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Never Just Right: 
Solving the Puzzle of 
Obsessive‐Compulsive 
Disorder 
Andrew Jacobs, Psy.D., C.Psych. 
Psychologist, Anxiety Disorders Program 
Jakov Shlik, MD, FRCPC 
Psychiatrist and Clinical Director, Anxiety Disorders Program 
Overview 
•  OCD: Impact 
•  What is OCD – and What Isn’t? 
•  OCD Treatment 
•  GePng Help in ORawa 
•  Online Resources 
Rates of OCD 
•  ORawa Metro Area, 2011:  1,236,324 people 
•  LifeZme prevalence of OCD: 2.3% 
– 28,435 people in ORawa will have diagnosable 
OCD in their lifeZme 
•  One‐year prevalence of OCD: 1.2%  
– 14,836 people in ORawa have diagnosable  
OCD this year 
 Based on data from NaZonal Comorbidity Survey (Ruscio et al, 2010) and StaZsZcs Canada (2012) 
OCD & Other Mental Health Concerns 
•  Over the course of a lifeZme, individuals with OCD 
oben experience the following: 
–  Other anxiety disorders:  76% 
–  Mood disorders: 63% 
–  Substance use disorders: 39% 
–  ANY disorder:  90% 
               Ruscio, Stein, Chiu, & Kessler, 2010 
What is OCD? 
(and what isn’t…) 
What are Obsessions? 
•  Intrusive, recurring, persistent thoughts, mental images, 
or urges that cause marked anxiety or distress 
•  More than “excessive worry” 
•  A person tries very hard to get rid of the  
obesssion with another thought or behaviour 
•  A person knows the obsession comes from his/her  
own mind 
             Based on DSM‐IV‐TR (2000) 
Some Common Obsessions 
•  Excessive, intrusive thoughts about dirt, germs, 
illness, or contaminaZon 
•  Fears of having accidentally caused harm 
•  Excessive doubZng of whether tasks were complete 
or accurate 
•  UpsePng, “nonsensical” need for specific order or 
exactness 
•  UpsePng aggressive, sexual, or religious thoughts 
that are out of character 
What Aren’t Obsessions? 
•  InfatuaZon 
•  Fantasies 
•  Over‐thinking 
•  UpsePng memories 
•  Worrying 
•  Intrusive thoughts* 
Intrusive Thoughts are NORMAL 
•  90% of people report experiencing intrusive thoughts 
(Salkovskis, 1998) 
•  It is not the intrusion that makes an obsession or 
OCD; it is our anxiety, distress, and reacZon to it 
So Why Not Just Stop  
Thinking About It? 
An Experiment 
What are Compulsions? 
•  RepeZZve behaviours or mental tasks a person must 
perform according to very set rules and/or in 
response to an obsession 
•  Compulsions aim to bring down distress or prevent a 
bad thing from happening, although they are either 
very excessive or wouldn’t realisZcally work 
            
                     Based on DSM‐IV‐TR (2000) 
Some Common Compulsions 
•  Checking doors, windows, locks,  
appliances many Zmes 
•  Washing and cleaning a great deal 
•  CounZng objects, words, etc 
•  Arranging and rearranging objects 
•  Following very specific “rituals” 
•  Looking for reassurance excessively 
What Aren’t Compulsions? 
•  Tidiness / orderliness 
•  Habits 
•  Impulses 
•  AddicZons 
•  SupersZZous behaviours (usually) 
Avoidance 
•  Triggers become linked with obsessions and are 
avoided 
–  Avoid due to fear of intrusive thoughts 
–  Avoid to prevent need to do compulsions 
The Cycle & Growth of OCD 
•  Obsessions are never saZsfied 
•  Compulsions are never complete 
•  Avoidance expands 
What Makes it a Disorder? 
•  Impact 
–  Very upsePng 
–  Quality of life 
–  Time‐consuming 
Treatment of OCD 
Exposure & Response PrevenZon (ERP) 
MedicaZons 
Exposure & Response PrevenZon 
•  Behavioural change‐based therapy 
•  Learning through new experiences 
•  EssenZally a process of reversing what the OCD is 
telling a person to think, feel, and do 
–  IdenZfy OCD cycle in acZon 
–  Face feared situaZons / triggers 
–  Carry through without compulsions 
–  Allow the anxiety to change and fade on its own 
Exposure 
•  Targets oben on a hierarchy of difficulty 
•  Gradually confront avoided items, situaZons,  
and thoughts 
•  Stay in the situaZon 
–  Anxiety gradually declines 
•  Repeat 
Response PrevenZon 
•  Stop compulsive behaviour 
–  Very challenging 
–  Leads to high anxiety at first 
•  Declines with Zme 
•  Alternate: “ruin” compulsion 
–  Example – touch something “contaminated”  
aber washing hands 
Gains from ERP 
•  Learn new things 
–  Feared outcome doesn’t happen 
–  Ability to cope is beRer than expected 
•  Fear and anxiety gradually decrease 
•  Avoidance gradually decreases 
•  Urge to do compulsions decreases 
•  Thoughts become less upsePng 
A Course of ERP 
•  Typically 10‐20 sessions, 60‐120 minutes 
•  Exposures are done both in session and on own 
•  Client is never forced to do anything 
ERP: The BoRom Line 
•  Very challenging, but it works 
–  Extremely well‐researched, established, and  
effecZve treatment for OCD 
–  ERP and similar therapies are effecZve for  
approximately 2/3 to 3/4 of individuals 
MedicaZons Used to Treat OCD 
•  Used to treat OCD: 
–  SSRIs / SNRIs – Serotonin Reuptake Inhibitors 
–  Tricyclic anZdepressants 
•  To help treatment 
–  Atypical anZpsychoZcs / mood stabilizers 
GePng Help for OCD in ORawa 
At The Royal 
•  Physician referral to The Royal 
•  Assessment by psychiatrist or psychologist 
–  Treatment is done both through medicaZons and  
through ERP 
–  ERP is usually done in a group 
In the Community 
•  Look for therapists with the following: 
–  Professionally qualified / licensed 
–  OCD‐specific experience 
–  Behavioural or cogniZve‐behavioural treatment approach 
•  Unless the pracZZoner is a physician, his/her services 
will likely not be covered by OHIP / RAMQ; however, 
private insurance may assist 
Online Resources 
•  InternaZonal OCD FoundaZon  
–  www.ocfoundaZon.org 
•  Anxiety & Depression AssociaZon of America 
–  www.adaa.org 
•  Anxiety Disorders AssociaZon of Ontario 
–  www.anxietydisordersontario.ca 
•  The Royal 
–  www.theroyal.ca 

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