In light of OCD Awareness Week, which runs from October 7 through October 13, we interviewed Dr. Fugen Neziroglu of Bio-Behavioral Institute in Great Neck, New York about what OCD is, its history, and what to look for in an OCD therapist.
What is OCD?
Obsessive Compulsive Disorder (OCD) is a preoccupation with thoughts, feelings, images and sensations (obsessions) and engagement in behaviors or mental acts (compulsions) in response to these obsessions. The thoughts are persistent and pervasive and cannot be repelled from the mind. While obsessions and compulsions usually exist together, they can often exist alone as well.
What are Obsessive Compulsive Spectrum Disorders?
Obsessive Compulsive Spectrum Disorders are a separate category in the diagnostic manual of mental disorders, and includes disorders that are similar to OCD. These include Body Dysmorphic Disorder (BDD); Excoriation Disorder (skin picking, cutting); Trichotillomania (Hairpulling) and Hoarding Disorder (HD).
What is the history of OCD treatment?
OCD treatment has advanced a lot over the last 30 years. We went from not having any treatments to very specific well researched treatments. Cognitive Behavior Therapy (CBT) is the first line treatment for OCD, and specifically a type of OCD called exposure response prevention (ERP).
In the 1970s OCD patients were being diagnosed as schizophrenic because their thoughts were viewed as bizarre or psychotic. We now know that individuals with OCD are not psychotic; they have thoughts that are persistent and pervasive, and behaviors they need to perform to ward off their thoughts, but most often they know these are senseless.
When we first started talking about OCD in the late 1970s, we met in local libraries trying to educate the public. There were only three places in the world then (Pennsylvania, London, and Montreal) that treated OCD and Bio-Behavioral Institute soon became one of the first to study and treat this disorder along with them. They were beginning to explore a form of cognitive behavior therapy called exposure and response prevention. Back then, it was believed that only a small percentage of people had OCD.
In 1980, we and a handful of researchers met in Ennis, Ireland to understand this under-recognized and under-diagnosed disorder. Over the course of many years, OCD became a household word and is now well recognized. However, many individuals still do not seek or receive appropriate treatment.
What is the best treatment for OCD?
Exposure and response prevention (ERP) is the primary treatment choice for Obsessive compulsive disorders. The treatment exposes individuals to their fears and prevents them from engaging in their compulsions. This is done by creating an anxiety hierarchy of situations that provoke distress, and gradually putting the person in those situations at a rate that they are able to tolerate. It is important to seek a therapist who is well trained, not only in cognitive behavioral therapy, but specifically exposure and response prevention.
What should a person do if ERP isn’t working?
If someone has received ERP but has not reached optimal change, doing an intensive outpatient program often yields better results. We have published a few studies showing the efficacy of intensive treatment where individuals are seen anywhere from 2 to 6 hours a day, or several times a week.
Bio-Behavioral was the first to implement an Intensive Outpatient Treatment for Anxiety Disorders in the United States. Since then there have been some residential programs that have opened up.
What are new OCD treatments are being researched?
We at the Bio-Behavioral Institute continue to conduct research on novel treatments. We are looking at the effect of adding other therapy approaches to ERP, such as Acceptance and Commitment Therapy, and Dialectical Behavior Therapy. We are also investigating the role of treating some of the predictor variables, especially overvalued ideation and trauma in increasing treatment response. We just published an article on bullying in obsessive compulsive disorder (OCD) and body dysmorphic disorder (BDD) vs. other disorders, in which we found that individuals with OCD were often victims of bullying, and individuals with BDD the bulliers. We have several publications showing that overvalued ideation, or the conviction you have about your beliefs, is a predictor of treatment outcomes. We are also noticing that DBT is helpful with some individuals who have OCD and have difficulty with their emotions. Finally, we are also beginning a new medication for OCD.
Dr. Fugen Neziroglu is a psychologist and co-founder of the Bio Behavioral institute, where she has researched anxiety disorders including obsessive-compulsive disorder for over 25 years.