Obsessive compulsive disorder - OCD treatment and therapy from NOCD

OCD is one of the top 10 causes of disability worldwide

OCD is often misdiagnosed or undiagnosed

One study found that OCD was missed in 70% of patients. It takes an average of 14-17 years for someone with OCD to be correctly diagnosed and find appropriate treatment.

Misdiagnosed OCD can be devastating

The lack of identification and proper diagnosis has detrimental effects on patients and can lead to an elevated risk of suicide and substance abuse disorders—as well as increased emotional and physical distress. Even traditional talk therapy can be detrimental for people with OCD , leading to prolonged suffering.

In a study of 36,788 OCD patients in the Swedish National Patient Register over the span of 44 years, researchers found that 4,297 individuals attempted suicide, and 545 died by suicide. Those with a substance abuse disorder had an increased risk of suicide. This study highlights that the risk of death by suicide is approximately 10 times higher for OCD patients than the general population .

Table of Contents

Learn to identify OCD

Gain a better understanding of how to diagnose and treat OCD with our free continuing education (CE) courses. Open to any provider.

See all courses

Explore our free CE courses

2 CE Credits

OCD Subtypes: Identification and Treatment

With PATRICK McGRATH, PhD

1.5 CE Credits

Social Anxiety Disorder: Fundamentals and Behavioral Treatment

With MIA NUNEZ, PhD

1 CE Credits

Medication Treatment for OCD: What Non-Prescribers Need to Know

With JAMIE FUESNER, MD

1.5 CE Credits

OCD in Adults: Symptoms, Assessment & An Introduction to First Line Treatments

With PATRICK McGRATH, PhD

Why OCD is misdiagnosed

Given the public misconceptions of OCD, many people do not associate their symptoms with it. Instead, they may experience fear, shame, and embarrassment, and a reluctance to speak openly even to healthcare providers. Taboo sexual OCD themes, for example, often go untreated. Taboo temptations, along with other harm-related obsessions such as urges to hurt oneself or others are crucial to identify and differentiate from harmful behavior. Developing trust and approaching questions in a gentle, empathetic way can be a way to surface these damaging—often suppressed—OCD symptoms.

Prevalent OCD types and themes

While OCD is often associated with themes of cleanliness or symmetry, there is a growing understanding of the prevalence of harm-related themes, taboo obsessions, and feared outcomes. A recent data study conducted on the NOCD community app analyzed over 7,001 unique words related with obsessions from 25,369 individuals. The findings highlight the significance of harm obsessions as a central focal point across various OCD themes. Self-reported obsessional thoughts related to relationship concerns and the need for things to be "just right" emerged as the second most common theme.

Common OCD thought patterns:

Gaps in clinical education

The challenge in identifying OCD symptoms stems in part from lack of consistent training in graduate and practicum programs. In addition, OCD is often overlooked because symptoms manifest as depression, anxiety, or substance abuse. 76% of people with OCD have a lifetime diagnosis of anxiety disorder making it hard to distinguish recurrent worry thoughts as OCD from situational or generalized anxiety.

Just as alarming, research indicates that substance abuse can develop as a coping mechanism for OCD symptoms [] and fewer than 50% of the people with this concurrence ever seek treatment for OCD. This reinforces the need to look deeper at indicators that may not present as primarily OCD in the presence of other symptoms.

Co-occurence with OCD:

Substance Abuse

40%

People with OCD

Depression

63%

Anxiety disorders

76%

Possible OCD manifestations

A man with the words 'OCD and Anxiety Disorders' overlayed.

Meet Vishnu

Vishnu has been seeking urgent medical care on multiple occasions this year due to panic attacks driven by an unfounded fear of having a serious medical condition. He becomes fixated on bodily sensations, which are a big source of distress and lead to excessive research of plausible causes that frequently result in sleepless nights.

In an attempt to alleviate his anxiety and prevent obsessive thoughts about contracting a virus, he compulsively uses hand sanitizers after every contact, resulting in skin-related issues like cracking and dryness. Despite seeking assistance and taking anxiety medication, his current treatment fails to effectively address these distressing thoughts and behaviors.

A man with the words 'OCD and Substance Abuse' overlayed.

Meet Roy

Roy's transition to college has proven to be more challenging than he anticipated. The party scene lured him in and he started consuming alcohol. One particular night, he drank excessively and experienced a blackout, leaving him with zero recollection of what happened during a portion of the evening. The uncertainty terrifies Roy, as vivid images of him hurting someone at the party persist in his mind.

His friends assure him that nothing happened, but Roy's fear persists and he's avoiding going out. He spends evenings alone in his dorm, but the isolation does not prevent the intrusive images that haunt his mind. In an attempt to alleviate these disturbing thoughts, he turns to alcohol and uses it to numb himself until the images dissipate.

A woman with the words 'OCD and Postpartum Depression' overlayed.

Meet Julia

Julia is a 28 year old woman who recently brought home her baby boy from the hospital.

From the moment he was born, Julia has looked at him from afar but has not yet touched him. She fears that she will accidentally do something inappropriate with him that will make her a child molester and scar him for life.

Julia's mother has had to move in with her and her husband to help take over caring for the newborn. Julia is willing to look at her son but won't touch him to be sure she doesn't cause any harm.

The first step in identifying OCD is building trust so that an individual can disclose their thoughts without fear of judgement.

Accurately diagnosing OCD

Once trust has been established, conducting a comprehensive assessment for OCD using recommended screening tools allows the complex, concealed, and taboo themes of the disorder to surface and be addressed. This holistic approach is necessary since so many people with OCD are not properly diagnosed when they initially seek help. Early, empathetic screening, accurate diagnoses, and an ever-growing network of informed providers are critical to alleviate the suffering caused by OCD.

The Diagnostic Interview for Anxiety, Mood, and Obsessive-compulsive and related Neuropsychiatric Disorders (DIAMOND) is a semi-structured diagnostic interview for OCD.DIAMOND
The Dimensional Obsessive-Compulsive Scale (DOCS) measures the severity of the most consistently identified OCD symptoms.DOCS
The Subjective Units of Distress Scale (SUDS) is a tool used for measuring the level of anxiety and discomfort individuals are experiencing on a 0-100 scale.SUDS
The Obsessive-Compulsive Inventory-Revised (OCI-12) is 12-item self-reported measure of OCD symptoms widely used in clinical settings.OCI-12

OCD Identification

Providers can now quickly identify if patients may be struggling with OCD symptoms by using an OCD identification tool designed by NOCD's Clinical Leaders. Patients can answer the questions prior to their session for the provider to review and determine next steps. This tool is successfully identifying cases of OCD in major practices across the US.

Click to download the tool to identify patients in your practice who may be struggling with OCD.
Clipboard CheckOCD Identification

Refer someone to NOCD

Here's how it works:

  1. 1
    The person you refer can book a free 15-minute assessment call with our intake team
  2. 2
    They will start a twice-weekly treatment plan and receive support between sessions
  3. 3
    You'll be given access to view their progress and outcomes

References

  1. Albert, U., Ronchi. D., Maina, G., & Pompili, M. (2019), Suicide Risk in Obsessive-Compulsive Disorder and Exploration of Risk Factors: A Systematic Review, Current Neuropharmacology, 681-696. [Full text]
  2. Ziegler S., Bednasch K., Baldofski S., & Rummel-Kluge C (2021) Long durations from symptom onset to diagnosis and from diagnosis to treatment in obsessive-compulsive disorder: A retrospective self-report study. PLoS ONE 16(12): e0261169.[Full text]
  3. World Health Assembly, 54. (2001). Ministerial round tables: mental health. World Health Organization. [Full text]
  4. Glazier K., Swing M., McGinn LK (2015). Half of obsessive-compulsive disorder cases misdiagnosed: vignette-based survey of primary care physicians. J Clin Psychiatry. [Full text]
  5. Fernández de la Cruz L, Rydell M, Runeson B, D'Onofrio BM, Brander G, Rück C, Lichtenstein P, Larsson H, Mataix-Cols D. (2017) Suicide in obsessive-compulsive disorder: a population-based study of 36,788 Swedish patients. Mol Psychiatry. [Full text]
  6. Feusner J. D., Mohideen R., Smith S., Patanam I., Vaitla A., Lam C., Massi M., & Leow A.(2021), Semantic Linkages of Obsessions From an International Obsessive-Compulsive Disorder Mobile App Data Set: Big Data Analytics StudyJ Med Internet [Full text][Multimedia Appendix 1]
  7. Ruscio, A. M., Stein, D.J., Chiu, W.T., Kessler, R.C. (2010). The epidemiology of obsessive-compulsive disorder in the National Comorbidity Survey Replication. Molecular Psychiatry, 15, 53–63. [Full text]
  8. Mancebo, M. C., Grant, J. E., Pinto, A., Eisen, J. L., & Rasmussen, S. A. (2009). Substance use disorders in an obsessive compulsive disorder clinical sample. Journal of Anxiety Disorders, 23, 429–435. [Full text]
  9. Cuzen, N. L., Stein, D. J., Lochner, C., & Fineberg, N. A. (2014). Comorbidity of obsessive-compulsive disorder and substance use disorder: A new heuristic. Human Psychopharmacology: Clinical and Experimental, 29(1), 89–93. [Full text]
  10. Sbrana, A., Bizzarri, J. V., Rucci, P., Gonnelli, C., Doria, M. R., Spagnolli, S., et al. (2005). The spectrum of substance use in mood and anxiety disorders. Comprehensive Psychiatry, 46, 6–13. [Full text]
  11. Swendsen, J., Conway, K. P., Degenhardt, L., Glantz, M., Jin, R., Merikangas, K. R., et al. (2010). Mental disorders as risk factors for substance use, abuse and dependence: Results from the 10-year follow-up of the National Comorbidity Survey. Addiction, 105, 1117–1128. [Full text]
  12. Mayerovitch, J. I., du Fort, G. G., Kakuma, R., Bland, R. C., Newman, S. C., & Pinard, G. (2003). Treatment seeking for obsessive-compulsive disorder: Role of obsessive-compulsive disorder symptoms and comorbid psychiatric diagnoses. Comprehensive Psychiatry, 44(2) 162–168. [Full text]
  13. Glazier, K., Calixte, R. M., Rothschild, R., & Pinto, A. (2013). High rates of OCD symptom misidentification by mental health professionals. Annals of Clinical Psychiatry, 25(3), 201–209. [Full text]