tracy_d74 (tracy_d74) wrote,

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The Doctor Answers . . .

bogwitch64 asked about treatment for disorders that involved panic and counting type behaviors.

The disorder being asked about is Obsessive-Compulsive Disorder (OCD). People may not have an actual panic attack (rapid heart beat, shortness of breath, feeling of doom, sweating, etc) but they will experience anxiety. First let’s get on the same page with regards to definitions.

Obsessions are persistent ideas, thoughts, impulses or images. They are different than just worrying or being anxious regarding real-life stressors. The thoughts are unrealistic, intrusive, inappropriate, and cause distress.  For example, ruminating about possible contamination if you shake someone’s hand is an obsessive thought.

Most common: contamination (being dirty), doubts (lock the door, turn off stove), need to have things in order.

Compulsions are repetitive behaviors (e.g., hand washing, ordering, checking the lights or the stove) or mental acts (e.g., praying, counting, repeating words silently) designed to prevent or reduce anxiety.  They DO NOT bring the person pleasure. In fact, persons with OCD find the behaviors overwhelming and unreasonable.

In order to be diagnosed with OCD the person must have obsessions and compulsions that meet all aspects of the above definitions, plus they must feel distressed and the compulsions or obsessions consume at least one hour of each day or interfere with daily routine.



OCD falls in the Anxiety Disorder camp. This means that clients will learn relaxation skills. After relaxation is learned, the typical course of treatment is exposure + response prevention. “What?” you ask. Let’s look at an example: Bob is afraid of contaminating his body with germs. He has obsessive thoughts about the cold, flu, incurable diseases. He is rarely sick, but he is still convinced he will become ill. To calm his anxiety he showers for one hour. He does not shake hands. He uses hand sanitizer when he touches anything.  When he washes his hands, he uses a new bar of soap. In therapy, I would have this client purposely touch something and not wash their hands. SO I would expose Bob to his fear and prevent him from responding with a compulsion. (I know. He would probably think I was evil). We would discuss how he did not get ill. We would also identify what was at the root of his obsessive thoughts (fear of death, fear of not being able to protect himself, fear of dying alone). New, more reality based thoughts would be generated.


Another example involves mental compulsions. Sarah experiences disturbing thoughts about death. Every time a thought related to death comes to mind she mentally counts in order to stop the thought.  Her counting leads inattention and self-absorption. I would want the client to face the real issue underlying the obsession and remain mindful (i.e., focus in great detail on the things around her: smells, colors, sounds, etc).



As Good As It Gets: Jack Nicholson nails it. You see over the course of the movie, his routine is disrupted. He cannot rely on his compulsions and nothing horrible happens to him. That is the goal of therapy . . . getting the person to see they are safe and capable.

Monk: it is a television show on USA. Adrian Monk is a detective who suffers from a contamination and order obsession. The season one introduction is below.

Tags: psychology
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