Obsessive-compulsive disorder
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Obsessive-compulsive disorder – often referred to as OCD for short – is a challenging anxiety disorder. Individuals who have this disorder are plagued with irrational fears, disturbing images or impulses, or other types of troubling thoughts known as obsessions. Obsessions are persistent, repetitive, and undesirable. These thoughts create significant anxiety that leads to a compulsive attempt to alleviate, neutralize or eliminate them. These compulsions usually take the form of rituals or repetitive behaviors that, by themselves, serve no functional purpose.
People with OCD often recognize the irrationality of their obsessive thoughts. They may try to ignore or suppress them, or neutralize them by redirecting their thoughts to something else. Those attempts typically fail. Their anxiety compels them to carry out the compulsive behavior. The compulsive behaviors may provide temporarily relief from the anxious feelings, but the obsessive thoughts inevitably return, and the cycle repeats itself.
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Who becomes afflicted with OCD?
Statistics on OCD vary depending on the source, and like many mental illnesses it is likely underreported for a variety of reasons. However, most statistics state that somewhere between 2 million to 3.3 million adults in the U.S. have OCD. Additionally, OCD also afflicts nearly a million children and teens as well. The onset of OCD is usually in adolescence or early adulthood. However, it is not uncommon for OCD to begin in childhood. According to the DSM-IV, OCD usually develops at a much earlier age in males than females. For males, it usually begins to develop between the ages of 6 to 15 years of age, whereas for females, the age of onset is often between the ages of 20 to 29 years of age. OCD occurs equally in both genders, and seen in people from all ethnicities and walks of life. It is more likely to occur in individuals who have a first-degree relative with either OCD or Tourette’s Disorder.
Course of OCD
OCD usually has a gradual onset, but it can appear suddenly as well. For most individuals with OCD, the course of the illness tends to wax and wane. It is thought that stress may cause symptoms to become worse at times.
Common OCD obsessions
OCD obsessions often revolve around a theme. Common OCD obsessions include:
• Disturbing thoughts which defy one’s religious faith
• Preoccupation with order and symmetry
• Violent or horrific impulses (e.g., thoughts of harming a loved one or doing something obscene)
• Preoccupation with dirt, germs or contamination
• Sexual thoughts and images (e.g., a pornographic scene that keeps going through one’s mind)
• Repeated doubts (e.g. about having left a burner on or a door unlocked)
Common OCD compulsions
Individuals with OCD engage in compulsive behaviors to reduce the anxiety brought about by their obsessions. Compulsive behaviors can significantly disrupt a person’s life, causing significant problems if they become excessive. Depending on the compulsion, it can be extremely time-consuming, expensive, and / or cause physical problems. Compulsive behaviors often lead to problems in relationships and may interfere with work. Common OCD compulsions include:
• Constantly checking things (e.g. burners or locks)
• Repetitive mental acts (e.g. counting things, saying things silently to oneself, praying)
• Excessive hand-washing or cleaning
• Constantly ordering or straightening things (e.g. alphabetizing pantry items)
• Always following a rigid sequence or idiosyncratic rules for a particular activity (e.g. eating food in a certain order)
• Avoiding contact with things due to fear of germs or contamination (e.g. touching doorknobs or shaking hands)
• Constantly demanding or asking for assurance
• Hoarding (e.g., refusing to discard worthless or worn-out items; buying or accumulating things in excessive quantities)
Complications of OCD
Individuals with OCD often have other psychiatric disorders as well, such as depression, substance abuse disorders, eating disorders, or other types of anxiety disorders. They may also have other serious problems related to their OCD:
• Marital problems or divorce
• Difficulties keeping a job
• Suicidal thoughts and attempts
• Skin problems (e.g. dermatitis, worsening of acne, skin lesions) due to excessive washing, scrubbing, or picking
• Financial problems due to hoarding (e.g. having to move to a larger home or rent storage, excessive spending, or the cost of feeding and caring for a very large number of pets in cases of pet hoarding)
• Inadequate time to tend to necessary daily tasks due to the amount of time spent on compulsive behaviors
• Poor quality of life
Other criteria for a diagnosis of OCD
While some people may be “neat freaks” or have idiosyncratic behaviors which suggest OCD, in order to qualify for a diagnosis the thoughts and behaviors must:
• Cause significant distress
• Take up more than an hour a day
• Significantly interfere with normal daily activities, performance at work or school, or regular social activities or relationships
Also, people with OCD must recognize the irrationality or excessiveness of their obsessions and compulsions at some point. In children, this criteria does not apply. The symptoms also must not be due to a medical condition or the effects of a substance (e.g. street drugs or medication), or specifically due to another mental health disorder (e.g. an eating disorder or trichotillomania).
Causes of OCD
The exact cause of OCD is not known, although research suggests several possibilities. It is most likely caused by a combination of factors. These include:
• Genetic predisposition
• Brain abnormalities
• Serotonin deficiency
• Environmental factors such as a traumatic events or learned behaviors
• Strep throat in childhood
Treatment for OCD
OCD is often difficult to treat effectively, however treatment can be very helpful in many cases. The two primary treatment options are psychotherapy and / or medication. With regards to psychotherapy, cognitive-behavioral therapy (CBT) is generally considered to be the most effective approach. CBT for OCD focuses on learning healthier routines and patterns of thought in order to alleviate or reduce the need for compulsive behaviors.
Medications for OCD can help control the symptoms. Antidepressants are usually tried before other types of medications as they can boost serotonin levels. Other psychiatric drugs may also be used depending on various factors.
Under-diagnosis of OCD
Unfortunately, many people with OCD are never diagnosed. There are several possible reasons for this including:
• Reluctance to seek treatment due to shame and embarrassment about one’s symptoms
• Tendency to become secretive and hide symptoms due to shame
• Lack of familiarity or understanding of OCD symptoms amongst some healthcare professionals
• Lack of access to appropriate treatment
If you are concerned that you or a loved one is suffering from OCD, it is important to have an evaluation by a mental health professional. Effective treatment can help reduce symptoms and improve the quality of your life.
