Finding Effective Treatment Options for a Friend with OCD

Q: Finding Effective Treatment Options for a Friend with OCD

Hello Mr. <br>Yang： Obsessive-Compulsive Disorder (OCD) is a persistent condition, but with a combination of medication and psychotherapy, symptoms can be significantly improved. <br>It sounds like your friend has also sought medical help, but the side effects of the medication h

Finding treatment options for obsessive-compulsive disorder (OCD) for a friend?

Hello, my friend suffers from obsessive-compulsive disorder (OCD), and I want to help him find treatment options and learn how to better support him.
Here’s a brief overview of his current situation.
He previously consulted a doctor who prescribed medication and recommended a few books for him to read.
Initially, he followed the prescribed dosage, but later the side effects of the medication caused him to feel lethargic, drowsy, and disrupted his circadian rhythm.
Given his personality and background, he cannot accept that a significant portion of his life is dominated and wasted by the side effects of the medication; otherwise, he becomes even more depressed and despondent.
He needs to stay alert to learn professional skills, so he eventually reduced his medication dosage.
Although he experiences fewer side effects now, this may also be a reason why his OCD symptoms have not significantly improved.
He has read the recommended books and has a general understanding of the causes of his symptoms and methods to suppress the compulsive behaviors.
However, these have not led to substantial improvements in his symptoms recently; he still tends to obsess over various details and cleanliness in his daily life.
For example, he is very concerned about what his body has touched and what his personal belongings have come into contact with.
Once he touches something he perceives as dirty, he can temporarily suppress his urges in social situations, but he must find a restroom that he deems sufficiently sanitary to wash his hands repeatedly (his hands are already chapped and red from excessive washing).
Even during showers, he spends up to two hours in the bathroom, needing to wash his hands multiple times for each body part he cleans.
Recently, these symptoms have intensified, leaving him exhausted and feeling hopeless about the future; he often expresses thoughts of wanting to die and escape from all the turmoil.
He frequently emphasizes that many OCD impulses are irrational repetitive behaviors, but his compulsions are based on specific reasons, which may make it even harder for him to break free from these urges.
His reasoning provides justification for his compulsive behaviors, most notably reflected in his cleanliness obsession leading to excessive handwashing.
As a friend, my understanding of OCD is limited, and I lack professional knowledge; I can only listen to his feelings and complaints and remind him not to blame himself, as these issues are caused by the disorder and external circumstances, not his fault.
However, this is not a long-term solution.
Each time I hear him talk about his pain and struggles, I feel a sense of helplessness rising within me...
I really want to help him but don’t know what else I can do.
He also wishes to be cured but is hindered by his financial situation and a general distrust of available medical resources, aside from the doctor who prescribed medication and recommended books (that doctor has not been helpful for my friend on a psychological level), and he has not sought other medical assistance.
I hope to receive some advice from you.
Thank you.

Yang Xiansheng, 20~29 year old female. Ask Date: 2020/12/15

Dr. Lin Mianzhang reply Psychiatry

Hello Mr.
Yang: Obsessive-Compulsive Disorder (OCD) is a persistent condition, but with a combination of medication and psychotherapy, symptoms can be significantly improved.
It sounds like your friend has also sought medical help, but the side effects of the medication have been intolerable for him.
If that's the case, you can encourage him to return to his doctor to discuss medication options, as there are many medications that do not cause drowsiness.
However, it may take some time to find the most suitable medication for him, as everyone’s physiology is different, and it often requires trying the medication to determine its effectiveness.
Therefore, patience is essential.

In terms of psychotherapy, the standard treatment for OCD is Exposure and Response Prevention (ERP), which involves practicing not performing compulsive behaviors and getting accustomed to the accompanying anxiety.
Over time, he may realize that performing the compulsive actions is unnecessary, and the anxiety will gradually diminish.
Psychotherapy typically requires a referral from a physician, but he can also seek out therapy centers that focus solely on psychotherapy.
However, the results may not be as optimal without accompanying medication.
If your friend lives in the northern part of Taiwan, you might recommend that he join Dr.
Tang Hwa-Sheng's OCD support group, where sharing experiences with other patients may boost his confidence in seeking treatment.
Alternatively, he can check out Dr.
Tang's Facebook page: OCD Club, to learn more about OCD.
Wishing your friend a speedy recovery!

Reply Date: 2020/12/15

More Info

Finding effective treatment options for a friend with Obsessive-Compulsive Disorder (OCD) can be challenging, especially when they are experiencing significant distress and functional impairment. Your friend's situation, characterized by compulsive behaviors such as excessive handwashing and a preoccupation with cleanliness, indicates that he may benefit from a more structured and comprehensive treatment approach. Here are some suggestions and insights that may help both you and your friend navigate this difficult journey.

Understanding OCD and Its Treatment
OCD is a mental health condition that involves unwanted, intrusive thoughts (obsessions) and repetitive behaviors (compulsions) performed to alleviate the anxiety caused by those thoughts. The treatment for OCD typically includes a combination of cognitive-behavioral therapy (CBT), specifically exposure and response prevention (ERP), and medication.

1. Cognitive-Behavioral Therapy (CBT): This is considered the first-line treatment for OCD. CBT helps individuals identify and challenge their obsessive thoughts and learn healthier coping mechanisms. ERP, a specific type of CBT, involves gradual exposure to the feared thoughts or situations while refraining from the compulsive behaviors. This can be particularly effective for your friend, as it directly addresses the compulsions he feels compelled to perform.

2. Medication: Selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine (Prozac), fluvoxamine (Luvox), or sertraline (Zoloft) are commonly prescribed for OCD. These medications can help reduce the severity of obsessive thoughts and compulsive behaviors. If your friend has experienced side effects from his current medication, it may be worth discussing alternative SSRIs with a psychiatrist. Sometimes, it takes a few tries to find the right medication and dosage that works without intolerable side effects.

Encouraging Professional Help
Given your friend's reluctance to seek further medical help due to past experiences, it may be beneficial to encourage him to consider a few options:
- Consult a Specialist: If he has not already seen a therapist who specializes in OCD, this could be a crucial step. A mental health professional with experience in treating OCD can provide tailored therapy and may be more effective than general practitioners.

- Support Groups: Encourage your friend to join a support group for individuals with OCD. Hearing from others who share similar experiences can provide comfort and practical coping strategies. It can also help him feel less isolated in his struggles.

- Psychoeducation: Learning more about OCD can empower your friend. Understanding that OCD is a recognized mental health disorder and that he is not alone in his experiences can help reduce feelings of shame or self-blame.

Supporting Your Friend
As a supportive friend, there are several ways you can help:
- Listen Actively: Continue to be a compassionate listener. Sometimes, just having someone to talk to can alleviate feelings of isolation.

- Encourage Healthy Coping Strategies: Suggest activities that promote relaxation and well-being, such as mindfulness, meditation, or gentle exercise. These can help reduce overall anxiety levels.

- Avoid Enabling Compulsions: While it’s important to be supportive, try not to enable his compulsive behaviors. For example, if he frequently asks you to reassure him about cleanliness, gently encourage him to confront those thoughts instead.

- Be Patient: Recovery from OCD can be a long process with ups and downs. Celebrate small victories with your friend and remind him that progress takes time.

Conclusion
Your desire to help your friend is commendable, and while you may feel powerless at times, your support can make a significant difference in his journey toward recovery. Encourage him to seek professional help and explore various treatment options, including therapy and medication. With the right support and treatment, it is possible for individuals with OCD to manage their symptoms and lead fulfilling lives. Remember, you are not alone in this; many resources and professionals are available to assist both you and your friend.

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