Contact your doctor if your symptoms worsen or don't respond to treatment. OCD typically has periods when symptoms become worse for no apparent reason. Seek help at such times to adjust your medication or for help in modifying your behavior.
If your symptoms don't respond to treatment, you may need to be hospitalized. Many psychiatric facilities provide varying levels of care, such as day care, evening care, and residential programs.
You and your family should learn as much as possible about OCD. OCD sufferers may wish to join the Obsessive-Compulsive Foundation or a local support group if available. Many books are available can offer insight into the disease as well as strategies for coping.
Obsessive-Compulsive Foundation, Inc.P.O. Box 70Milford, Connecticut 06460-0070USA1-203-878-5669
Obsessive-Compulsive Information Center2711 Allen BoulevardMiddleton, Wisconsin 53562USA1-608-836-8070
Your doctor is the best source of information on the drug treatment choices available to you.
Behavioral and cognitive therapies against OCD help you learn to cope with and reduce obsessions and compulsions. Cognitive behavioral therapy has been shown to be effective in treating OCD, and can be used in addition to or instead of medication. Behavioral techniques involve gradually bringing you into contact with your fears, either through actual or imaginary exposure. Cognitive therapy helps you to examine and evaluate fears, and consider other ways of dealing with anxiety.
Behavioral therapy typically takes place over a 10-week period. Intensive therapy involving two- to three-hour sessions daily for three weeks is another alternative. This form of therapy can be done individually or in-group sessions. While cognitive and behavior therapies provide long-lasting benefits, many people find them too anxiety-provoking, and prefer using medication exclusively.
For severe cases of OCD that don't respond to medical or behavioral therapy, surgery may be an option. Surgery for OCD involves removing part of the brain. Depending on the part removed, the procedures are called cingulotomy, subcaudate tractotomy, limbic leucotomy, or capsulotomy. Recent surgical techniques involve creating a lesion on the brain with gamma irradiation. About 25% to 30% of patients who have undergone surgery have benefited from it. Possible side effects, however uncommon, include infection, hemorrhage, epileptic seizures, and weight gain.
Pregnant patients should try behavioral therapy before taking medications for OCD. If medication is necessary, pregnant women should discuss the safest drug choices with their physicians.
Patients with other co-existing diseases, such as depression, require tailored drug treatment regimens.
Elderly patients require modified drug treatments. Lower doses of medication may be used, and clomipramine may be avoided because of its effects on the heart and tendency to cause constipation.
Symptoms of OCD are rarely completely eliminated; most people experience occasional flare-ups of the disorder throughout life. OCD seldom goes away on its own. Even with treatment, most people have symptoms that improve and worsen. Symptoms tend to worsen during times of stress, although many report that they also seem to appear out of nowhere. Even with appropriate treatment, symptoms rarely disappear completely, but can often be considerably reduced.
Between 50% and 80% of patients improve with anti-obsessive-compulsive drugs. On average, symptoms of obsessions and compulsions improve from 30% to 70%.
Consult your doctor if you anticipate stress that may worsen your symptoms. For some people with OCD, stress invariably makes symptoms worse. Times of high stress, such as pregnancy, a relationship breakup, a career change, or a move to a new location warrant discussion with a doctor about coping strategies or medication needs.
Seek help whenever problems arise, and get annual check-ups. Even with appropriate treatment, symptoms may worsen unexpectedly. Medications can be temporarily adjusted, or your doctor may recommend new behavioral coping strategies. If OCD symptoms are under control, check in with your doctor once a year.
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