Obsessive Compulsive Disorder (OCD)
OCD is a disorder where the individual is plagued by uncontrollable obsessions and compulsions that interfere with his/her daily functioning. It is an anxiety disorder that can start at any age, although most commonly it begins in childhood through to early adulthood. While it is a waxing and waning disorder, if left untreated, it can escalate in severity over time.
Obsessions are characterized by persistent, irrational ideas or images that keep returning again and again. Compulsions are repetitive behaviors that are intended to prevent or correct some dreaded event. The most common obsessions are repetitive thoughts, impulses or images that are anxiety provoking. They occur against one's will, are intrusive and persistent and are, often, personally repugnant. These can include:
- Fear of becoming contaminated
- Fear that something terrible might happen if something isn't done correctly
- Fear of causing offense
- Fear of throwing something away that might be important
- The urge for things to feel just right
- Scrupulous or religious thoughts
Compulsions are conscious behaviors or rituals that are done to alleviate anxiety caused by the obsessions and are carried out even though the person is aware that these actions are senseless or excessive. Compulsions can often take the form of:
- Washing or cleaning hands excessively
- Ritually checking things excessively
- Doing things "perfectly"
- Saving things
- Repeating things
- Avoiding things
- Making mental checklist or saying mantras over and over
The UCLA Adult OCD Program provides a range of services to accommodate all types of OCD and OC spectrum disorders. Services are available to suit variations in intensity of OCD from mild, to moderate, to severe.
Typical treatment for OCD includes cognitive behavior therapy or medication. Often, a combination of both is beneficial.
Cognitive behavior therapy for OCD takes the form of Exposure and Response Prevention (ERP). This is the process of gradually exposing oneself to the object or situation that causes anxiety and then refraining from doing the associated compulsion. Initially ERP causes anxiety, but this decreases over time as the compulsion is resisted. It is a highly successful and effective treatment for OCD. Studies show that this therapy can help between 60-90% of patients. It can improve symptoms by between 50-85%. Many people maintain their treatment gains over time but they may require 'top-up' therapy occasionally if symptoms flare up during stressful times.
The first line medications for the treatment of OCD are the Serotonin Reuptake Inhibitors (SRI's). These are medications such as Prozac, Zoloft, Paxil, or Luvox. However, there are many other medications that can be used with the SRI's to augment the effects of the SRI. There are also other medications that can be used when the SRI's are not effective. Studies show that medications help about 50-60% of people with OCD and can improve symptoms by 30-40%. However, upon abrupt discontinuation, OCD symptoms may return within 6 months for some people. Therefore for people with more than mild OCD, an optimal approach to treatment would be to combine both medication and behavior therapy.
Although the treatment of choice for OCD is the same regardless of the severity of the disorder (CBT and/or medication), the frequency and intensity of the therapy will vary depending on the severity of the disorder.
People with mild forms of OCD, that is people who are able to work and maintain a full active life but find it a struggle, will be able to find appropriate treatment in an outpatient setting. Outpatient therapy usually involves seeing the therapist once or twice a week for 1-hour sessions.
People with more moderate-severe OCD where the OCD affects work and social functioning, or even makes working impossible, may need more intensive therapy. Intensive therapy is frequently done in a partial hospital setting. This involves between 2 and 6 hours a day of therapy, every day for a number of weeks.
People who are disabled by their OCD, that is, unable to work or live independently, who need assistance from friends or family may need to consider a residential OCD program that provides around the clock supervision and control of compulsions. (UCLA does not have a residential program).
Whatever the severity of the OCD, treatment should begin with a thorough evaluation and assessment. Following evaluation, a therapist can recommend the level (intensity) of treatment required that will be most effective for each individual.
The Obsessive-Compulsive Disorder Intensive Treatment Program at the Resnick Neuropsychiatric Hospital at UCLA is for people who have moderate to severe OCD symptoms and a strong commitment to treating their disorder. OCD is a disabling disorder of distressing obsessions and time-consuming compulsions, often resulting in a less than full life. This can be changed however with behavior therapy in the form of Exposure and Response Management. This treatment is based on the fact that prolonged, direct contact with a fearful stimulus is necessary if anxiety is to diminish.
The Obsessive-Compulsive Disorder Intensive Treatment Program operates from 9 -1 p.m., Monday through Friday. Maximum length of stay is 30 treatment days (6 weeks). It has been shown that many people with OCD may be effectively treated using a combination of cognitive behavior therapy (CBT) and medication. This program provides both intensive daily CBT and state-of-the-art medication management.
Because, for many people, the OCD makes work and social functioning difficult, the goal of this program is that each participant should be able to accomplish at least one of the following by the time they leave the program: return to work or a volunteer position, enroll in a class or educational program, or be able to live more independently.
On admission to the OCD Intensive Treatment Program, each participant is assigned a behavior therapist with whom they will work daily on a one-on-one basis. The first week in the program is spent in going through detailed and specific assessment of the participant's OCD and related problems; this involves questionnaires, interviews and self-monitoring of the OCD. Based on this information, both participant and behavior therapist can establish a personalized program of behavior therapy. An individualized behavior therapy regimen is then incorporated into a highly structured program of education and support. Participants will also take part in therapeutic groups, and also be expected to do assignments on their own. Homework is a significant component of this treatment as participants must learn how to translate their new found cognitive and behavioral skills to the home situation.
Education and support of the family or involved loved ones is an integral part of the program. Often, those people living with someone who has OCD have questions and concerns about how best to help. The program will provide support and information on how to cope with a loved one who has OCD.
To take part in the OCD Intensive Treatment Program, participants must first be evaluated. Call 1 800 825 9989 option #2 for an appointment for an evaluation for the OCD Intensive Treatment Program. The program accepts most insurance policies including medicare.
For more information about the UCLA OCD Intensive Treatment Program call (310) 794- 7305.
The Semel Institute and Resnick Neuropsychiatric Hospital are world leaders in the diagnosis and treatment of OCD and is part of the UCLA Anxiety Disorders Program. Its highly specialized program is designed to accommodate people with all types of cases, ranging from mild to severe.
Highly trained specialists in cognitive behavior therapy, including Exposure and Response Prevention (ERP), and in medication management of anxiety disorders are responsible for and implement the program. In addition, a variety of clinical settings is offered to suit differing needs. These include:
- Intensive Treatment Program
- Research groups
To further ensure the best and most appropriate treatment, OCD program is divided into two departments:
- Adult OCD Program: (310) 825-9989
- Child and Adolescent OCD Program: (310) 825-2373
For people who can manage their anxiety disorders on a weekly, outpatient basis, UCLA Outpatient Anxiety Disorders Clinic provides both Behavior Therapy and Medication Management. It treats all anxiety disorders, including OCD, Panic Disorder, Agoraphobia, Social Phobia and Post-traumatic Stress Disorder. The clinic also offers an extensive evaluation and treatment program. If you are uncertain about which course of action may be most appropriate for you, please use the number and assistance will be provided.
For further information, please contact us by calling the UCLA Anxiety Disorders Clinic (310) 825-9989