Obsessive Compulsive Disorder (OCD) and BFRBs

OCD is a “beloved” specialty of Dr. Ostoja’s. OCD spectrum disorder include well known presentations, such as frequent hand-washing, germ-phobia, blood contamination fears, hoarding, or scrupulous orderliness or punctuality. However, there are many less well-known manifestations of this disorder, including excessive reassurance seeking, checking up on loved ones to make sure that they are OK (repeated phone calls),  obsessive re-living of unpleasant memories in which the client feels they made a mistake or offended someone, “sticky-brain” phenomena with inability to get rid of unpleasant images, fears of acting on frightening “impulses” (they are not truly impulses), such as looking at other people’s private body parts, shouting or engaging in embarrassing acts in public places, acting violently toward others or self, and other experiences of overvaluing one’s thoughts. OCD can be broadly described as an excessive need for absolute control over one’s environment, both internally (thoughts and emotions), and externally (people and events in one’s life). OCD people hold a deep seated and often unconscious belief that if they could only do everything right, they could prevent all uncomfortable feelings in self and others. Most OCD sufferers unconsciously attempt to control the world through overt acts (compulsions, avoidance, controlling others) and superstitious mental rituals (mental over-checking, such as over-thinking prior events to make sure they did not do something reprehensible; questioning their motives, censoring all thoughts, feelings and reactions). The end goal is prevention of anything that could be deemed unpleasant. Many clients who suffer from depression and anxiety may have milder underlying forms of obsessive thinking that can respond well to traditional OCD therapies.

In addition to the above traditional OCD symptoms, the OCD spectrum is also often associated with:

Body Dysmorphic Disorder (BDD) (often secretive and greatly undiagnosed, but debilitating)

Trichotillomania (compulsive hair-pulling)

Excoriation Disorder (Dermatillomania or skin picking)

These disorders, often referred to as Body Focused Repetitive Behaviors (BFRBs), also respond to many traditional OCD interventions, but usually also require additional specialized techniques. These include sensory awareness, behavior monitoring, and training in emotional self-regulation techniques (e.g., CBT and DBT techniques).

As indicated in my page on “Integrating Diverse Therapy Approaches,” I have found that adding EMDR (Eye Movement Desensitization and Reprocessing) techniques to the treatment of OCD and BFRBs can greatly facilitate treatment progress. Although EMDR was originally developed to treat easily identifiable trauma (e.g., accidents, combat trauma), it has since been applied with great success to “small t” traumas. These can range from an incident of being embarrassed in one’s kindergarten class to a profound experience at a cosmetic office where one learns that pores can be cleared of “gunk.” These seemingly minor incidents can become etched in the brain circuitry in a way that perpetuates maladaptive behaviors. A shy person may avoid social situations because they past embarrassing incidents have not been processed and integrated effectively. A skin picking behavior of a person with excoriation disorder may be fueled by an image of “gunk” in the pores.  These memories or memories may not be consciously linked to those past experiences, but EMDR processing of those memories can lessen the intensity of the feelings and urges. This makes the behavioral and cognitive strategies less difficult to implement. EMDR does not require active remembering or understanding of such past events (unlike psychoanalysis). Some people remember such experiences, and others can process them by focusing on their feelings and sensations that arise when they experience OCD or BFRBs thoughts or impulses.

I also teach Mindfulness and “Brain Lock” approaches to lessen the power of obsessions, compulsions and BFRBs.

I treat children, adolescents and adults with the OCD spectrum disorders.  OCD can cause severe suffering in the affected patient, and in his or her family. Some patients resist treatment and are brought in by families.

For severely affected patients, co-joint medication treatment is highly recommended. I work with Psychiatrists and Primary care physicians to coordinate treatment. Usually family support is a necessary component of treatment, as are extended 90 minute sessions.

For less affected clients who struggle with mild unpleasant obsessions or mild disturbing images, education and cognitive and midnfulness approaches are available.

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