OCD impacts an estimated 1.2% of adults in the United States. While cognitive behavioral therapy (CBT) and exposure and response prevention therapy (ERP) tend to be the most commonly prescribed treatments for OCD, EMDR is also effective. In this article, we'll explore what OCD is, the role of trauma as a risk factor in developing OCD, and how EMDR can be utilized as an effective treatment for OCD.
What is OCD?
According to the Diagnostic and Statistical Manual of Mental Disorders (DSM 5TR), Obsessive-Compulsive Disorder (OCD) is defined by two main components: obsessions and/or compulsions. These obsessions/compulsions tend to be time consuming, cause distress, and/or negatively impact daily functioning. Additionally, in order to be considered OCD, the obsessions/compulsions must not caused by the use of a substance, a by medical condition, or by some other psychological disorder.
What is an obsession?
Obsessions are intrusive, unwanted thoughts, images, or urges that cause significant distress. They often feel persistent and uncontrollable, and they tend to cause extreme anxiety. To cope with this discomfort, individuals experiencing unwanted obsessions, often try to stop (or "neutralize") their obsessions with certain thoughts or actions. These attempts to suppress obsessions are called compulsions (more on that below).
Common Obsessions
Contamination: Fear of germs, dirt, or illness, often accompanied by a need to clean or avoid contact with perceived contaminants.
Symmetry: An intense need for order, balance, or things feeling "just right."
Harm: Fear of causing harm to oneself or others, either accidentally or intentionally.
Forbidden/Taboo Thoughts: Intrusive thoughts about topics that feel inappropriate, such as violence, religion, or sexuality.
Misconceptions About Obsessions
Many people misunderstand obsessions, believing that they are just simple worries or overthinking. In reality, obsessions are far more distressing. Additionally, people with obsessions of harm or forbidden thoughts often struggle with feelings of guilt or fear that they are "bad" at their core. This is not true -- obsessions are not reflective of an individual’s true desires, beliefs, or character. Understanding this is crucial to reducing stigma and offering meaningful support to those with OCD.
What is a compulsion?
Compulsions are repetitive behaviors or mental acts that someone feels driven to perform in response to an obsession. They’re usually intended to neutralize the obsession.
Common Compulsions
Cleaning: In response to a contamination obsession, an individual might feel compelled to engage in excessive hand-washing or cleaning.
Ordering: In response to a symmetry obsession, an individual might feel compelled to repeat, order, or count things. For example, they may arrange objects until they feel "just right" or repeatedly count steps while walking.
Checking: In response to a harm obsession, an individual might feel compelled to ensure safety by checking to make sure that no harm has been done. For example, checking to make sure the front door is locked or checking to make sure the oven is turned off.
Misconceptions About Compulsions
Compulsions are often misunderstood as harmless quirks or simple coping strategies. In reality, they are intense, repetitive actions driven by overwhelming anxiety and a need to alleviate distress caused by obsessions. Rather than providing relief, compulsions often perpetuate the cycle of OCD and can significantly disrupt daily life.
What is accommodation?
Accommodation is when friends or family members participate in an individual's compulsive rituals. While friends and family members may make these accommodations from a place of love, this involvement can actually make OCD symptoms worse.
What is sensory phenomena?
Sensory phenomena are physical sensations or somatic feelings that precede compulsions. These might include a feeling incompleteness or a sensation of uneasiness that something is not "just right." According to the Diagnostic and Statistical Manual of Mental Disorders (DSM 5TR), 60% of people with OCD experience sensory phenomena.
What causes OCD?
The development of Obsessive-Compulsive Disorder (OCD) is shaped by a combination of environmental influences, genetic predisposition, and individual temperament.
Risk Factors For Developing OCD
Environmental: Exposure to certain environmental factors can lead to a higher likelihood of developing OCD. In particular, traumatic events in childhood (including pre-verbal, perinatal traumas) can increase the risk of developing OCD.
Genetic: There is a genetic component to OCD. Research shows that people who have parents, siblings, or children with OCD are 2x more likely to have OCD themselves than people who don't have a close relative with OCD. Moreover, if those parents, siblings, or children developed OCD in childhood, then the likelihood goes up to 10x.
Temperamental: There are also temperamental factors that lead to a higher likelihood of someone developing OCD. Specifically, there is some evidence to suggest that people who tend to internalize their feelings, feel more comfortable experiencing negative emotions (like anger, fear, or guilt), and who tended to be hesitant when faced with new experiences in childhood have a greater likelihood of developing OCD.
Can trauma cause OCD?
Yes, research suggests that trauma can cause OCD. According to the Diagnostic and Statistical Manual of Mental Disorders (DSM 5TR), environmental factors, including exposure to traumatic experiences, can increase the likelihood of developing OCD. Research shows that traumatic experiences and stressful life events can directly cause obsessions to begin. A study conducted in 2007 found that 54% of individuals with an OCD diagnosis had experienced at least one traumatic life event, and that those individuals who had experienced a traumatic life event had more severe OCD symptoms. Genetic and temperamental factors also play a role in the development of OCD.
What is the best type of therapy for OCD?
One of the most common treatments for OCD is Exposure Response Prevention (ERP) therapy. ERP is a type of cognitive-behavioral therapy (CBT) that can help individuals with OCD face their fears (or triggers) and resist the urge to perform compulsions. Research shows that ERP therapy is effective in reducing OCD symptoms by 60% to 80%. That said, ERP still has certain limitations.
Drawbacks of ERP for OCD
Too Frightening: Some individuals with OCD find exposure to theirs fears/triggers to be too frightening to engage in. Research shows that 25% of individual with OCD choose not to engage in ERP therapy once they learn it will require them to face their fears
Homework: ERP therapy often requires homework. Some people don't have the time or energy to complete their ERP homework
Obsessions without Compulsions: Some individuals with OCD experience obsessions without compulsions. ERP is less effective for these individuals
A study conducted in 2017 found that Eye Movement Desensitization and Reprocessing (EMDR) therapy is as effective as ERP therapy in treating OCD. Whereas ERP focuses on facing fears, EMDR focuses on reprocessing the distressing memories or beliefs that cause those fears. Both can help to relieve OCD symptoms. Moreover, a 2020 study found that combining EMDR and ERP is more effective than ERP alone.
Is EMDR effective in treating OCD?
Yes. EMDR is an effective treatment for treating OCD. Studies have found that EMDR therapy helps reduce obsessions, compulsions, and the anxiety tied to them.
How can EMDR therapy help people with obsessions and/or compulsions?
EMDR works by targeting and reprocessing the distressing memories, beliefs, and experiences that are at the root of an individual's OCD symptoms. In other words, it targets the environmental factors that contribute to OCD, helping individuals struggling with obsessions/compulsions to regain a sense of control over their thoughts and behaviors.
FAQs About EMDR Therapy
Q: What is EMDR therapy?
A: EMDR stands for Eye Movement Desensitization and Reprocessing. It’s a therapy designed to help people process and heal from traumatic or distressing experiences.
Q: How long does EMDR therapy take?
A: The length of treatment depends on your specific needs, but many people see results within 8 to 12 sessions. Some may need more or fewer sessions.
Q: Is EMDR only for trauma?
A: No. While EMDR is best known for treating PTSD, it can also help with anxiety, depression, OCD, phobias, and other mental health conditions.
Q: Does EMDR work for everyone?
A: EMDR is effective for many people, but it’s not a one-size-fits-all solution. Your therapist can help you decide if it’s the right approach for you.
Q: Can EMDR be combined with other treatments?
A: Absolutely. This is known as adjunctive EMDR. Many people benefit from combining EMDR with other therapies like CBT, as well as with medication and self-care strategies.
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EMDR Therapy for OCD in NYC, Brooklyn, and Online
The first step to beginning EMDR therapy for OCD is finding a qualified therapist to work with. If you're already working an ERP or CBT therapist that you feel comfortable with, adjunctive EMDR therapy might be a good option for you. Don't hesitate to reach out if you're based in New York and have questions about the process. With the right support, you can reduce your symptoms and regain control over your life.
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