Ezine Article - Is OCD Curable?

If you ask the internet, there’s a cure for everything. Cancer? Check. Diabetes? Check. Rosacea? Check. Restless leg syndrome? Never have a sleepless night again!

Sometimes, the claims are true and there is a cure - many cancers, for example, are curable when caught early and the survivors go on to live normal, long lives. Other diseases, such as diabetes, have no cure, though they’re treatable and controllable.

Obsessive compulsive disorder is a disease that belongs in the latter category, although this is counter to many of the claims found online. A quick Google search of “curing OCD” returns varying results, from ten-day quick cure programs to anecdotal reports that claim the secret to stopping OCD is eating two bananas each morning.

Yet, in truth, OCD is a certainty for those who have it - you can’t cut it out of your body, and you can’t kill it with medication. But, you can treat it and control it. While this doesn’t solve the problem entirely, it is the next best thing: Cure adjacent.

Why OCD is a Lifelong Disorder

The reason OCD can’t be cured is mostly due to its causes. Science hasn’t yet pointed its finger at the exact reason some people end up with OCD when others don’t, but research has taught us that the disorder develops as the result of several complicated factors.

Many of these factors, including brain abnormalities, brain structure, and genetics, are things that can’t be changed. For example, people with OCD often have lower levels of serotonin, which is treated with antidepressants that increase serotonin levels. But the cause of those low levels, communication problems between the deeper levels and front of the brain, can be the result of structural abnormalities in the OCD brain, rendering these causes untouchable.

Of course, OCD is much more complicated than low serotonin or brain structure and science continues to explore all the reasons for its existence. Recent research suggests that the OCD brain makes errors in processing information, with hyperactivation in several areas of the brain and hypoactivation during inhibitory control.

Genetics matter, too, as approximately 25% of people with OCD have an immediate family history. Still, the genetics of the disorder are complicated and scientists don’t believe a single gene causes OCD the way a single gene causes sickle cell disease, muscular dystrophy, and Huntington’s. They don’t even believe that there’s a dominating mutation that makes OCD likely (such as we see with BRCA mutations and breast cancer). Rather, it’s believed that the hereditary origins of OCD come from the combination of multiple genes and how the alleles interact with one another.

All of the above paves the way for new treatments, as doctors can work on targeting brain activation abnormalities and even attempt to suppress the expression of certain genes. But, unless they can find a way to permanently correct the abnormality or reengineer the gene, OCD might remain treated, but not cured.

Surgery and OCD

You cannot cut out OCD, as that would require, in effect, the impossible removal of the brain. But, there are surgical options available for those who have tried everything else. One such procedure involves interrupting the hyperactive neural circuit between the prefrontal cortex (which dictates cognitive behavior, personality, and decision-making) and the nucleus accumbens (which plays a role in the reward centers).

This interruption can be completed either by overriding the brain’s electrical system with deep brain stimulation or by making a lesion in the brain that directly interrupts the overactive path. These types of procedures, while new to the world of OCD, have been used in those with other conditions, namely epilepsy and Parkinson’s disease. 

The above is brain surgery….literally, which is why it’s limited to people with OCD who have exhausted all other options. However, even those who undergo it are not cured. OCD symptoms decrease and tend to cause significantly less stress, yet they don’t go away altogether, and it’s recommended that those who undergo surgery continue therapy and take medication if needed.

The Conundrum of the Cure

Another factor in the elusive cure is the limitations of modern medicine, and OCD is not alone in its inability to fully resolve; many illnesses are not curable, arguably even most. This has to do with the avenues science has in curing disease: Most are cured surgically or with medications that kill the root cause (though the immune system may also do this on its own). When breast cancer is limited to the breast, for example, the breast is surgically removed, taking the cancer with it. As a result, the patient is cured. When someone comes down with strep, they’re given antibiotics, which kill the bacteria and return the patient to normal.

Yet all sorts of other diseases - from epilepsy to lupus, from asthma to Crohn’s disease, from bipolar disorder to OCD - do not have one problematic area that can be cut out. They also don’t involve a foreign invader (a virus or bacteria) that can be fought off. And, thus, their resolution mystifies doctors.

None of this is to imply that modern medicine is lacking; conversely, it’s come leaps and bounds. In fact, penicillin, perhaps the most important finding in the history of health, wasn’t even discovered until 1928, less than a hundred years ago. Alexander Fleming came upon it by accident, and it took another 15 or so years for the medication to enter the mainstream.

As a result, it’s now unusual for people in developed nations to die from strep throat or bacterial pneumonia (once a leading cause of death). It’s always possible that OCD will follow suit: Who knows, in a hundred years, maybe people will look back, scratch their heads, and marvel that there was ever a time when OCD wasn’t curable. But, until then, if we can’t cure it, we aim to at least control it.

The Closest Thing to a Cure

The above is not to suggest that there is no one walking around who feels that their OCD has gone away entirely. In fact, many people who have OCD no longer fit the diagnostic criteria after treatment. In other words, their symptoms are not disabling enough to warrant being classified as a disorder. However, just because OCD is well-controlled, that doesn’t mean it’s gone.

Think about it like asthma. It’s not uncommon for asthmatics to experience severe flare-ups in childhood, only to find that their wheezing and coughing all but disappear in adulthood. This doesn’t mean their asthma is gone, as it’s a lifelong disorder. It may become latent, possibly for long periods of time, only to reappear when triggered by allergens, cigarette smoke, humidity, wet weather, or underlying respiratory infections.

OCD is similar - it may be so well controlled that the sufferer feels they’ve beaten it entirely, but it’s merely in a state of dormancy. This is important, as it requires vigilance - OCD will jump at the chance to reappear if the sufferer lets their guard down.

Symptom-Free OCD

So, who are the people with OCD experiencing a relatively symptom-free existence? More often than not, they’re the ones who successfully complete exposure response and prevention (ERP) therapy, sometimes supplemented with medication or other types of therapy (such as acceptance and commitment therapy). 

Symptom-free OCD is most common in those who have one of the following characteristics:

• They receive treatment as early as possible: Ideally, sufferers should receive treatment as soon as the disease appears (if it first appears in childhood, they should receive therapy in childhood). Unfortunately, this is not common as it takes the average OCD sufferer between fourteen and seventeen years to receive proper treatment.

• The person is responsive to medication: Around 70% of OCD sufferers respond to medication, but, even in the responsive, pharmaceuticals don't work completely. Unlike an aspirin that may entirely eliminate a headache or amoxicillin that may entirely eliminate an infection-causing earache, medicine for OCD works by reducing symptoms, not removing them. Depending on the medication, responsive OCD sufferers experience a 40-60% reduction in symptoms, which is often enough to help them complete ERPs.

Whether or not the individual responds to medication lies in their genetics. OCD medicines, like most pharmaceuticals, are designed for people who metabolize drugs normally. For those whose genetics change this metabolism, either metabolizing the drugs too quickly or too slowly, antidepressants are often ineffective and other medications may be recommended.

• The person engaged in ERP therapy: If OCD is a monster, ERP is its Achilles’s heel. ERP is well-regarded as the gold standard of treatment, with most of those who engage in it experiencing a large degree of relief.

ERP is a bit of a “face your fears” concept where sufferers are asked to expose themselves to their distressing thoughts and then refrain from engaging in their neutralizing compulsions. On paper, it sounds easy enough but, in practice, it’s extraordinarily hard to do. The anxiety ERPs generate often overwhelms the sufferer, leaving them to engage in their rituals. If they can resist the compulsions, however, ERPs become easier and easier and OCD symptoms abate.

• The person only suffers from one type of OCD: Some people suffer from one type of OCD, whereas others suffer from different types at the same time. The more types of OCD a person has, the more things OCD latches onto, making it harder to conquer. For example, if someone has Contamination OCD, they can focus their ERPs on things like doorknobs or public restrooms. But, if they have Contamination OCD and Harm OCD, they’d have to broaden their ERPs to also focus on driving, holding knives around loved ones, or walking down stairs behind vulnerable people.

Because ERPs are so challenging, those who must engage in a variety to treat all their OCD flavors are most likely to find the anxiety overwhelming, thus giving in to their compulsions and keeping OCD at the forefront.

The Dangers in Believing OCD is Curable

Believing that OCD is curable may feel like a benign thing, but it can have unintended consequences. Some of the backfiring is practical while, some, more emotional.

Overall, the OCD sufferer who believes OCD is curable may unwittingly set themselves up for the following dangers:

Setting unrealistic expectations: As William Shakespeare said, “Expectations are the root of all heartache.” While that seems a little extreme (no offense to The Bard), he has a point. When OCD sufferers expect themselves to be cured, rather than simply expecting to work hard to control their OCD, they automatically set themselves up for disappointment. Once disappointment festers, it’s much easier to throw in the towel.

Trapping themselves in a cycle of shame: OCD sufferers chasing that elusive cure will never find it and, as OCD sufferers tend to do, they will then blame themselves. People with OCD are very self-critical by nature and tend to find shame in areas where none is warranted. If the OCD sufferer believes that OCD is curable, and then inevitably fails to cure themselves, they will perpetuate this cycle of shame.

Wasting time and money: In some cases, people with OCD may spend time and money on quick-cure programs, elixirs, or herbal medications that don’t really work. They may also load up on things like CBD or St. John’s Wort, supplements that may help reduce symptoms to some degree but won’t offer an outright cure. Usually, this results in minimal financial commitment - 30 dollars here or 40 dollars there. But some programs are costly, from the perspective of both money and time. This doesn’t mean OCD programs aren’t worth the investment - if the programs are ERP-based, they’ll be effective. But they won’t provide a cure, no matter how on point they are.

Perpetuating misconceptions about OCD: OCD is extraordinarily misunderstood, with the majority of the population believing it’s a minor illness that involves a preference for tidiness and order as well as a propensity for anal-retentiveness. In reality, OCD is a leading cause of disability, especially among young adults, and a disorder driven by anxiety rather than personal preference. While some people with OCD do have compulsions that involve tidiness or order, many sufferers could care less if their house is clean, if their car is free of clutter, or if people touch their things.

These mischaracterizations of OCD paint it as a personality quirk, leading people to minimize its terror and misdiagnose themselves with having it. For instance, the person who likes to color coordinate their shoe rack and claims that they’re “so OCD” does not have OCD at all. The person with actual OCD doesn’t typically care if their shoe rack is color coordinated from a preference standpoint; they color coordinate as a compulsion because their OCD tells them things like they’ll get in a train accident if they don’t organize or their dad will die of COVID if their sandals aren’t lined up with their hiking boots. 

Focusing on a magic solution rather than the hard treatment: Looking for a cure to OCD instead of going through the difficult treatment is sort of like looking for a get-rich-quick scheme instead of earning, saving, and making smart financial choices. In short, it sets you up to get burned. Moreover, it wastes energy chasing something you’ll never catch, energy that is better used toward ERP and evidenced-based treatment.

In Closing

As demonstrated throughout this blog, tying OCD to any sort of cure is problematic. Yet, there is one area where the dangers of this failed assumption are most acute: Vigilance.

The OCD sufferer who believes they’re cured will, in theory, never cure their OCD because they won’t see OCD as a lifelong part of them (which it is, unfortunately). And this results in them letting down their guard and failing to remain vigilant. It’s akin to the alcoholic who doesn’t see alcoholism as a lifelong disorder, thus not taking precautions around beer or wine. Just as an alcoholic may reignite their disease by taking a shot of tequila, even if it starts as one shot, one time, the OCD sufferer may reignite their disease by engaging in a compulsion, even if it starts as one compulsion, one time.

The OCD sufferer does themself a favor by understanding that OCD is always around, lurking in the shadows of the mind and biding its time to pop out. Even when it feels as though it’s gone, it’s not: OCD just doesn’t work that way. The more sufferers understand this, the better they arm themselves to recognize OCD when OCD is trying to weasel its way back in, lock in fears, force compulsions, and control lives.

In other words, OCD is a lifelong villain and, thus, requires the sufferer to be a lifelong superhero. Keep your cape on and wear it proudly.