OCD and how psychodynamic psychotherapy can help

For the sake of clarity, I believe it is necessary to make a distinction between obsessive compulsive disorder (OCD) and obsessive compulsive personality disorder (OCPD).

Obsessive compulsive disorder (OCD) is a psychiatric disorder characterised by the presence of obsessions and compulsions. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) previously classified OCD as an anxiety disorder. After the DSM-5 was updated in 2013 OCD has been classified as a separate, distinct category.

Obsessive compulsive personality disorder (OCPD) is a personality disorder characterised by extreme perfectionism, order and control.

Differences between OCD and OCPD

• OCD: Involves specific obsessions and compulsions.
• OCPD: Involves a pervasive pattern of preoccupation with order, perfectionism and control.
• OCD: Symptoms are egodystonic that is, the urge to perform an action is associated with the knowledge that the action is excessive, irrelevant and irrational.
• OCPD: Symptoms are egosyntonic in other words, consistent with the individual's self-concept and not perceived as problematic.
• OCD: Distress comes from intrusive thoughts and the need to perform compulsions.
• OCPD: Distress typically arises from the rigidity and perfectionism impacting the person’s relationships and efficiency.

Understanding obsessions and compulsions

Obsessions

Obsessions are unwanted and intrusive thoughts, images, or impulses that repeatedly and persistently intrude into a person’s mind. These thoughts are often distressing and generate anxiety and discomfort. Common examples of obsessions include fear of contamination, fixation on order and arranging objects symmetrically, fear of unintentionally harming others, or concern about catastrophic events that might occur.

Compulsions

Compulsions are repetitive behaviours (e.g., washing hands, ordering, checking) or mental acts (e.g., praying, counting, repeating words mentally) that a person feels compelled to perform in response to an obsession or to respond to internal rules which they believe must be rigidly applied. Although compulsions are attempts to manage the anxiety stemming from obsessions, they end up creating a vicious cycle. The act of performing compulsions can temporarily alleviate anxiety, but ultimately, it only serves to reinforce the obsessions, leading to an increase in anxiety and a strong dependence on compulsions to feel better.

The impact on daily life

Obsessions and compulsions in OCD can cause significant suffering and substantial interference in everyday life, relationships, work activities, and social interactions. In some cases, the person may recognise that the obsessions are products of their own mind and that the compulsions are unreasonable, but feels unable to resist them and bound to carry them out.

Diagnosis and treatment

The first step to getting help for OCD is to speak to the GP who may also refer the patient to a specialist mental health team.

The treatment for OCD varies depending on the cases and their severity and should include psychological therapy, medication, or a combination of both. Medications such as selective serotonin reuptake inhibitors (SSRIs) are prescribed by a doctor (GP or psychiatrist) to help regulate mood and reduce obsessive-compulsive symptoms.

Although the National Institute for Health and Care Excellence (NICE) guidelines consider cognitive behavioural therapy (CBT) as the preferred psychotherapy for OCD, other therapeutic approaches can help.

How psychodynamic psychotherapy can help treat OCD

• Gaining greater awareness of one’s internal world: Psychodynamic psychotherapy encourages the exploration and understanding of the person’s unconscious thoughts, feelings, and desires, helping them develop better self-awareness. Through the therapeutic process, the individual can confront and integrate parts of themselves that may have been repressed or considered unacceptable.
• Reducing excessive sense of responsibility and perfectionism: Psychodynamic psychotherapy can help the person better understand the origins of their sense of responsibility and perfectionism and address it in a more balanced way.
• Exploring and understanding relationship patterns: Psychodynamic psychotherapy examines unresolved conflicts and symptoms that come from past dysfunctional relationships.
• Understanding the patient’s life history: Psychodynamic psychotherapy aims to explore the subject’s past and childhood experiences to better understand the roots of their current disorders.
• General improvement in the person’s life: Although psychodynamic psychotherapy cannot guarantee the complete disappearance of symptoms, it can lead to significant improvement in the individual’s quality of life, increasing their confidence, reducing feelings of alienation, and enhancing their capacity for personal fulfilment.