OCD site developer 311.
(photo credit: Paul Kitagaki/Sacramento Bee/MCT)
In the 1997 romantic comedy As Good as It Gets, Jack Nicholson portrays Melvin
Udall, a romantic novelist who spouts sexist, racist and homophobic remarks
during social interactions. The man is very difficult, unfriendly and best left
alone, and that is the way he chooses to live his life. He goes to the same
restaurant daily for his breakfast and gets waited on by the same waitress,
Carol (Helen Hunt). Melvin has to eat food with plastic ware, sit in the same
spot, avoid walking on sidewalk cracks and has to do everything five times (wash
hands, lock the door, set up piles of paper and more). He wears gloves for
everything. When Melvin washes his hands, he throws away the soap.
Melvin’s excuse for his behavior is that he’s diagnosed as
OCD (obsessive-compulsive disorder) is well named,
as it is a disorder where people have intrusive obsessions and/or compulsions.
The first symptoms of OCD often begin during childhood or adolescence, however
the median age of onset is 19. About 2.5 percent of the population will get OCD
sometime during their life. It affects both men and women equally and it
is prevalent in every country.
Obsessions are ideas, thoughts, images,
impulses, etc. that intrude into one’s mind and that are upsetting, such as “I
wonder if I left the gas on,” or “Did I lock the door?” Compulsions are things
people do often, over and over, in a stereotyped way to reduce their distress.
Everyone has some obsessive-compulsive behaviors from time to time and this is
quite normal. However, the disorder is diagnosed if a person is suffering
from these symptoms and it takes up significant time and energy and/or causes
Psychologists and behavioral scientists are not sure what
causes OCD, but there is reason to believe it is partly genetic. What we do know
is that contrary to Freudian thinking, it is not caused by bad toilet training.
I see the OCD symptoms as an overlearned response to stress that has become a
primary mode of behavior. People with OCD usually understand that they
have a problem. The trouble is that they can’t control it and it creates havoc
in their social and professional lives.
Evidence points to the fact that
OCD symptoms tend to intensify when the person is under stress; nevertheless,
they remain quite persistent and a central part of a sufferer’s
character. Clearly, the OCD person suffers from intrusive thoughts and
compulsive behaviors. The individual feels like he/she is out of
The treatment of choice for OCD is cognitive- behavioral therapy
and relaxation training. Cognitive-behavioral therapy, or CBT, is a
treatment method that includes doing things like intentionally exposing a person
to what he fears (called exposure) and teaching the individual to try to refrain
from carrying out compulsions (called response prevention). This
seemingly simple but important act begins to do some very powerful
deconditioning in the brain and counteracts OCD overlearned behavior.
Melvin Udall’s case, a therapist would instruct him to try to tolerate one of
his disturbing and irrational beliefs that is always followed by a compulsive
behavior, such as “if I don’t use my own plastic spoons, I will become deathly
ill from the germs transmitted by my using the restaurant’s silverware.” Within
the context of this psychological prescription, Melvin could be taught some deep
breathing, a very useful relaxation technique, and introduced to a meditation
technique called “mindfulness.”
Mindfulness teaches a person suffering
from intrusive and disturbing thoughts or fears how to observe and distance
oneself from them, thereby giving the individual more control over dysfunctional
thoughts. Response prevention aims at helping the individual to refrain from the
usual knee-jerk compulsive behavior and to try to learn firsthand under
therapeutic guidance that he/she will not fall apart if the compulsive behavior
is not activated. This is a central component of the treatment of OCD and
evidence-based research has shown this approach to be highly effective in
treating its symptoms.
Contrary to what many would believe, psychiatric
medication without psychological treatment has a poor track record in the
treatment of OCD. However, when combined with CBT, relaxation training and
mindfulness meditation, medication can be a useful adjunct in the treatment of
OCD.The writer is a marital, child and adult psychotherapist practicing
in Jerusalem and Ra’anana.