OCD and Flooding Exposure

As an advocate for OCD awareness and proper treatment, I thought I was familiar with most things related to obsessive-compulsive disorder. However, it was not until recently that I heard the term “flooding” in reference to OCD, and over the past couple of months I have connected with three parents of children with OCD who have dealt with this technique.

For those of you who aren’t familiar with flooding as it relates to OCD, it involves the use of exposure and response prevention (ERP) therapy. But instead of those with OCD creating a hierarchy and then working with their therapists to determine which exposures should be tackled first (also known as graduated exposures), they are “flooded” with the exposures that cause them the most fear and anxiety — the ones at the top of their hierarchy.

As with any exposure, the person with OCD needs to remain in the situation, refraining from compulsions, until the anxiety subsides. To help clarify the difference between flooding and graduated exposures, the analogy of going for a swim is often used. If you jump right into the icy cold water, you feel the shock of the cold, though you will eventually acclimate. This is comparable to flooding. Entering the water slowly, perhaps dipping your toes first and then dabbing your arms, is similar to a graduated exposure. There is less shock to the body and it is likely more tolerable.  The hope is that both ways lead to the same result – an enjoyable swim.

Now back to the parents I mentioned above. In each case, their young adult children experienced flooding while attending residential treatment programs specializing in the treatment of OCD. None of the parents felt it was helpful, and two were firmly convinced this treatment backfired, as their children regressed considerably. This is not surprising to me or to most people familiar with OCD and its proper treatment. Whereas graduated exposures afford those with OCD a measure of control over their treatment, flooding does not. And exposing someone with OCD to their worst fears immediately? It is too much too quickly. At the risk of sounding melodramatic, I actually think it borders on inhumane treatment.

So why was flooding used in these cases? As far as I know, the only reason is that because health insurance coverage limited the length of time their children could stay in the residential program, there was only enough time to use flooding, not graduated exposures.

There is so much wrong with this picture. Unless I am missing something, flooding does not ever appear to be in the best interest of those with OCD who have bravely reached out for proper treatment. And certainly not being allotted enough time by insurance companies to get the help they need and deserve is also not in the best interests of anyone — except perhaps the insurance companies. This is frustrating to say the least, and just one more example of why we need to advocate for ourselves and our loved ones when it comes to the fight against OCD. There is much work left to do!

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