OCD Spectrum Clinic

OCD is an anxiety disorder.  Obsessions are repetitive thoughts or images, accompanied by anxiety or distressed feelings. Compulsions are actions or thoughts meant to relieve the anxiety.  Obsessions come in varying forms such as doubting, guilt, fear of ‘bad’ things happening to a loved one or oneself.  Although most people realize the obsessions are not objectively true, they cannot resist doing the compulsion to get relief.

Obsessions
Sex, fear of harming others, morbid thoughts, contamination, religious obsessions, body image, perfectionistic obsessions, superstitious types of obsessions, obsessions about sexual orientation, doubting, guilt, looming danger or imminent harm, numbers and their power to cause negative consequences, any thought may be an obsession if the person obsesses about the thought, and ‘bad’ words or curse words.

Compulsions
Cleaning, washing, hand-washing, checking (and re-checking), need for perfection, counting compulsions, touching or tapping compulsions, praying compulsions (prayer is positive, compulsive praying may not be positive), compulsions involving physical appearance such as Body Dysmorphic Disorder (excessive concern about and preoccupied by a perceived defect in ones physical features), compulsions involving rules family members must engage in such as keeping things in a certain order or cleaned in a certain way, hoarding/collecting, and mental compulsions (pure obsessions are rare. When it seems there are pure obsessions, there are very often mental compulsions present or very subtle compulsions).

Repeating compulsions could involve re-reading or writing, routines and body movements, or repeating a certain number of times (safe numbers). Reassurance and Enabling – asking for or seeking reassurance is a compulsion.  Giving reassurance is an enabling compulsion.  Those who supply reassurance must learn to stop, but not necessarily all at once.  This is built into the treatment plan.

The “Just Right” Phenomenon
An action is repeated until it feels “just right”.  An example of this is when a person must repeat a simple step forward with a foot, over and over, until it feels “just right”.

Co-Morbid conditions (often seen with OCD)
These conditions include Depression, Anxiety, Phobias, ADD or ADHD, Procrastination and Slowness, Body Dysmorphic Disorder, and Bi-Polar Disorder.

When evaluating a person who suffers from OCD, it is necessary to identify and treat any co-morbid condition.  If depression or other condition is treated, it is more likely that the OCD sufferer will improve in treatment.

Treatment Plan
The goal at the OCD Spectrum is to make us obsolete.  OCD is a chronic illness.  It cannot be cured, but is extremely controllable.  In this light, each patient learns to take action if symptoms return.  Treatment is done with a collaborative approach, with a focus on treatment relapse prevention.  If necessary, we offer “Booster Sessions” so that an individual can get back on track and get rid of returning symptoms. Our goal is to have you and your family members become experts in the treatment of OCD. After treatment, periodic appointments are always available to deal with any lingering issues and to reinforce treatment and wellness goals.

1.Intake, history and family history
2.Diagnosis
3.Education – In war, it is necessary to know your enemy.  Knowledge is power.  Knowledge also helps relieve some anxiety and is motivational.  It is easier to stay motivated when you know the enemy you are dealing with.
4.Notebook – Each patient is asked to create a notebook to keep a list of symptoms, i.e. obsessions and compulsions, a list of medications taken including dosage, effect, and any side effects (saves patient from the trouble of remembering all of the information or contacting a number of doctors seen over a long period of time). If you see a new doctor for medication in the future, you will ease his/her job and limit trying a medication that was previously taken.

The second part of the notebook is a list of obsessions and compulsions (which may change over time).  This is the list where exposure choices will be made from.  The list will be accompanied by SUDS (Subjective Units of Distress Scale) ranking, which may be 0-10 or 0-100 with 0 being no anxiety/distress, and 10 or 100 being the most severe ranking.

The third section will be for charting the progress of treatment.  Using charts to map progress has been repeatedly shown to add to successful outcomes of the treatment.

Exposure and Response Prevention (ERP)
Also called Exposure and Ritual Prevention, it is the recognized treatment of choice for OCD.  It is based on habituation.  For example, a person who has a fear of heights is helped to overcome the fear by directly exposing him/her to a high place until there is no longer an anxiety response. Anxiety is our body’s way of warning us that there is danger so that we can seek safety either by fighting or taking flight.  Anxiety is also known as the Fight or Flight Syndrome.

Medication
Medication is often necessary to help someone be successful in their ERP practice. Not everyone needs medication.  If needed, the issue will be discussed in session.

The OCD Spectrum of Disorders
These are diagnostic categories seen as related to OCD and often seen as co-morbid or co-existing with OCD.

Body Dysmorphic Disorders (BDD)

This is defined as not perceiving the objective reality or a misperception of the body.  An example of this is a person seeing a body part as being ugly, defected or deformed.  This is either a gross exaggeration of the body imperfection or seeing a problem that does not exist at all.  Compulsions involved may include checking, seeking repetitive reassurance or covering the area from public view.

Trichotillomania (TTM)
A condition whereby a person compulsively searches for a particular feel of a hair, and then pulls that hair out.  This can lead to bald patches or total baldness.  The hair may be from the head, eyebrows, eyelashes or from any other part of the body.  The treatment for this is called “Habit Reversal” which involves awareness training and competing muscular responses.

Anorexia Nervosa
An eating disorder characterized by extremely low body weight, body image distortion, and an obsessive fear of gaining weight. Individuals with anorexia nervosa are known to control body weight commonly through the means of voluntary starvation. 

Bulimia
Bulimia or Bulimia Nervosa is an eating disorder characterized by recurrent binge eating, followed by vomiting (purging), fasting, or the use of enemas, laxatives, or diuretics. Over-exercising is also very common with this disorder.  

Tourettes Syndrome
This disorder involves repetitive, stereotyped, involuntary movements and vocalizations called tics. Vocal tics include coprolalia (uttering swear words) or echolalia (repeating the words or phrases of others). Some of the more common physical tics include eye blinking, facial grimacing, shoulder shrugging, and head or shoulder jerking.

Nail Biting (Onychophagia) and Compulsive Skin Picking (Dermatillomania)
People who suffer from these behaviors may experience bleeding, bruises, infections, or even permanent damage to the fingers or skin. The behavior is often unconscious, and if unaware of their actions, people with this compulsion may have difficulty stopping.

Dr. Michael Zatkowsky is a licensed Clinical Psychologist who has received specialized clinical training in the treatment of OCD.  He has worked with children as young as three years old, through adults up to age 90.  He has treated a wide variety of disorders and life’s problems.  This has enabled him to be accurate with diagnostic issues that are sometimes overlapping and confusing.  With an accurate diagnosis, appropriate treatment will be provided.

Dr. Zatkowsky has studied obsessive compulsive spectrum disorders extensively.  He is a Professional Member of the National Obsessive Compulsive Foundation.  He has attended National OCD conventions, lectured on the subject, and has consulted with and trained other professionals to treat OCD.  Dr. Zatkowsky received additional training in treating OCD through the Behavior Therapy Institute of the National Obsessive Compulsive Foundation.

Dr. Zatkowsky has a Masters in School Psychology and a Doctorate in Clinical Psychology.  He has worked with a variety of conditions including depression, anxiety, OCD Spectrum, bipolar disorder, personality disorders, the psychological issues of adoption and infertility, and chronic illness.

For appointment or further information please call 480-451-4000.