Why Is Obsessive Compulsive Disorder So Challenging To Treat?

Why Is Obsessive Compulsive Disorder So Challenging To Treat?

Can You Treat Obsessive Compulsive Disorder?

Obsessive-compulsive disorder (OCD) is a mental disorder where the afflicted suffers from recurring obsessions and compulsions. The American Psychiatric Association (APA) defines OCD as follows:

OCD is a disorder in which people have recurring, unwanted thoughts, ideas or sensations (obsessions) that make them feel driven to do something repetitively (compulsions). The repetitive behaviors, such as hand washing, checking on things or cleaning, can significantly interfere with the person’s daily activities and social interactions.

OCD can be difficult to treat, depending upon the severity of the condition in patients. In certain cases, OCD may be mild enough that it is barely noticeable, while other patients are defined by the illness. Treatment regimens for OCD depend upon the individual, the neurologist, psychologist and/or psychiatrist. Patients also vary in how they respond to treatment, with a combination of therapy and medication, and contrarian treatment options such as Deep TMS for OCD. With particularly severe OCD, patients often express deep concern about how ‘empty and meaningless’ their lives would be in the absence of the OCD.

Frederic Neuman M.D. penned an op-ed in Psychology Today, ‘Why is OCD so Hard to Treat?’. In his estimation, treating OCD must be done on an individualized basis, from patient to patient. To successfully treat OCD, the patient must put the OCD to the test. In one such example, he recounts the story of several patients who believed that they would have terrible misfortune (accidents, getting fired from a job, hearing news of illness or tragedy) if they wore the wrong clothing.

The doctor encouraged them to purposely wear the wrong clothing, to defy the superstitions and phantom beliefs that the patients attributed to wearing the ‘wrong clothing’. As it turned out, several patients abandoned or curtailed their misattributed beliefs, although the difficulty of dealing with OCD remained. Dr. Neuman M.D. followed the standard treatment protocol for OCD which is known as, ‘Exposure and Response Prevention’.

Since treatment can be especially difficult in severe cases, clinicians and medical professionals are turning to alternative techniques for treating OCD. The Deep TMS treatment for OCD has proven to be highly effective, with statistics showing as many as 1 in 3 patients responding positively to the treatment. At its core, Deep TMS treatment (FDA cleared for OCD treatment) utilizes electromagnetic pulses to act upon neural activity of brain structures.

The American Journal of Psychiatry confirmed how efficacious brain stimulation on the medial prefrontal cortex and anterior cingulate cortex. This can be used in conjunction with other established treatment regimens such as lifestyle changes, psychopharmacology, cognitive behavioral therapy, as well as exposure and response prevention therapy.

 

Why is OCD so Difficult to Deal With?

Obsessive-compulsive disorder needs to be demystified in order to be understood, and ultimately treated. There are many symptoms associated with OCD, notably compulsive rituals, avoidance, intrusive and obsessional thoughts, and impulses. This condition affects approximately 2.5% of people, and is evenly split between men and women. It begins in adolescence, fluctuates with time, and is heightened during stressful periods. Doctors do not know why obsessions and compulsions develop in people.

A tremendous body of research into OCD has been conducted, yet there are different schools of thought about OCD. On the one hand, serotonin-related brain chemistry may give rise to OCD, and on the other experts believe that there may be environmental factors at play.

An example of such would be an individual believing that thinking about performing certain actions is equivalent to actually performing those actions. There are shortcomings in both approaches, and thus neither can be accepted as a de facto cause of OCD. In truth, OCD is likely a combination of brain chemistry and environmental elements, to a large degree.

Treatment of OCD relies on breaking associations in the patient. A commonly used approach to treating OCD is called Cognitive Behavioral Therapy. Once again, the Exposure and Response (ERP) technique is adopted to debunk these misattributed mindsets. Patients with OCD are so deeply invested in their thoughts and actions that they find it tremendously difficult to let go of them.

They create their world around the OCD, and attempt to justify the OCD with what is going on in the world (such as further justification for repetitive hand washing, disinfecting of surfaces, and social distancing with coronavirus in full effect). Viewed in perspective, OCD must be treated in a way that demystifies the condition, and breaks the misattributed correlations between ‘obsessions & compulsions’ and reality.

 

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