Understanding Obsessive-Compulsive Disorder

Joseph McNamara, Ph.D., a psychologist at UF Health Psychiatry and co-director of the UF Center for OCD, Anxiety and Related Disorders, debunks several common misperceptions about obsessive-compulsive disorder, or OCD.

There are several key components to OCD

OCD is sparked by a recurring obsessive thought, which is distressing to the patient. The patient is prompted by his or her distress to do something to make the thought go away. This is the compulsion aspect of OCD. In fulfilling the compulsion, the thought is only temporarily erased. In fact, the patient has actually reinforced the thought.

McNamara explained, in the case of a child being afraid to touch a doorknob, parents often try to curb the child’s fears by opening doors for the child.

“Every time they [parents] do that, unfortunately, they are reinforcing for their child that doorknobs are something they need to be afraid of,” McNamara said. “And so the child’s fear of doorknobs is going to grow and grow and grow.”

OCD is maintained by fear

OCD is maintained by avoidance and accommodation, which both feed into the patients fear.

“What we really want to do is work with patients to go from, ‘How do I avoid or accommodate?” to ‘How do I approach?’” McNamara said.

McNamara continued with his example to demonstrate this concept:

• Avoidance - refusal to touch a doorknob.
• Accommodation - accommodating to touch a doorknob (wearing gloves, wrapping hand in towel).
• Approach - touching the doorknob and embracing whatever may happen.

At UF Health Psychiatry, patients with OCD work in different techniques toward the “approach” method through exposure response prevention, a part of cognitive behavioral therapy. Patients are encouraged to recognize the fear and ask, “What’s something I can do to approach my fear and break it down to something that’s within the range of what I can do?”

With exposure response prevention, a patient will systematically work his or her way to the approach method. A patient who is afraid of touching a doorknob will not start off touching a doorknob. First steps for the patient could include being close to the doorknob or placing his or her hand near, but not touching, the doorknob.

“You start at the bottom of the fear ladder and you climb your way up,” McNamara said.

Most patients, especially children, don’t realize that exposure to their fears will actually help. But it’s crucial for patients to find somebody they can work with to help face these fears, which is why UF Health Psychiatry’s summer camp is called Fear Facers.

Every case is not the same

McNamara has been working in an OCD clinic for over 10 years, and has never seen two cases of OCD that are exactly the same.

Often, people will equate someone being a germaphobe, or preferring things neat, to having OCD. He said this isn’t the case and there’s a lot of variability in how OCD symptoms present themselves.

There is hope for OCD patients

McNamara said most people don’t understand how severe OCD can be. In fact, it’s ranked by the World Health Organization as one of the top 10 most-disabling disorders. Most patients are afraid to seek help. The average length of time before somebody gets into treatment is about seven to 10 years.

There’s hope at UF Health Psychiatry, though, where up to 85 percent of patients have a 50 percent reduction in symptoms by the time they complete their 15th session. McNamara’s goal is for his patients to feel like they are in control of their lives rather than OCD controlling their lives.

“I think one of the things OCD takes away from people is the hope that it can ever get any better,” he said. “We are determined to help our patients regain hope and improve their quality of life.”

OCD Awareness Week is Oct. 7 to 13.