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By Michael E. Jones, LMFT  Perhaps you suspect you are one of the 3 million American adults affected by Obsessive-Compulsive Disorder (OCD). Or maybe you or a loved one was just diagnosed with this condition. What next?
As a psychotherapist specializing in the treatment of OCD and related disorders, I have compiled the following suggestions to help you make wise treatment choices.
- If you have not been formally diagnosed with OCD, do not assume you have it because your friends told you so, or because you double-check your door locks, or because you sometimes have “inappropriate” thoughts. The fact is that OCD causes significant distress for those afflicted by it. Some people double-check their door locks every time they leave the house; someone with OCD may have to check it forty times every morning. While almost every one of us have some strange thoughts cross our minds, an individual with OCD can cling to just one for days, worrying why they had the thought. The point is this: If you think you might have OCD, get a professional opinion and a formal diagnosis.
- If you have just been diagnosed with OCD, get into therapy as well as getting medication. Talk therapy is not only very helpful for people with OCD, it is critical. Medication enables you to use the techniques you’ll learn in therapy to manage your OCD, it does not “cure” it.
- Select your therapist wisely. Do not enlist the aid of a therapist who can only provide you with “depth” therapy, who wants to examine your childhood and what your obsessions today may symbolize from your history. Your obsessions do not, in fact, symbolize anything other than what they are: thoughts that repeat in a loop. The literature strongly suggests that not only will depth therapy fail to help you; it may actually harm the person with OCD. The more you focus on your obsessions or compulsions, the stronger they get. On the other hand, OCD responds incredibly well to cognitive-behavioral therapy, which focuses on controlling and managing your symptoms. As a practitioner of both cognitive-behavioral and psychodynamic therapy, I can make these statements with certainty.
- Accept that you have a medical condition which has psychological and behavioral manifestations. I do not believe that anyone, given what we know today about OCD, can argue that it is anything but a primary medical condition. An individual’s lack of internal resources to manage the symptoms is what therapy and medication fulfill. To the best of my knowledge, no one has ever been “cured” of OCD. Rather, we aim for symptom reduction.
- Reducing OCD thoughts and behaviors changes your brain. Every time the person with OCD turns an obsession over in his mind again and again, or checks the door forty times, they create neural pathways in the brain which makes the symptoms stronger. Conversely, every time that same person changes their response to the feeling that “something is wrong,” they create new and, hopefully, improved neural pathways that strengthen the new behavior. Changing your responses is made much easier with the help of medication.
- Finally, when you’re feeling strong enough, try to find the humor in your symptoms. In general, people need to laugh as much as possible. People with OCD, I believe, need to laugh even more. Let’s face it, OCD can be depressing if you’re mired in it, and there are close chemical connections between OCD and depression. Digging for the lighter side of OCD, however, should be done only when you are ready. A professor of mine once recounted the story of treating a young lady with OCD for many months. Her most prominent symptom was the repetitive thought of killing her child. Frustrated by months of no progress in the case, he began the next session by asking matter-of-factly, “So, did you kill the kid yet?” His attempt at making fun of her obsession backfired, as the client never showed up again.
So how can you find the humor in a dark obsession? One time, a colleague of mine pointed out the pivotal role of attribution in disturbing thoughts by saying, “I just had the wildest thought of killing my family on the subway this morning. Must be allergies.” This kind of thought could send someone with OCD into a tailspin: “Why did I have that thought? What does that mean? Am I a killer just waiting to happen?” If this sounds like you, next time you have such a thought (and you will) focus on coming up with a humorous basis of the thought, rather than a sinister one. Keep in mind that if you were a killer-in-waiting, you wouldn’t be wondering why you have these thoughts. You’d likely being figuring out what weapons to use!
These are only a few suggestions; there are many approaches depending upon the particulars of you and your symptoms. Following these basic principles, though, will help you on your way to living in spite of OCD! About the Author...
Michael Jones, LMFT, is a psychotherapist in Los Angeles specializing in obsessive-compulsive spectrum disorders as well as mood and personality disorders. He is regularly available for appointments at his office in Pasadena, CA, and has limited availability in San Francisco, CA. Last Update: 9/28/2022
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