It is commonly accepted that OCD is a chronic condition for which there is no cure. This idea is frequently used as an excuse for incomplete treatment, especially of compulsive rumination. Many patients who have completed ERP no longer do any physical compulsions but still ruminate. These patients are often told that the reason they’re not completely better is that OCD is a chronic condition, when the real reason is that no one has taught them how to completely stop ruminating.
So, am I saying OCD is curable? Let’s answer that question with another question:
Would you say someone who engages in absolutely no compulsion or avoidance has OCD?
I would say they don’t. I would say that OCD consists of compulsion and avoidance, and that therefore, by definition, no compulsion or avoidance means no OCD.
The counterargument I would expect is that this person would still have intrusive thoughts.
But this argument falls apart when you break down ‘intrusive thoughts’ into (1) uncomfortable thoughts that occur to you, and (2) any engagement whatsoever with these thoughts — i.e., compulsive rumination.
While an uncomfortable thought occurring to you isn’t controllable, this is also not a symptom of OCD; it’s a symptom of being human. And any engagement whatsoever with the thought is controllable and is a compulsion — and we said this person doesn’t do any compulsions.
So would you say that someone who engages in absolutely no compulsion or avoidance — who sometimes has uncomfortable thoughts like all other humans, but doesn’t engage with them at all — has OCD? I would say they don’t, or at least they don’t right now.
Thus, drawing a clear distinction between a thought occurring to you, and any engagement whatsoever with that thought, leads to the conclusion that a person can completely eliminate their OCD.
So does this mean OCD is curable? Well, it’s definitely much more curable than people think it is. But if the word ‘cure’ means that something is permanently better, I wouldn’t say OCD is curable, because OCD will only remain better as long as compulsion and avoidance are completely eliminated. Consider the imperfect analogy of someone who gets their cholesterol under control by changing their diet.* Have they been cured? Only as long as they maintain the changes that made them better.
While it might sound daunting, eliminating compulsion and avoidance does not entail an ongoing struggle. In fact, once a person sees that they have complete control over these behaviors, staying away from them becomes easy. This is why, in my mind, the goal of treatment is not only to eliminate current symptoms, but to help the patient see that they are completely in control of their behavior, including their mental behavior. That way even if they do fall back into compulsion or avoidance in the future, they know they have the ability to get back on track immediately.
So I’m not sure whether I can say that OCD is ‘curable,’ but I know that it is possible to get completely better, to the degree that OCD is no longer a part of your life or even something you think about. And this is the standard that I think every patient and therapist should strive for.
* The difference is that the dietary changes cause a change in the cholesterol, while the elimination of compulsion and avoidance are themselves the elimination of OCD.