Attn psychology/psychiatry/medicine grads

what solutions are there to OCD?

OCD. obsessive compulsive disorder. i mean for real. can't sleep at night because i can't stop doing my compulsions and if i absolutely absolutely force myself to sleep i give up and turn the light back on because i'm obsessing so much about them that i can't sleep anyway. i do not mean maple. i mean washing-hands-until-they-bleed type meaningless behaviours.

um, if you are clinically trained, i'm also apparently comorbid anxiety with some executive dysfunction. i've had some attempt with imagery therapy to help me sleep better but this has been almost completely thwarted by the OCD.

i can think of several interventions:
- cbt - cognitive behavioural therapy (i guess imagery goes into this.)
- aba - applied behavioural analysis
- don't know of any medication. i refuse to take medication unless it has a huge amount of scientifically solid evidence behind it, but if it's there i'd like to know about it.
- don't place much hope on psychodynamic therapies but if there's evidence for it i'd be curious about it too.

in this thread i am asking what options for therapy/intervention are there for ocd, with evidence, that you guys know of? posting in the rubik's cube to emphasise serious question.

sincere thanks in advance.

I'm pretty sure there is no "solution". I did what you could have done; looked it up on the interbutts:

Behavioral therapy

The specific technique used in BT/CBT is called exposure and ritual prevention (also known as "exposure and response prevention") or ERP; this involves gradually learning to tolerate the anxiety associated with not performing the ritual behavior. At first, for example, someone might touch something only very mildly "contaminated" (such as a tissue that has been touched by another tissue that has been touched by the end of a toothpick that has touched a book that came from a "contaminated" location, such as a school.) That is the "exposure". The "ritual prevention" is not washing. Another example might be leaving the house and checking the lock only once (exposure) without going back and checking again (ritual prevention). The person fairly quickly habituates to the anxiety-producing situation and discovers that their anxiety level has dropped considerably; they can then progress to touching something more "contaminated" or not checking the lock at all—again, without performing the ritual behavior of washing or checking.

Exposure ritual/response prevention has been demonstrated to be the most effective treatment for OCD. It has generally been accepted that psychotherapy, in combination with psychotropic medication, is more effective than either option alone. However, more recent studies have shown no difference in outcomes for those treated with the combination of medicine and CBT versus CBT alone.[40]

Recently it has been reported simultaneous administration of D-Cycloserin (an antibiotic) substantially improves effectiveness of Exposure and Response prevention

Cognitive behavioral therapy
Exposure and response prevention

And then, of course, you've got all of those drugs and meds that manage most of the aspects.

thanks greg, appreciate you took the time to copy it out for me. sounds kinda like what cbt might also call systematic desensitisation? i've been referred to a cbt psychologist, that is probably what they will get me to do. my fiance has also suggested that particular technique for my heliophobia... guess i can be sure it will feature prominently in the weeks/months/years to come!

(i wonder where it will all end...)

drugs? which aspects were you thinking of?

Sourced from Wikipedia, "Medications as treatment include selective serotonin reuptake inhibitors (SSRIs) such as paroxetine (Seroxat, Paxil, Xetanor, ParoMerck, Rexetin), sertraline (Zoloft, Stimuloton), fluoxetine (Prozac, Bioxetin), escitalopram (Lexapro), and fluvoxamine (Luvox) as well as the tricyclic antidepressants, in particular clomipramine (Anafranil). SSRIs prevent excess serotonin from being pumped back into the original neuron that released it. Instead, serotonin can then bind to the receptor sites of nearby neurons and send chemical messages or signals that can help regulate the excessive anxiety and obsessive thoughts. In some treatment-resistant cases, a combination of clomipramine and an SSRI has shown to be effective even when neither drug on its own has been efficacious."

My two cents: Recent research data gathered by Valenstein in his book, "Blaming the Brain" highly suggests that SSRIs serve a substrate/receptor relationship in which drugs such as Prozac instead of regulating receptor sites, stimulate more receptor sites to grow as a result of the unexpected surge in prozac as a viable substrate. In order to meet the added amount of chemical material, the receptors will multiply in order to meet the increased demand and therefore will require more Prozac in order to cause similar effects in the patient. Because not all of the biochemical pathways in the brain are known, there is no clear explanation of this phenomenon. At the same time, there is no clear prediction that this treatment will not cause receptor growth within the human brain in order to meet the increase in serotonin.

Disclaimer: I'm only an undergraduate who's taken three graduate level psychology courses. I'm a double major in Psychology and Genetics/Biotechnology.

You might not even receive Prozac or an SSRI as treatment. If you want to know more, you can check wikipedia. The information there is pretty sound believe it or not.

http://en.wikipedia.org/wiki/Obsessive-c...Medication

Note: It seems like everyone and their mom is a cognitive-behavioral therapist. It tends to compromise the ridiculous unyielding view of behaviorist with cognitive ideology which has always been a sort of compromise between Freudian psychotherapy and Skinner behaviorism. In general it's probably the best person you can see. I wouldn't see a psychiatrist until you see a therapist first. But don't see a psychotherapist, because the only thing they would want you to do is to probably talk about your issues like many people do on a forum and try to find greater meaning behind your past than what's really there.

Honestly though, different strokes for different folks. No two humans are made the same way and I honestly think that psychotic people have gotten shafted by social engineering and a tyranny of the majority. Explore all options. It's the least you could do for yourself.

The only real way to beat OCD is to suffer through the agony of ignoring your compulsions. Eventually after ignoring them long enough you'll realize that life continues just fine without doing them. It's just that simple, it's just that brutal.

thanks azalea for your thoughts. i have had a close loved one on several ssri's and saw disaster upon disaster. it turns out one of her antidepressants increased her suicidal thoughts (we ask ourselves what is the point there?). i guess i am a bit cautious about mood disorder drugs.

i am at once fascinated and horrified by the comment from the book you mentioned regarding prozac and serotonin. it underscores how we call ourselves scientists and find one thing that a neurotransmitter does and leap into it with drug companies and marketing and all and we don't even know what the effects really do until we do some involuntary "human experiments" in the drug industry. with mood disorder drugs especially i think it will be a long time before we know exactly what serotonin does and how it behaves, let alone the drugs that change it.

this is one of my big reasons for being cautious about drugs, but i am still open to suggestions if there truly is research for it. (and not medical spin. there is a lot of medical spin. i am very well-acquainted with medical spin. my fiance does a lot of that.)

i am also a psychology graduate who is now doing a psychology-based masters (although i never did much into drugs.)

exploring all options: will do. the first thing is to come clean and tell someone who can refer me or something.

The only real way to beat OCD is to suffer through the agony of ignoring your compulsions. Eventually after ignoring them long enough you'll realize that life continues just fine without doing them. It's just that simple, it's just that brutal.

what evidence is there for this intervention?

i have 100% faith that this will "go away" eventually. in the meantime, i still don't sleep, still am causing permanent damage to my body, and in fact have done this behaviour on and off every day for the last 10 years. 10 years? yes, eventually i believe i won't struggle with this anymore but if it's been here for 10 years and i haven't done anything about it, i don't see why "not doing anything about it" will change anything.

maybe i don't really understand what you mean by ignoring my compulsions? my compulsions do not in themselves bother me, although i "know" that they are inherently unhealthy for me. someone who cuts themselves on a regular basis is not disturbed by the blood or the cutting, but they know that it's unhealthy.

not sure about every other person who's had ocd but for me the compulsions are as shameful (in terms of hiding it from other people) as hiding anorexic behaviour. (i am very glad this is an anonymous forum.) i do not mean the compulsions are embarrassing in themselves. but the "ignoring" solution does not change the fact that you live in constant shame (or whatever portion of your life is taken up by the ocd.)

btw, for me it's not hopelessly pervasive, just persistent: doesn't take up a huge part of my day (mostly just my sleep and study), but i can't stop it from doing so.

the obsessions bother me i guess but it is not possible to simply "ignore" the obsessions. imagine if you have an obsessive thought, it pervades all your other thoughts and unless you knock yourself out you will be thinking about it. and if you meant "permit the obsession and deliberately not do the compulsion," that takes such a huge amount of effort (is it possible?) that frankly i would rather just do the compulsion if it requires that much effort. is there any technique you know of that will help me "deliberately not do the compulsion"?

- in the meantime, i still forget to sleep.
- when i don't forget to sleep, i feel guilty that i'm doing my compulsions and not sleeping.
and i still don't sleep.
- shame: having to hide it from other people or they will comment.
- the compulsion in itself involves hurting myself.
- yes i don't want scars or permanent damage (i'm sure have permanent damage already, though i know it could be worse) but no matter how much i tell myself this it doesn't prevent me from doing it.

i do not see how "ignoring" any part of it will make me more healthy. isn't "ignoring" what i have been doing for the last 10 years?

(really sorry it has been so rambly)

thanks azalea for your thoughts. i have had a close loved one on several ssri's and saw disaster upon disaster. it turns out one of her antidepressants increased her suicidal thoughts (we ask ourselves what is the point there?). i guess i am a bit cautious about mood disorder drugs.

i am at once fascinated and horrified by the comment from the book you mentioned regarding prozac and serotonin. it underscores how we call ourselves scientists and find one thing that a neurotransmitter does and leap into it with drug companies and marketing and all and we don't even know what the effects really do until we do some involuntary "human experiments" in the drug industry. with mood disorder drugs especially i think it will be a long time before we know exactly what serotonin does and how it behaves, let alone the drugs that change it.

this is one of my big reasons for being cautious about drugs, but i am still open to suggestions if there truly is research for it. (and not medical spin. there is a lot of medical spin. i am very well-acquainted with medical spin. my fiance does a lot of that.)

i am also a psychology graduate who is now doing a psychology-based masters (although i never did much into drugs.)

exploring all options: will do. the first thing is to come clean and tell someone who can refer me or something.

what evidence is there for this intervention?

i have 100% faith that this will "go away" eventually. in the meantime, i still don't sleep, still am causing permanent damage to my body, and in fact have done this behaviour on and off every day for the last 10 years. 10 years? yes, eventually i believe i won't struggle with this anymore but if it's been here for 10 years and i haven't done anything about it, i don't see why "not doing anything about it" will change anything.

maybe i don't really understand what you mean by ignoring my compulsions? my compulsions do not in themselves bother me, although i "know" that they are inherently unhealthy for me. someone who cuts themselves on a regular basis is not disturbed by the blood or the cutting, but they know that it's unhealthy.

not sure about every other person who's had ocd but for me the compulsions are as shameful (in terms of hiding it from other people) as hiding anorexic behaviour. (i am very glad this is an anonymous forum.) i do not mean the compulsions are embarrassing in themselves. but the "ignoring" solution does not change the fact that you live in constant shame (or whatever portion of your life is taken up by the ocd.)

btw, for me it's not hopelessly pervasive, just persistent: doesn't take up a huge part of my day (mostly just my sleep and study), but i can't stop it from doing so.

the obsessions bother me i guess but it is not possible to simply "ignore" the obsessions. imagine if you have an obsessive thought, it pervades all your other thoughts and unless you knock yourself out you will be thinking about it. and if you meant "permit the obsession and deliberately not do the compulsion," that takes such a huge amount of effort (is it possible?) that frankly i would rather just do the compulsion if it requires that much effort. is there any technique you know of that will help me "deliberately not do the compulsion"?

- in the meantime, i still forget to sleep.
- when i don't forget to sleep, i feel guilty that i'm doing my compulsions and not sleeping.
and i still don't sleep.
- shame: having to hide it from other people or they will comment.
- the compulsion in itself involves hurting myself.
- yes i don't want scars or permanent damage (i'm sure have permanent damage already, though i know it could be worse) but no matter how much i tell myself this it doesn't prevent me from doing it.

i do not see how "ignoring" any part of it will make me more healthy. isn't "ignoring" what i have been doing for the last 10 years?

(really sorry it has been so rambly)

With the help of friends, you can get a jump start on overcoming the obsessions by having them forcibly prevent you from completing your compulsions. In the same manner that rehab forces someone to quit a drug, at least for a short period, this gives you a timeframe to be unable to complete the compulsion. Whether or not you continue to avoid it afterwards (which should gradually get easier and easier) is up to you. However, if the problem lies in a brain dysfunction or is the result of chemical/hormonal imbalances, drugs may be the only viable solution.

With the help of friends, you can get a jump start on overcoming the obsessions by having them forcibly prevent you from completing your compulsions. In the same manner that rehab forces someone to quit a drug, at least for a short period, this gives you a timeframe to be unable to complete the compulsion. Whether or not you continue to avoid it afterwards (which should gradually get easier and easier) is up to you. However, if the problem lies in a brain dysfunction or is the result of chemical/hormonal imbalances, drugs may be the only viable solution.

i do not think my friends are able to stop me doing all my compulsions, some of them are kind of embarrassing. it is not the sort of thing i would tell my friends, and not the sort of thing friends would generally want to be involved with anyway. my fiance stops me when he sees me doing it but that is not very often. also i don't exactly come up and display my ocd in public. i hide it. not sure what situation would arise in which my friends could ever help me in this respect?

i believe i have pervasive brain dysfunctions. however the literature is very clear that no drug can cure autism, for example, even though it is a brain dysfunction. i am not convinced that a drug is capable of curing ocd. it is very much tied up with attention and executive dysfunction and frontal lobes and that sort of thing and i'm going to go out on a limb and say i don't think it's possible to cure it with a drug... unless there is some evidence for it?

still looking for evidence if anyone has any (: does anyone have an advance on azalea's serotonin info?

i do not think my friends are able to stop me doing all my compulsions, some of them are kind of embarrassing. it is not the sort of thing i would tell my friends, and not the sort of thing friends would generally want to be involved with anyway. my fiance stops me when he sees me doing it but that is not very often. also i don't exactly come up and display my ocd in public. i hide it. not sure what situation would arise in which my friends could ever help me in this respect?

i believe i have pervasive brain dysfunctions. however the literature is very clear that no drug can cure autism, for example, even though it is a brain dysfunction. i am not convinced that a drug is capable of curing ocd. it is very much tied up with attention and executive dysfunction and frontal lobes and that sort of thing and i'm going to go out on a limb and say i don't think it's possible to cure it with a drug... unless there is some evidence for it?

still looking for evidence if anyone has any (: does anyone have an advance on azalea's serotonin info?

Never studied psychiatry so much as psychology, so I'm unsure on the drugs aspect, what I meant is that a chemical imbalance would be extremely difficult to treat without altering that imbalance (which would almost certainly require a drug of some sort). Whether or not we have such a drug, no clue.

As for the friends thing, maybe ask your family, or even a doctor, to help. If they really are your friends, they won't hold the OCD against you, and most families (I understand not all) would help you through it. Most people have at least some minor psych issues that they hide, so it's not like people won't understand, some just happen to be asshats about these sorts of things.

Never studied psychiatry so much as psychology, so I'm unsure on the drugs aspect, what I meant is that a chemical imbalance would be extremely difficult to treat without altering that imbalance (which would almost certainly require a drug of some sort). Whether or not we have such a drug, no clue.

As for the friends thing, maybe ask your family, or even a doctor, to help. If they really are your friends, they won't hold the OCD against you, and most families (I understand not all) would help you through it. Most people have at least some minor psych issues that they hide, so it's not like people won't understand, some just happen to be asshats about these sorts of things.

thanks for your thoughts. i am seeing a range of specialists but i still do not think it is appropriate to ask my friends. don't know how to explain any more clearly but trust me, it is not the sort of thing a friend would even want to know about. it is not an issue of prejudice...

i made this thread because i am getting some rather unscientific advice from one of my specialists (who should know better!), was hoping to expand my evidence base so i know what to think.

thanks for your thoughts. i am seeing a range of specialists but i still do not think it is appropriate to ask my friends. don't know how to explain any more clearly but trust me, it is not the sort of thing a friend would even want to know about. it is not an issue of prejudice...

i made this thread because i am getting some rather unscientific advice from one of my specialists (who should know better!), was hoping to expand my evidence base so i know what to think.

I'll take your word for it, as you seem pretty adamant about that fact, and I don't want to push the issue. Family or a doctor may be able to help with the de-sensitizing therapy if that's the route you decide to go (again, similar treatment to what a drug addict would receive, but not in the slightest trying to compare the 2 problems, only a treatment). Group therapy/support groups may be helpful as well (any time you feel your compulsion, you contact the support group or appointed "buddy" in an attempt to have them talk you down from it).

Holy crap. Some people are really pretentious. It's no wonder why people with minor psychological quirks can't survive in today's society. It's because everyone is shoving a solution down their throats without thinking that they have already sought various methods themselves in order to find their own solution, "OMG Ji! Just suffer through it!" or "OMG Ji! Depend on your family and friends!" There's a reason why she wanted advice from psychiatrists and psychologists. It's because she's probably looking for case studies of people who have been exposed to various representations of the OCD complex and the therapeutic/scientific solutions that were found in the process. At least offer a scientific basis or a study to back up what action she should take. You'd think that people just posted for the sake of looking at their own post. What will the next proposition be?

Ji use the heart of the cards.

It seems like people fail to grasp the fact that you've exhausted nearly all the choices that would run through a common person's mind such as just bearing your compulsions or depending on your family to help you out. This isn't a condition where you can just offer arbitrary advice people that could fit nearly any other context. Even though nannerz is the only medical student on the forum, people can still offer solutions. It's just that you should back it up with some type of scientific information or background in order to help her out. Your solutions are just as viable as Ji using mustard gas in order to try to help her problems. You just can't tell another person how to change a major component of their life without putting in the time and effort to provide facts of previous success. Otherwise Ji will be no more than an initial experiment to test out your own hypothesis as to what the proper treatment should be to help her out. This is not the Pits of Hell or the Speakeasy for Christ's sake. I'm just so pissed off by the insensitivity and negligence expressed in the past couple of posts. And now I must go back to Physics.

It seems like people fail to grasp the fact that you've exhausted nearly all the choices that would run through a common person's mind such as just bearing your compulsions or depending on your family to help you out.

you are right in the fact most people cannot understand ji's situation, its pretty harsh of yourself to criticize them. non of these people are mocking her, but simply suggesting things they have research. that research is a sign they care for her... and frankly thats about all most of the people here can do. this is an internet forum. im sure the friends she has confided in RL has tried to help her like her husband, but people here do not have that luxury.

i feel for you ji. i think im osd about touching my face(also pulling out stubble), while it doesn't do anything harmful to me it does give me a slight case of acne and is annoying. nothing compared to loosing sleep, but i feel for ya!

I'm just so pissed off by the insensitivity and negligence expressed in the past couple of posts.

All I've seen is people offering their condolences and trying to at least show they care by trying to think of solutions. A psychologist or psychiatrist would be the best place to seek evidence-based tests and solutions, this is a gaming forum. Further, who the hell do you think you are to decide that what we are doing isn't what she wants? If there is anyone acting pretentious here, it is you for speaking for her and bringing a vast amount of negativity to a place where she is seeking at the least help and reassurance.

To Ji, I'm sorry if I haven't been overly helpful, I abandoned studying psych when I decided to join the military, but I can research some support groups for you to contact in hopes of finding a more realistic or helpful suggestion than those posted here, or at least to give you people to talk/relate to about the OCD.