I have OCD. Now what?

Far beyond sorting colors, checking and rechecking doorlocks, washing your hands 10 times a day or being terrified of germs, Obsessive Compulsive Disorder (OCD), unknown to many and often stigmatized in movies and books, causes great psychological and emotional suffering. It is characterized by strong, unwanted and intrusive obsessions that cause a feeling of impending danger and anxiety in the patient. To counter this, they may resort to compulsions; repetitive behaviors that calm them down but interrupt their routine and prevent them from leading a functional everyday life. If left untreated, patients avoid frightening situations which, in some cases, condemns them to social isolation.

According to experts the worldwide prevalence of OCD is close to 2% and the causes of the disorder are multifactorial. The symptoms also vary greatly, depending on the case: a patient whose obsession is a fear of contamination may need to take three showers in a row before leaving the house. Another patient whose fear is hurting a loved one may spend several hours of their day picking up any object they see on the street, so that no one will trip over. However, not all behaviors are directly related to the object of their obsessions. A young child may be unable to pay attention in school because he or she persistently counts to 100 in their head during class, convinced that if they do this their parents won’t leave their side.

Antonio Galán, president of the OCD Madrid Association, has been fighting the disorder for years. “Living with this is a pain in the neck. When the thoughts come, the feeling resembles an anxiety attack,” he says. Galán, for example, is afraid of losing his job, and while at home he folds his clothes and organizes his closet to neutralize that fear. But many patients know that repeating these behaviors will not solve the problem or quell the fear, which is very frustrating for them. “Besides which, it is cumulative; the more episodes you have and the more behaviors you need to neutralize them, the more exhausted you end up,” he says. To avoid this, many people who do not get the necessary help prefer to stay home, isolating themselves socially and emotionally. “The way to deal with this disorder is through therapy, so that there is a change of behavior,” says Galán, who says his condition has improved a lot by seeking help.

The most common treatment is cognitive behavioral therapy, explains Nieves Álvarez, a psychologist at the OCD Madrid Association. With this technique, widely used throughout the world, patients confront their obsessions through controlled exposure to their fear. “It has proven to be the most effective method, although sometimes it falls short,” she admits. To adequately treat OCD, experts recommend the therapist specializes in this type of treatment and also to combine it with other, newer methods, such as mindfulness.

An alternative treatment

There is another option for those who have received treatment for years without experiencing any notable improvement. A study carried out by the Bellvitge Hospital and the Institut d’Investigacions Biomèdiques de Bellvitge in Barcelona, Spain, and published in October, concludes that deep brain stimulation is a safe and effective technique for treating OCD, reducing obsessive symptoms in the long term by 42.5%. Brain stimulation, used successfully to treat diseases such as Parkinson’s, is a reversible operation that has been practiced for more than 40 years. It consists of implanting electrodes through small holes in the skull to stimulate specific points in the brain. “In the case of obsessive disorders, patients who undergo this operation must have spent at least five years with severe symptoms and be resistant to all the usual approaches,” explains María del Pino Alonso, a psychiatrist at the OCD Unit of the Bellvitge Hospital and director of the study.

To be considered a severe case, professionals take two factors into account: dedicating more than eight hours a day to uncontrollable behaviors, and being incapable of working, studying or having a normal social life. “For many of these patients it is very difficult to live independently, because they need help to maintain hygiene, enter and leave the house, or eat,” says Alonso. The analysis followed the evolution of 25 severe OCD patients for an average of 6.4 years (from 2007 to 2020), one of the largest samples ever undertaken in the world. “60% of cases experience a significant improvement in symptoms. It is a good proportion if we take into account that many of them were in treatment for more than 10 years without improving much before undergoing the operation,” says Alonso.

Still, the technique is not widely used. Up to 5% of those affected are considered resistant to all treatments, explains Alonso, who claims that many more should undergo the operation and attributes the scarce use of brain stimulation for psychiatric disorders to patients and psychiatrists not being aware that the option exists.

Although OCD is considered a chronic disorder, some psychologists claim that the symptoms can disappear completely. “That’s difficult,” Galán explains, “but with a lot of work and commitment in therapy, you can lead a perfectly normal life.”