There are two basic courses of action for Obsessive Compulsive Disorder recognized by the mainstream psychiatric community. One is to medicate with an SSRI (selective serotonin reuptake inhibitor ), medications such as Paxil, Zoloft, Lexapro or Prozac. The other is Cognitive Behavioral Therapy (CBT). Both have shown to be very effective for treating/managing OCD.
Medications
Although not a “cure” for OCD, medications are often a first-line treatment for anyone who has moderate to severe OCD symptoms. Because SSRIs allow the serotonin to remain available to the neurons in the brain longer, the serotonin is able to reduce the anxiety symptoms. In addition to SSRIs, sometimes older anti-depressant medications, specifically one called Anafranil, are added with additional benefit. For extremely resistant (or co-morbid) OCD, other medications, such as atypical antipsychotics are added.
CBT
Cognitive Behavioral Therapy is the preferred psychotherapy method for people suffering from OCD. Unlike traditional behavior modification approaches (external rewards and consequences to change behaviors), CBT starts by addressing a person’s faulty belief systems and using their cognition to change their thoughts and address their behaviors.
Part of this approach is Exposure and Response Prevention (ERP), which is slowly exposing yourself to your known triggers and controlling your usual compulsive responses to those anxiety-provoking triggers. This part of the therapy is often highly painful to endure, but is done after the person has addressed their OCD cognitively.
So what about kids? That’s a hard one, as young children do not have the ability to cognitively address their illogical thinking. One of the hallmarks of OCD in adults is that they understand the intrusive thoughts and compulsive behaviors are illogical, and this itself is distressing. With children, the OCD thoughts and behaviors may not be recognized by the child as problematic. Instead, the children are on high anxiety alert, in many cases all the time. And the distress these children are in often produces high levels of frustration, triggering aggressive and/or self-injurious behaviors.
CBT is the preferred treatment method, but there are other experiential ways of treating anxiety in smaller children that can have some positive effects on OCD (because it is an anxiety disorder). Visualizations, psychodrama, EMDR and other techniques are used to address anxiety triggers in children (and adults).
Biomedical Alternatives
These alternative treatments have limited research behind them, but many people report a lessening of OCD symptoms. The first is inositol, a sweet-tasting supplement that at high doses has been shown to lessen OCD symptoms.
Some people have had success with St. John’s Wort,an herb that is known to help with depression as well and increase serotonin production. If you are taking an SSRI, use caution when considering any medication or supplement that increases serotonin production. Others that do this include 5HTP and SAM-e.
Some biochemists and doctors believe that people with OCD (and the related disorder of Tourettes) have extremely low levels of magnesium and B vitamins. Supplementing those can be helpful as well.
Psychosurgery
Probably the most controversial treatment for OCD, but one definitely under study is actual surgery on the brain. Psychosurgery is actually the term for several different procedures, all focused at the interior brain structures associated with OCD – the limbic system, the cingulate region, the basil ganglia and the caudate nucleus.
The surgery actually shows some very positive results in the “last resort” patients (people for which none of the medications or therapies have been successful). And more research is being done all the time.
Less permanent brain-based treatment include:
• Vagus nerve stimulation
• Deep brain stimulation
• Transcranial magnetic stimulation
Related Links:
Psychotherapy for Children with OCD
Inositol – What Everyone with OCD Needs
TS-Plus Control – a compounded supplement to treat Tourettes/OCD
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