Director: Gerald Nestadt, M.D., M.P.H.
OVERVIEW
Obsessive-compulsive disorder (OCD) is a mental disorder that usually begins in adolescence or early adulthood, although it may begin in childhood. The signs and symptoms vary from person to person, but all people with OCD have either obsessions or compulsions or both.
Dr. Gerald Nestadt directs the OCD Clinic at Johns Hopkins. He is a psychiatrist experienced in the clinical management of OCD and is actively involved in research pertaining to OCD. The clinic provides comprehensive assessments for individuals suffering from OCD or related disorders. Patients, or their clinicians, can seek a consultation or ‘second opinion’ or can receive treatment in the clinic. The clinic works with several behavioral psychologists in the Baltimore area who provide the behavioral therapy component to the treatment.
For additional information about the clinic or to schedule an appointment please call Debbie Martin at 410-955-4838 or email gnestadt@jhmi.edu.
GENERAL OCD TREATMENT INFORMATION
Effective treatments for each person with OCD varies just as the symptoms of OCD vary from person to person. The individual affected by OCD and their family members and friends can benefit from learning all they can about the disorder. Treatments can include one or more of the following:
- Medications: Finding the most effective medication is important and useful. A series of trials on different medications is not uncommon. It is important to discuss your symptoms honestly and openly and report any side effects to your treating physician.
- Cognitive-Behavioral Therapy: Behavior therapy is currently the non-pharmacological treatment of choice in the treatment of OCD. A clinical psychologist trained in behavioral therapy techniques can work with you to effectively reduce symptoms of OCD. Behavior therapy (specifically, exposure with response prevention) is often as effective as medication alone, but the most successful treatment often is a combination of medication and behavioral therapy. The behavioral model states that obsessions give rise to anxiety, and this anxiety is then reduced by compulsive behaviors. That is, compulsive rituals are strengthened and maintained because they decrease the anxiety by terminating the event that gives rise to it. For example, some event, such as touching a doorknob, activates an obsessive thought, such as that of contamination. The obsessive thought next generates feelings of anxiety and discomfort, which are relieved by performance of a compulsive ritual, such as hand washing. Successful behavior therapy first breaks the connection between the obsessive thought and the anxiety it produces and then breaks the connection between the performance of a ritual and the reduction in anxiety that follows. The former is accomplished by exposure and the latter by response prevention. Thus, the behavioral treatment of OCD based on this model is called exposure and response prevention. In exposure, patients confront (expose themselves to) the object, thought, or situation that frightens them. Exposure can consist of real contact with the feared object (in vivo exposure) or only in the patient’s imagination (imaginary exposure). In response prevention, compulsive rituals that function to decrease the distress brought on by obsessive thoughts are delayed or prevented entirely. Habituation is the process by which exposure therapy is thought to work. Obsessive thoughts or images produce feelings of anxiety or distress that continue to increase to very uncomfortable levels. In the absence of a neutralizing ritual, this distress will eventually decrease to levels that are tolerable or vanish almost entirely. At this point the rituals will disappear because there is nothing left to escape from and they are no longer reinforced by reductions in anxiety.
- Inpatient Hospitalization: As with any psychiatric disorder, OCD can cause a range of impairment. In rare cases, psychiatric inpatient hospitalization is necessary for individuals with severe OCD symptoms. OCD can become debilitating at times and significantly affect one’s functioning. Please call the Psychiatry Admissions Office at 410-955-5104 during business hours for additional information regarding arranging an inpatient admission to The Johns Hopkins Hospital.
Click here for information about OCD Research
Click here for the OCD website
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