“Feeding the dog took two hours as I checked and re-checked I’d given him the right food and the right amount.” The British homemaker Hayley Martin suffered from obsessive-compulsive disorder. As its name suggests, obsessive-compulsive disorder (OCD) is defined by the presence of two symptoms: obsessions and compulsions (Abramowitz, Taylor, & McKay, 2009).

695

Dog feeding unfortunately was the least of Hayley Martin’s problems. Obsessive thoughts dominated her family relationships: “The fear I had, that someone I love would be hurt or die as a result of me not checking everything is safe, was all-consuming. It was taking four hours to check and re-check that the gas was off.” OCD affected her relations with friends: “If I phoned someone I was terrified I’d offended them and had to call them back to make sure I hadn’t.” It also affected her health; she eventually had a heart attack from the stress of OCD (“Checking House Was Safe,” 2010).

DEFINING FEATURES AND PREVALENCE. In the DSM, the defining features of obsessive-compulsive disorder include the following:

The compulsive behavior of OCD is irrational—and people with OCD know it. They know that the gas is turned off, the water isn’t running, the door is locked, and their hands are clean. Yet this cold, factual knowledge is not enough. They still experience anxiety about potential harm and compulsively engage in behavior that the anxiety triggers.

As with other psychological disorders, the symptoms of OCD may sound familiar to you. Most of us, from time to time, worry excessively about everyday harms and engage in some extra “checking” behavior. However, OCD is more severe, and more rare, than this. The extreme anxiety and compulsiveness of obsessive-compulsive disorder strike about 1% of the adult population (Franklin & Foa, 2011).

TREATMENT. A number of therapeutic strategies benefit people with OCD. One is exposure and response prevention (Franklin & Foa, 2011). In exposure and response prevention therapy, therapists cause clients to come into contact with the stimuli that trigger their obsessions. They then prevent the clients from engaging in their usual compulsive behavior. Suppose, for example, that the therapist is working with a client who compulsively washes her hands to avoid germs. The therapist might lead the client to touch an object that is not perfectly clean, and then prevent her from washing her hands. At first, this is anxiety provoking for the client. After repeated exposure, however, the anxiety tends to dissipate as the client sees that no harm results when the typical compulsive behaviors are not performed.

In addition, both cognitive therapy and drug therapy can treat OCD successfully. Cognitive therapists combat clients’ irrational beliefs, such as the belief that harm will befall people if the client does not compulsively check and recheck situations. In drug therapies, drugs used to treat depression also have been found to benefit OCD patients. However, a drawback is that they have these benefits only while patients continue to take the drugs (Franklin & Foa, 2011). By comparison, cognitive-behavioral therapy instills skills that remain with clients long after therapy concludes. This advantage leads many therapists to promote “skills, not pills”—that is, to endorse cognitive and behavioral approaches rather than drugs.

696