
    • Am I confusing a thought of my own with a fact?
    • Are my interpretations of the situation accurate or realistic?
    • Am I 100% sure that my thought will come true?
    • Am I seeing a possibility as an absolute certainty?
    • Are my predictions of what will happen based purely on my feelings?
    • Would a friend agree that the scenario in my head is likely to happen?
    • Is there a more rational way of looking at this situation?
  4. [23] Unhelpful interpretations are usually caused by confused ways of thinking often seen with OCD sufferers. Examples of common thought traps include: [24]
    • Catastrophizing is when you are sure (without any evidence at all) that the worst-case scenario will come to pass. Challenge catastrophizing by telling yourself that the worst-case is very rarely what ends up happening.
    • Filtering is the trap that causes you to only see the bad that happens and ignore, or filter out, the good. To counter filtering, ask yourself what parts of a situation you are failing to take into account, specifically the positive ones.
    • Over-generalization is the exaggeration of one situation to all situations, like thinking that because you misspelled something you always make stupid mistakes. Avoid over-generalization by thinking about counter-evidence (moments when you were very clever or caught and improved an error).
    • Black-and-white thinking means that situations are seen in extremes of either success or failure. For example, if you fail to wash your hands one time that they might have germs on them you are a bad, irresponsible person. Try shutting black-and-white thinking down by taking a serious looks at whether or not you have actually produced any bad effects and reminding yourself that this is not the time (nor is any time, really) to make an absolute judgment about your personality.
    • You can find more of these traps here .
  5. OCD is a chronic condition, and having unpleasant or unwanted thoughts is not something within your control. [25] Recognize that these thoughts are simply annoyances that do not have any effect outside of your own mind. Your thoughts are simply thoughts, and they don't have any bearing on who you are as a person.
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Part 4
Part 4 of 4:

Managing OCD with Diet and Lifestyle Modifications

  1. Because OCD is a type of anxiety disorder, stress can trigger symptoms, making them increasingly difficult to manage and overcome. [26] Any lifestyle changes you can make that keep stress and excessive worries at bay will also make it more likely for symptoms of OCD to relax.
  2. Omega-3 fatty acids can help directly to increase your brain’s serotonin levels, the same neurotransmitters affected by pharmaceutical drugs to treat OCD. This means that these foods also help manage your anxiety. [27] . Favor foods that are rich in omega-3 fatty acids over supplements. They include: [28]
    • Flax seeds and walnuts
    • Sardines, salmon, and shrimp
    • Soybeans and tofu
    • Cauliflower and winter squash
  3. Caffeine actually suppresses the production of serotonin in your brain. [29] Foods and drinks that contain caffeine include:
    • Coffee and coffee-flavored ice cream
    • Black tea, green tea, and energy drinks
    • Colas
    • Chocolate and cocoa products
  4. Exercising not only improves your muscle strength and cardiovascular health, but also can help to combat anxiety and OCD tendencies. When you exercise, you boost your body’s production of endorphins, which are hormones that are responsible for elevating your mood, reducing anxiety, and fighting depression. [30]
    • Try to exercise for at least 30 minutes, five times a week [31] . Some examples of healthy exercise include running, biking, lifting weights, swimming, and rock climbing.
  5. Among its numerous other benefits, sunlight increases the synthesis of serotonin in your brain by stopping nerve cells from reabsorbing it. [32] . Exercising in the sunlight will allow you to kill two birds with one stone!
  6. Deal with stress . When you are stressed, you are much more likely to see an increase (or an increased intensity) of your symptoms. So, learning the mental and physical methods to lessen stress is beneficial all around. Examples include the following:
    • Making long-term healthy lifestyle changes, like diet and exercise
    • Using to-do lists
    • Reducing negative self-talk
    • Practicing progressive muscle relaxation
    • Learning mindfulness and visualization meditations
    • Learning to identify sources of stress
    • Learn to say no when you are invited to take on more than you know you can manage
  7. There are support groups made up of people dealing with problems similar to yours. In these groups you can discuss your experiences and struggles with people who can relate. These support groups are good for lending reassurance and reducing feelings of isolation that often accompany OCD. [33]
    • Talk to your therapist or doctor about support groups in your area. You can also run an online search to locate support groups near you.
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      Tips

      • It's important to get a diagnosis from a mental health professional, because other conditions can cause symptoms that are similar to OCD. For example, if you feel a general, pervasive worry about everything, you may have Generalized Anxiety Disorder rather than OCD. If your fear is intense but localized to one or a few things, you may be dealing with phobias rather than OCD. Only a professional can make an accurate diagnosis and get you the treatment you need. [34]
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      • Symptoms of OCD commonly progress slowly and may vary in severity throughout one’s lifetime but are usually at their peak when triggered by stress.
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      • You should consult a specialist if your obsessions or compulsions are already affecting your total well-being.
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      References

      1. ↑ http://www.mayoclinic.org/diseases-conditions/ocd/basics/definition/con-20027827
      2. ↑ http://www.apa.org/helpcenter/choose-therapist.aspx
      3. ↑ http://www.mayoclinic.org/diseases-conditions/ocd/basics/tests-diagnosis/con-20027827
      4. ↑ https://iocdf.org/about-ocd/how-is-ocd-diagnosed/
      5. ↑ http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0072746/
      6. ↑ https://iocdf.org/about-ocd/ocd-treatment/erp/
      7. ↑ https://iocdf.org/about-ocd/ocd-treatment/meds/
      8. ↑ http://emedicine.medscape.com/article/1934139-medication#2
      9. ↑ http://emedicine.medscape.com/article/1934139-medication
      1. ↑ http://emedicine.medscape.com/article/1934139-medication#3
      2. ↑ http://www.mayoclinic.org/diseases-conditions/ocd/basics/treatment/con-20027827
      3. ↑ https://www.helpguide.org/articles/anxiety/obssessive-compulsive-disorder-ocd.htm
      4. ↑ https://www.helpguide.org/articles/anxiety/obssessive-compulsive-disorder-ocd.htm
      5. ↑ https://iocdf.org/expert-opinions/expert-opinion-self-directed-erp/
      6. ↑ http://www.anxietybc.com/sites/default/files/adult_hmocd.pdf
      7. ↑ http://www.anxietybc.com/sites/default/files/adult_hmocd.pdf
      8. ↑ http://www.anxietybc.com/sites/default/files/adult_hmocd.pdf
      9. ↑ http://www.anxietybc.com/sites/default/files/adult_hmocd.pdf
      10. ↑ http://www.anxietybc.com/sites/default/files/adult_hmocd.pdf
      11. ↑ http://www.anxietybc.com/sites/default/files/Managing_Obsessions.pdf
      12. ↑ http://www.anxietybc.com/sites/default/files/Managing_Obsessions.pdf
      13. ↑ http://www.anxietybc.com/sites/default/files/Managing_Obsessions.pdf
      14. ↑ http://www.anxietybc.com/sites/default/files/RealisticThinking.pdf
      15. ↑ http://www.anxietybc.com/sites/default/files/Managing_Obsessions.pdf
      16. ↑ http://beyondocd.org/expert-perspectives/articles/ten-things-you-need-to-know-to-overcome-ocd
      17. ↑ http://www.helpguide.org/articles/anxiety/obssessive-compulsive-disorder-ocd.htm#take
      18. ↑ http://www.hindawi.com/journals/omcl/2014/313570/
      19. ↑ http://www.hsph.harvard.edu/nutritionsource/omega-3-fats/
      20. ↑ http://www.ncbi.nlm.nih.gov/pubmed/8039038
      21. ↑ http://www.health.harvard.edu/press_releases/benefits-of-exercisereduces-stress-anxiety-and-helps-fight-depression
      22. ↑ http://www.heart.org/HEARTORG/GettingHealthy/PhysicalActivity/FitnessBasics/American-Heart-Association-Recommendations-for-Physical-Activity-in-Adults_UCM_307976_Article.jsp
      23. ↑ http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2077351/
      24. ↑ https://iocdf.org/ocd-finding-help/supportgroups/
      25. ↑ http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0072746/

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