Are You Sure I’m Not Annoying You? Yes, But OCD is Real!

OCD can be disabling. Treatment can help.

Obsessive Compulsive Disorder (OCD) is a common illness. What is the difference between being “obsessed” colloquially and having a brain disorder? According to IODCF:

most people have unwanted intrusive thoughts from time to time, but in the context of OCD, these intrusive thoughts come frequently and trigger extreme anxiety that gets in the way of day-to-day functioning.

I actually dislike the term “anxiety.” My issue? We often stop asking questions about what a person is anxious about. Often, the conversation stops at “just” anxious. The distress inside people’s minds is not obvious. Understanding that, as opposed to avoiding “making someone anxious,” helps people get to a better life. This is the core of exposure and response prevention therapy,(EXRP) a potent treatment for OCD.

OCD is serious: the suicide completion rate is ten times higher than depression. It can be difficult to treat. Good options exist, and even better options exist now than ever!

The dragon Smaug is in therapy for Hoarding—which is often a co-occurring condition with OCD.

“I don’t have OCD. I mean, I’m really, really obsessive, but I don’t wash my hands all the time.”

It might be OCD. You don't have to suffer needlessly. Some evidence-based options past EXRP, like that offered by NOCD and others, include:

Serotonin Reuptake Inhibitor Medications: Fluvoxamine and many others have efficacy, but often at higher doses than used in depression.

Clomipramine is a tricyclic antidepressant and a gold standard of care.

Acceptance and Commitment (ACT) therapy can be helpful.

Deep TMS: Most (58%) treatment-resistant patients get substantial improvement and will be replicated in large real-world data. This effect is long-lasting: (86.7%) had ‘durability’ of ≥1 year. Most importantly: 31% of patients will get to full remission of symptoms.

And there is promising but early data on the potential role of psilocybin from ongoing research done at John’s Hopkins.

—Owen Scott Muir, M.D.