This post first appeared on my blog in December 2013….
Until recently I had never heard the term “flooding” in reference to obsessive-compulsive disorder, but over the past couple of months I’ve 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, they need to remain in the situation, refraining from compulsions, until the anxiety subsides. To 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.
Back to the parents I mentioned. In each case, their young adult children experienced flooding while attending residential treatment programs for OCD. None of the parents felt it was helpful, and at least two are convinced this treatment backfired, and their children regressed. This is not surprising to me. 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? At the risk of sounding melodramatic, I think it borders on being inhumane.
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 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 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 deserve is also not in the best interests of anyone – except the insurance companies. Frustrating to say the least. We still have so much work to do in the fight against OCD.