Exploring the Impact of Severe OCD and How Residential Treatment Can Help
Obsessive-compulsive disorder affects over 2 million people in the United States alone. If your loved one struggles with severe OCD, it is critical that you recognize the symptoms of the illness and its impact on wellbeing and functionality in order to more deeply understand their experience. If your loved one has not yet found effective treatment, it is also essential to explore treatment options that will address the full scope of their needs.
The words “obsessive-compulsive disorder” are often imagined to signify a desire for cleanliness or orderliness. In the popular imagination, this desire is quirky but ultimately harmless, more likely to result in a spic and span home or thoroughly washed hands than serious psychological distress. In some ways, this speaks to the commonality of obsessions and compulsions—many people can identify to some extent with the desire for symmetry, the need for checking, and illogical but intrusive thoughts. After all, walking down the sidewalk without stepping on the cracks or double-checking that the oven is turned off are familiar phenomena for large portions of the population.
However, those living with obsessive-compulsive disorder (OCD), particularly severe articulations of the illness, know that OCD goes far beyond such benign thoughts and behaviors. While the “popularization” of the language of OCD has in some ways helped to destigmatize the condition and bring it into public consciousness, it often also renders the suffering of those with OCD all but invisible. The true nature of the illness remains hidden and those living may feel misunderstood, isolated, and ignored. If your loved one is struggling with severe OCD, it is critical to gain a full understanding of how the illness manifests, how to support your family member, and how to move toward recovery.
The Symptoms of Obsessive-Compulsive Disorder
Obsessive-compulsive disorder is a chronic mental health disorder characterized by repeated, intrusive, and disturbing thoughts (obsessions) and repetitive behaviors (compulsions) undertaken in response to those obsessions. While each person’s obsessions and compulsions may have unique aspects to them, they often fall into common patterns:
- Fear of dirt, germs, or contamination
- Fear of harming yourself or others
- Fear of losing control of yourself
- Disturbing thoughts, often involving sexual, violent, or blasphemous subject matter
- Superstitious beliefs, particularly involving whether something is lucky or unlucky
- Desire for order, symmetry, and balance
- Doubting whether you have completed tasks correctly, including everyday tasks such as locking doors or shutting off the oven.
- Excessive cleaning, including washing the body
- Repeated checking of things such as locks, light switches, and appliances
- Arranging things the “correct” order
- Tapping, counting, or repeating words or phrases
- Excessive participation in religious rituals
- Checking if loved ones are safe
- Saving or hoarding useless items
- Sticking to precise routines and schedules
Often, compulsions will correspond to obsessions. For example, excessive hand-washing is a logical response to overwhelming fear of germs and contamination. However, some compulsions do not logically follow from a specific obsession. Additionally, while many people with OCD recognize the irrationality of these obsessions and compulsions, they are unable to resolve them, leaving them in a constant loop of distress and fruitless attempts at alleviating their anxiety.
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The Impact of Severe OCD on Wellbeing and Functionality
The severity of OCD can vary greatly from person to person and fluctuate over time. For some, OCD symptoms remain relatively unintrusive in day-to-day life, causing minimal disruption to daily activities and overall emotional wellness. As one author writes in Psychology Today, “Many are [initially] able to keep their obsessive-compulsive symptoms under control during the hours they are engaged at work or school.” However, as the illness progresses, obsessions may intensify due to the development of more disturbing thoughts, more frequent thoughts, and heightened anxious responses to these thoughts. Simultaneously, compulsions may become more elaborate and time-consuming. This rising severity is often triggered by experiences of emotional distress.
For Jon, checking became a constant activity after his mother died. “It takes me over an hour to leave the house each day,” he says. “I need to check every window, door, and appliance in the house several times to make sure everything is safe before I leave. Even after that process is complete I’ll often get in my car and get a sense that something isn’t right, so I’ll go back and check everything again.” And it doesn’t end once he’s at work. “I check my work over many times, which means I often get behind on projects. I’m scared of losing my job because of it. But if I don’t check, my anxiety becomes crushing. It’s the only thing I can think about.”
Sarah also understands what it’s like to have OCD control your life. From the time she was in her early teens, she has believed that she will cause harm to others by spreading disease. As she grew older, the idea that she was contaminated and presented a grave risk to those around her only intensified, causing her to take ever more drastic steps to protect her loved ones from infection. “I used to be able to get away with just washing my hands very well,” she says. “Now, it’s more serious. If I need to meet someone, I shower several times first, will only wear newly-washed clothes, and will not touch them. I keep a list of the people I interacted and when I met them with so I can check the timeline in case they get sick.” Both due to the fact that preparation for socialization takes so long and that she thinks she may still be a danger in spite of the steps she takes to prevent the spread of disease, she minimizes social contact as much as possible:
I never invite anyone over because it would be impossible to decontaminate the entire house. Romantic relationships are out of the question for me. I don’t even open the door for the grocery delivery man—I ask him to leave the box on the porch.
Indeed, for people like Sarah, the illness “may become so severe that time-consuming rituals make it impossible for them to have outside relationships and cause them to lose their autonomy and financial independence.” Its symptoms can prevent normal engagement in social and professional life, cutting your loved one off from critical relationships and activities. Additionally, the pervasive anxiety coupled with social isolation and inability to participate in everyday activities can cause deep psychological pain, self-loathing, and depression. In some cases, people with severe OCD may even experience suicidal thoughts.
Seeking Treatment for Severe OCD
While OCD can be deeply damaging emotionally and behaviorally, it is treatable using a combination of pharmacological and psychotherapeutic treatment modalities:
- Medications: A number of medications may be used to treat OCD symptoms. The most common of these is selective serotonin reuptake inhibitors (SSRIs), a class that includes medications such as Prozac, Paxil, Lexapro, and Zoloft. Serotonin-norepinephrine reuptake inhibitors (SNRIs) and the tricyclic antidepressant Anafranil may also be used in some cases. These medications may be augmented with antipsychotics. Unfortunately, pharmacotherapy alone often fails to provide complete and durable relief of symptoms.
- Psychotherapy: Psychotherapy is often a critical part of OCD treatment, whether used in conjunction with medications or alone. In fact, psychotherapy has been shown to outperform antipsychotic medication as an augmentation strategy for those with severe OCD. Of particular value is exposure and response prevention (ERP), in which “patients encounter the source of their obsession repeatedly and learn ways to stop performing associated rituals until they are able to resist their compulsions.” This may be combined with cognitive therapy to help your loved one identify and re-evaluate damaging beliefs, replacing them with healthier, reality-based alternatives. In doing so, they can break through obsessions and, as a result, resist compulsive behaviors.
For some, participating in these treatment modalities in an outpatient setting can fully resolve symptoms over time. For people with severe OCD, however, long-term residential treatment may be a better choice, particularly if outpatient care has failed to provide successful outcomes.
In residential treatment, your loved one can engage in a comprehensive treatment plan tailored to their unique needs in a safe, supportive environment. The intensity of treatment allows your loved one to quickly establish strong therapeutic bonds with their treatment team and find rapid relief of acute symptoms. This includes both establishing effective pharmacological protocols and creating strategies for coping with intrusive thoughts, anxiety, and compulsive urges. However, the impact of severe goes beyond acute symptomatology. As such, it is critical that your loved one has the support they need to closely examine their illness and its effect on every aspect of their life. With the guidance of expert clinicians, they can gain the insight and skills necessary to regulate their emotions, participate in healthy self-care, form and maintain positive relationships, and regain the day-to-day functionality compromised by OCD. In order to ensure durable healing, it is also essential to address any co-occurring mental health disorders and developing tools for coping with stressors that may trigger relapse.
The structure of long-term residential care ensures that your loved one receives the treatments and supports necessary for each stage of healing, allowing for deep recovery to take root. As your loved one regains control of their illness and their life, their confidence, independence, and resilience will grow immeasurably and their full potential can truly be realized. By guiding them toward the care they need, you can help them open the door to long-lasting wellness and renewed inner tranquility.
Hanbleceya offers long-term residential treatment for people struggling with mental health disorders as well as co-occurring substance use disorders. Contact us to learn more about our renowned San Diego-based program and how we can help you or your loved one start the journey toward wellness.