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The Many Guises of OCD - Dr. Martin Seif

Q: As a therapist trained in traditional talk therapy, I find work with OCD clients difficult and frustrating. Can you offer guidelines about the principles of effective treatment?

A: The past 3 decades have seen a revolution in the understanding and treatment of obsessive compulsive disorder (OCD). In the early 1980s, OCD was thought to be rare, and there were no established best methods for treatment; however, we now understand OCD to be quite common, and a clearer understanding of its nature has led to the development of effective treatments, especially exposure and response prevention (ERP), sometimes called exposure and ritual prevention. Additionally, the introduction of effective psychopharmacology has broadened the range of people with this disorder who can be helped.

Understanding OCD begins with grasping the similarities and differences among the phenomena that comprise it. Obsessions are repetitive thoughts or images that feel uncontrollable, threatening, repulsive, or shocking. They arrive in a whoosh, accompanied by an urge to avoid or remove them. Compulsions are actions or thoughts that function temporarily to lower anxiety. It’s easy to recognize behavioral compulsions like cleaning and checking, but purely mental compulsions are far more common and important than previously understood. Mental compulsions include counting rituals, memory checking, distractions, ritualized prayer, and self-reassurances. Clients will often refer to their mental compulsions as rationalizing or analyzing or even problem-solving. Since mental compulsions often go unnoticed, you’re probably seeing more people with OCD than you think.



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