Areas of Specialization - Adults

Exposure and Response Prevention for Obsessive Compulsive Disorder

Obsessive compulsive disorder causes individuals to become trapped in a pattern of repetitive thoughts and behaviors that are senseless and distressing yet extremely difficult to overcome. People with obsessive compulsive disorder should not be confused with the more common characteristic of having high standards of performance and being exceptionally organized and perfectionistic. This type of "compulsiveness" does not interfere with a person's functioning and may contribute to a person's motivation, self-esteem and success. The behavioral model of obsessive compulsive disorder explains that obsessions result in anxiety and this anxiety is then reduced by engaging in compulsive behaviors or mental rituals. In other words, compulsions are strengthened and maintained because they decrease anxiety by stopping the obsessive thought. For example, a person touches a doorknob and an obsessive thought of germs and contamination is triggered. This thought results in anxiety and extreme discomfort which is relieved by performing the compulsive behavior of hand washing.

Obsessions

These are unwanted thoughts, ideas or impulses that repeatedly occur. Persistent fears that harm or illness may befall oneself or a loved one, an excessive concern with becoming contaminated, or an unreasonable need to do things correctly or perfectly are common. Obsessions also can have a violent, aggressive, or sexual nature. The individual repetitively experiences a distressing thought such as "My hands have germs, I must wash them.", "I may have left the stove on, I have to check the knobs.", "I may stab my daughter.", "Did I hit someone with my car?" These thoughts are intrusive, unpleasant and result in a tremendous amount of anxiety and discomfort.

Compulsions

In response to their obsessions, most people with obsessive compulsive disorder engage in repetitive behaviors. The most common compulsions are excessive washing and checking; other rituals include counting, repeating, hoarding, and rearranging. Mental rituals, such as repeating phrases, sentences or numbers, listmaking, and ruminative checking are also common. These compulsions generally function to prevent harm to the person with obsessive compulsive disorder or significant others. People with obsessive compulsive disorder can have strictly controlled rituals or have rituals that are intricate and change over time. Performing rituals may give the person with obsessive compulsive disorder immediate relief from anxiety, but this respite is only temporary.

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