Psychofarm Podcast What Is OCD? How to Understand It, Recognize It, and Treat It
Core DSM-5 OCD Features
- OCD involves intrusive thoughts coupled with compulsions to neutralize them, which distinguishes it from simple anxiety.
- The compulsion is usually excessive and aimed at reducing distress not rational prevention of feared events.
OCD Symptoms vs Disorder
- OCD symptoms can be normal, but OCD proper develops from progression of symptoms becoming rigid and disabling.
- OCD diagnostic cutoff depends on distress, duration, and impact on functioning, distinguishing it from developmental rituals or mild symptoms.
How ERP Therapy Starves the OCD Urge Monster
ERP (Exposure Response Prevention) treats OCD by teaching patients to tolerate uncertainty and resist compulsions, essentially starving the "urge monster" that feeds on compulsive behavior.
The OCD cycle involves:
- A trigger causing an intrusive thought
- A catastrophic appraisal increasing distress
- Distress leading to compulsive actions
Compulsions provide temporary relief, reinforcing the cycle. ERP works by exposing patients to triggers and preventing compulsions, encouraging distress tolerance without using distraction or calming techniques that can worsen OCD.
The goal is not to stop intrusive thoughts but to reduce their threatening meaning and compulsive responses through repeated exposure and response prevention.
> The amygdala is stupid and thinks that the compulsion reduced distress, so it reinforces the behavior, making it hard to stop. ERP starves this urge monster by resisting compulsions. > > — Dr. Malzberg