An 8 year old girl presented with OCD after being bullied by a new kid in school. She started having intrusive thoughts about her sister drowning in the family swimming pool, grabbing hold of the steering wheel and running someone over, her dog jumping out of the window, stabbing someone with a knife and touching people’s private parts. She started avoiding television, swimming pools, driving in the car, or anything that might trigger these upsetting thoughts. She would compulsively jump over cracks and doorways, repeat actions in sets of 4 and developed simple motor tics like smelling her fingers, scrunching her lips and symmetrical tapping in an attempt to relieve the physical tension that these obsessions caused her. The girl reported significant improvement in her obsessive thoughts after a short-term course of exposure therapy and response prevention. She was no longer avoiding her perceived stressors and found the images and thoughts to be boring. As her anxiety decreased and habit reversal techniques were employed, her tic-like behavior stopped. Within three and a half months, the girl and her mother reported that she was OCD free.
A 29 year old attorney obsessed over whether or not her behaviors were 100% ethical. She would ruminate over past or current mistakes and constantly worried about someone being mad at her for her imperfections. She spent hours every day mentally reviewing mistakes she had made in the last 15 years and tried to reassure herself that those mistakes were okay. But her mind continued to jump from one guilty obsession to another. She tried to magically undo her mistakes through compulsive finger counting, creating a tension in her body, spelling the word PERFECT on her fingers, and nodding until she felt just right. Through 7 weeks of ERP she was able to desensitize to the idea of being imperfect and was able to stop ritualizing. She reported having nothing to talk about with regard to her OCD since she felt freed of obsessions and was now able to focus on achieving other life goals that have been neglected by years of obsessing.
A 25 year old nanny was battling constant intrusive thoughts about going crazy, hearing voices, having paranoia and hurting children. She reported having relatives with mental illness and compulsively searched for reassurance that she was not going to have her life destroyed by declining mental health. She compulsively searched for clues that supported as well as negated her fears. Through short-term ERP treatment, she learned how to stop her mental rituals, desensitize to her thoughts, and ultimately quiet her mind. She terminated treatment feeling very confident in her ability to be non-reactive to her thoughts.
A 29 year old gentleman presented with fear of swallowing. He reported having a history of OCD including hair twisting, being bothered by turtle necks, unable to sleep in shirts, being obsessively aware of his own breathing, and a fear of having herpes. His recent fear of swallowing was set off by a feeling that food was stuck in his throat. He obsessed about the possibility of always having this particular obsession and never being able to eat normally again. He claimed he couldn’t remember how to eat normally and was having regular panic attacks around food. He lost 10 pounds in a week and relied on protein shakes for sustenance. We built a manageable hierarchy of exposures and effectively challenged his fears around food within a matter of weeks. He reported significant improvement in his fears around choking and was able to resume eating the way he used to.
A 23 year old camp director had a history of OCD since middle school that had gotten progressively worse. He feared catching sexually transmitted diseases through contaminated objects that may have touched his genitals. He would wash his wallet, ATM card, or anything else that had been in contact with possible viruses. He would spend at least an hour and a half in the shower and would spend 45 of those minutes washing his hands and scrubbing under his nails. If he used a shower that his family member used, he would avoid touching the faucet or walls for fear of getting recontaminated. Through short-term ERP therapy, he was able to reduce his obsessions and compulsions to a subclinical level.
A 29 year old software engineer had struggled with OCD since 15 years old. She spent hours per day ruminating on mistakes that she could have made that may bring misfortune to someone else. She obsessed over spelling mistakes and typos, fearing that her misspellings may have bad meaning and could magically attach badness to something or someone. She feared that she must be perfect all the time or she would be responsible for something awful happening. Through repetitive exposure to script writing, tape recording and visual imagery, she was successfully able to habituate to her fears and lead a much more productive and satisfying life.
A 26 year old social worker presented with OCD symptoms that exacerbated after a break up with her boyfriend. She reported spending endless hours making lists, rewriting the lists and mentally reviewing to-do lists and detailed analyses of her moods moment to moment. She claimed that she hoarded lists and would feel panicked if she didn’t write things down. Through short-term ERP, she was able to stop the mental reviewing and list making and reported feeling “as good as new”.
A 25 year old comedienne with a history of OCD reported several obsessive fears including a fear of doing something blasphemous like offending someone, writing and sending a hurtful email, harming someone while driving, and causing a fire by leaving on the stove. She also became hyperaware of her own breathing and feared not breathing correctly . Within a few months time, she had a significant reduction in her OCD symptoms and her overall mood. She no longer avoided cooking or driving, did not compulsively check emails before she sent them, and her breathing obsession remitted.
A 29 year old junior hedge fund analyst struggled with obsessive worrying about being gay. He became hyperaware of any physical tension he had in his body when he came in contact with males or females. He compared how he felt with men vs women, desperately tried to push certain thoughts and feelings away, tried to compensate for homosexual images by being promiscuous with women, etc. His obsessive mind would wreak havoc in social situations and thus, he relied heavily on alcohol to help him socialize. After a course of short-term exposure therapy and response prevention, his obsessions decreased significantly, his reliance on alcohol ceased, and his reaction to the thoughts subsided.
A 35 year old real estate agent with a history of OCD obsessed over the possibility that she could have started a fire if she forgot to blow out candles, if she didn’t unplug her electrical outlets, or if she didn’t shut off her faucet which might cause an electrical fire if the wires got wet. She’d have her doorman check her apartment regularly. She would attach signs around her apartment indicating whether things were turned off or unplugged since she did not trust what her eyes saw or her memory. She showed almost immediate improvement with exposure therapy and response prevention and graduated treatment in 6 sessions.
