Obsessive Compulsive Disorder (OCD) is characterized by nagging thoughts and fears which in turn lead to compulsive behaviors. Although only obsessive thoughts or only compulsive behaviors may occur, they usually occur together, as the behaviors arise as an irrational solution to deal with frightening thoughts. This disorder can be managed well through a combination of therapy, understanding, and self-help methods (including overall lifestyle changes).
Steps
Part 1 of 4: Managing OCD with Therapy
Step 1. Choose a psychologist
Find a professional who is experienced in treating this disorder or other associated diseases. You can search for it by contacting your family doctor, asking friends or family if they can indicate a trusted one or by doing an online search and consulting the national register of psychologists.
Make sure they are someone you feel comfortable with and who are qualified to meet your needs
Step 2. Get a diagnosis
It is important to see a professional to get a diagnosis, as you may be suffering from other problems that have symptoms similar to OCD. You can see your family doctor, but a mental health professional is better suited to make the diagnosis. This disease has two groups of symptoms: obsessions and compulsions. Obsessive symptoms consist of constant, nagging and unpleasant thoughts, impulses or images that trigger feelings of distress or apprehension. Thoughts or images may continue to manifest in your mind, even if you wish to avoid or drive them away. Compulsive symptoms are behaviors you engage in to cope with obsession-related worry. These behaviors arise from the idea that they are able to prevent fears from coming true and often present themselves as rules or rituals. Together, the obsessions and compulsions create characteristic patterns such as those described below:
- Those who are afraid of contagion and the spread of dirt usually have compulsive behaviors related to hygiene and hand washing.
- Other people repeatedly check things (whether the door is closed, the oven is off, and so on) that they associate with potential dangers.
- Still others are convinced that if things are not done right, terrible events can happen to themselves or their loved ones.
- Many obsess about order and symmetry; they often have superstitions regarding certain orders or dispositions.
- There are also people who fear that unpleasant things will happen if they throw away anything (like broken objects or old newspapers). This disorder is called compulsive hoarding, or disposophobia.
- In order for you to be diagnosed with OCD, you must have obsessions and compulsions almost every day for at least two weeks; alternatively, the disease is diagnosed if the obsessions and compulsions interfere significantly in everyday life (for example, you have a terrible fear of germs to the point that you wash your hands so often that they bleed and you cannot touch anything beyond outside your home).
Step 3. Work with a therapist to control compulsive behaviors
This type of therapy focuses on exposure and response prevention (ERP), meaning that your doctor exposes you to the things that frighten or obsess you to help you cope and manage these anxieties in a healthy way.
Sessions can be individual, family or group
Step 4. Talk to your doctor to find suitable medications
This can be a trial and error process, in some cases you may find that a combination of various drugs is more effective than a single drug.
- The drugs that are usually prescribed are selective serotonin reuptake inhibitors (SSRIs), such as citalopram, fluoxetine (Prozac), paroxetine and escitalopram (Cipralex). These active ingredients increase the activity of neurotransmitters that help balance mood and reduce stress (serotonin).
- Another class of drugs prescribed regularly are tricyclic antidepressants (TCAs), such as clomipramine, which have been approved by the US FDA for the treatment of OCD. SSRIs are generally preferred over clomipramine because they have fewer side effects.
- Never stop taking any medication without first checking with the doctor who prescribed it for you, otherwise you may cause a return of symptoms and some drug withdrawal side effects.
Part 2 of 4: Implementing Exposure and Response Prevention (ERP)
Step 1. Get to know the vicious circle of OCD
This disorder occurs when an unpleasant thought occurs in the mind (for example, the idea of passing on a disease to your loved ones), followed by an extreme interpretation (perhaps this thought makes you believe that you are a bad person who hurts others through neglect). This association between thought and exaggerated conclusion creates a lot of anxiety.
- Since anxiety causes a lot of discomfort, you do this to prevent your fears from happening. In the specific example, you could wash your hands every time you touch something and say a prayer for loved ones as you wash them.
- Thanks to this ritual you can quickly relieve anxiety, but negative thoughts gradually surface more and more often (to the point that it becomes almost impossible not to think about them). This is the vicious circle of OCD.
- The main aspects of ERP are to expose yourself to situations that lead to obsessions, without engaging in useless strategies to overcome them (compulsive behavior).
- If your ailment is very severe, you can try this therapeutic approach under the guidance of a professional.
Step 2. Identify the triggers
Anything that leads you to obsessive thinking and compulsive behavior (situation, object, person, or other thoughts) is called a "trigger" because it activates the OCD cycle. Understanding what triggers the disorder is crucial, as this is the factor you need to expose yourself to and then resist the urge to engage in irrational behavior that relieves anxiety.
Grab a pen and paper and spend a week writing down the factors that trigger your obsessive and compulsive behaviors
Step 3. Write the fears in order of severity
Once you've tracked your obsessions and compulsions for a week, rank all situations from least frightening to most terrible.
- For example, if you are afraid of contagion, living at home with your parents could be a problem with a low level of importance. In this case, on a scale of 1 to 10 it could be considered a level 1 fear. However, if you have to go to a public bathroom, the fear level could be much higher and reach a value of 8 or 9 on the scale.
- Use different fear scales if you have different sets of "triggers". For example, you should categorize all the fears associated with illnesses, while classifying all those related to the prevention of some natural disaster into another group.
Step 4. Face your fears
For the method of exposure to work, it is important to try to resist the compulsive behavior during or after the manifestation of fear (as much as possible). This is because ERP therapy teaches you to cope with fears without the compulsive behaviors that come with it.
- Afterward, ask someone you trust to show you how they perform tasks where OCD interferes. Learning from other people is very useful, because it is very likely that you have been having compulsive behaviors for some time and that you no longer know how to deal with scary situations without resorting to them. To return to the example of hand hygiene, you can ask your family about their habits in this regard, in order to have a more "rational" criterion of how and when to wash them.
- If it is too difficult to resist compulsive behavior completely (especially in the early days), at least try to delay it, rather than avoid it altogether. For example, after leaving the house (exhibition) wait 5 minutes before returning to check the appliances and only check them twice instead of five. Gradually increasing your control times can help you eventually give up on the action completely.
- If you eventually give in to the need for the compulsive behavior, try to immediately expose yourself to the same frightening situation and repeat the procedure until the fear is reduced by half. Therefore, leave the house again immediately after going through the process described above and continue until the intensity of fear drops from "8" to "4" on the previously described scale.
Step 5. Go to the next exposure
Once you feel just a little bit of anxiety while performing an exercise, you can proceed with another scary aspect. After several practice you should only be able to feel a little anxiety when you wait 5 minutes before checking the systems once you leave the house; at this point, you can challenge yourself and wait 8 minutes.
- Remember that even when you experience very intense anxiety, the fear spikes, but then it slowly subsides. If you don't respond to the fear, it will disappear on its own.
- Exposure can be a very challenging experience and you shouldn't hesitate to ask for the help of those close to you if you need additional support.
Part 3 of 4: Learning to Manage Obsessive Thoughts
Step 1. Take note of obsessive thoughts
To address some of the pointless interpretations you give to your obsessions, you first need to know what they are. The best way to do this is to start keeping track of two things: the obsessions and the meanings or interpretations you give to those obsessions.
- Again, dedicate a week to jot down the list of your obsessions on paper, indicating three per day (associating each of them with your interpretation).
- Write down the situation that triggered the obsessive thoughts at that particular juncture. When did you first think? What happened during that experience? Also note any emotions you experienced when the obsession arose. Assign an importance value to the emotion and its duration on a scale from 0 (no importance) to 10 (the maximum intensity you can imagine).
Step 2. Monitor interpretations of obsessive thoughts
As you write down your thoughts, you must also write down the interpretations or meanings you attribute to them. To understand these interpretations (as it can be a difficult task), ask yourself these questions:
- What's so upsetting about this obsession?
- How does obsession affect you or your personality?
- What kind of person could you be if you didn't react to that obsession?
- What can happen to you if you don't react to this thought?
Step 3. Challenge your interpretations
This will help you understand that your impulsive thoughts are not realistic for many reasons. Not only that, you will also realize that your interpretations are not at all useful in finding the solution to the problems that such thoughts create. Ask yourself the following questions to prove yourself wrong:
- What evidence do you really have for or against this interpretation?
- What are the advantages and disadvantages of this kind of thinking?
- Are you confusing a thought of your own with a real fact?
- Are your interpretations of the situation accurate and realistic?
- Are you 100% sure that this thought of yours will come true?
- Do you have the possibility to verify that it is an absolute certainty?
- Are your predictions of what will happen based solely on your feelings?
- Could a friend agree that the hypothesis in your mind can come true?
- Is there a more rational way to analyze the situation?
Step 4. Learn realistic thinking techniques
Unnecessary interpretations are usually due to confused ways of thinking that often occur in OCD patients. Some examples of "trap" thoughts are:
- Catastrophization: Occurs when you are certain (without any evidence) that the worst case scenario will occur. Address this approach by reminding yourself that it is very rare for the most serious situation to occur.
- Filter: It is the trap that makes you notice only the negative things that occur, making you ignore - or filter - the positive ones. To counter this, ask yourself what aspect of the situation you are avoiding, especially the positive one.
- Generalization: it consists of exasperating a situation by applying it to all the others, for example thinking of always making stupid mistakes just because you once spelled a word incorrectly. To avoid generalizing, think about evidence that shows the exact opposite (times when you have been very insightful and have spotted or corrected a mistake).
- Dichotomous thinking, that is to see "all white or all black": it always means evaluating situations from the most extreme point of view, such as full successes or total failures. For example, if you can't wash your hands on an occasion where they might have germs, you are a bad and irresponsible person. Try to avoid this mental approach by carefully analyzing if you have really caused any negative effects and remind yourself that this is not the time (as it never is, actually) to make an absolute judgment about your personality.
- Search online or check with your therapist for other obsessive thinking traps.
Step 5. Resist the urge to blame yourself
OCD is a chronic disease, and unpleasant or unwanted thoughts are not something you can control. Recognize that such thoughts are just annoyances that have no effect outside your mind; they are only mental images and have no bearing on your person.
Part 4 of 4: Managing OCD with Diet and Lifestyle Changes
Step 1. Be aware of the correlation between illness and lifestyle
Since OCD is a type of disorder associated with anxiety, stress can trigger symptoms, making them increasingly difficult to manage and overcome. Any changes in habits that can keep stress and excessive worries under control can also help manage and reduce OCD symptoms.
Step 2. Eat foods rich in omega-3 fatty acids
These precious substances directly help to increase the level of serotonin in the brain, the same neurotransmitter that drugs act on to treat the disorder. This means that this food also helps manage anxiety. Go for foods that are rich in omega-3s rather than supplements; here are some of them:
- Flax seeds and dried fruit;
- Sardines, salmon and shrimps;
- Soy beans and tofu;
- Cauliflower and pumpkin.
Step 3. Limit caffeine-based foods and drinks
This substance actually suppresses the production of serotonin in the brain. Among the foods and drinks that contain it are:
- Coffee and coffee flavored ice cream;
- Black tea, green tea and energy drinks;
- Drinks with cola;
- Chocolate and cocoa products.
Step 4. Exercise regularly
Exercise not only improves muscle strength and cardiovascular health, but also fights anxiety and OCD tendencies. When you exercise, your body increases the production of endorphins, hormones that lift mood, reduce anxiety and fight depression.
Try to exercise at least half an hour a day, five days a week. Some examples of healthy exercise are running, cycling, weight lifting, and climbing
Step 5. Spend more time outdoors
In addition to numerous other benefits, sunlight increases serotonin synthesis in the brain by blocking its reabsorption by nerve cells. Exercising outdoors gives you a double benefit.
Step 6. Manage your stress
When you are stressed, your symptoms are more likely to increase (or worsen their intensity). Therefore, learning to use mental and physical techniques to reduce emotional tension is beneficial in a general sense. Here are some useful examples:
- Make healthy lifestyle changes over the long term, such as in nutrition and physical activity
- Draw up a to-do list;
- Reduce negative internal dialogue;
- Practice progressive muscle relaxation;
- Learn mindfulness, visualization and meditation;
- Learn to recognize sources of stress;
- Learn to say no when asked to do more than you can handle.
Step 7. Join a support group
There are several specific support groups for people facing similar problems to yours. During the meetings you can discuss your experiences and difficulties with people who can understand you. These groups are great for the sense of security they convey and for reducing the isolation that often accompanies people with OCD.
Talk to your therapist or family doctor to find a support group in your area; if necessary, also contact the competent ASL or do an online search to find one near home
Advice
- Symptoms of OCD typically progress slowly and can vary in severity over the patient's lifetime, although they are usually more intense when triggered by stress.
- You need to see a specialist if your obsessions or compulsions are already affecting overall well-being.
- It is important to get a diagnosis from a mental health professional, because there may be other illnesses that exhibit OCD-like symptoms. For example, if you have a general and widespread sense of concern about everything, you may be suffering from generalized anxiety disorder and not obsessive compulsive. If the fear is intense but limited to one or a few things, it could be some phobia rather than OCD. Only a professional doctor can make an accurate diagnosis and provide you with the treatments you need.
