Obsessive-Compulsive Disorder (OCD)
Most of us have heard the term OCD used in a casual way, to refer to someone who has high standards of cleanliness or organization. However, this disorder is more than just the need for a clean kitchen. OCD, or obsessive-compulsive disorder, is a disorder that involves recurring thoughts, images or urges (obsessions) that compel a person to engage in behaviors (compulsions) repeatedly. This pattern of thoughts and behaviors can be very difficult to live with, making it hard to function in daily life.
What Is OCD?
Although it’s common to have recurring thoughts or fixations, most people are able to suppress or control these when necessary, keeping them from overtaking one’s life. However, those who suffer from OCD don’t have this same ability. The thoughts that plague people with OCD are very persistent and intrusive, and ignoring them causes extreme distress.
To cope with these intrusive thoughts and obsessions, people with OCD develop behaviors that in the short-term alleviate the anxiety caused by intrusive thoughts and obsession. Those with OCD often feel that if they don’t engage in these compulsive behaviors, there will be a disastrous outcome. Once someone with OCD begins to engage in the compulsive behaviors their anxiety decreases, as such, they engage in the compulsive behaviors more. Eventually, the behaviors become repetitive and ritualistic, and the cycle of OCD takes hold.
Many people with OCD know rationally that their thoughts don’t reflect reality, but they still have great difficulty coping with them or resisting the urge to do compulsive behaviors. To be formally diagnosed with OCD, you have to have obsessional thoughts and/or compulsions that take up over an hour of each day, result in great distress, and hinder daily functioning.
Although OCD is considered a chronic disorder, one’s symptoms typically fluctuate throughout someone’s life, worsening during periods of stress. Symptoms can be anywhere from minor to debilitating, and the obsessions and compulsions present can change and develop throughout one’s life. OCD varies in severity depending on the person, so some have more trouble managing it than others.
Who is Affected by OCD?
About 2-3% of people in the U.S. suffer from OCD, with slightly more women than men being affected. This chronic disorder typically develops in childhood, adolescence, or early adulthood. It is estimated that about 1 in 100 adults have OCD, while 1 in 200 children suffer from this disorder.
Symptoms of OCD
Those with OCD may have obsessions, compulsions, or a combination of the two. These can affect all areas of one’s life, making it difficult to function normally, maintain relationships and meet responsibilities. The obsessions that those with OCD experience are intrusive, meaning they enter the brain even when the person is trying to focus on other things. Obsessions feel out of the patient’s control and cannot be ignored or pushed away.
Obsessions
Obsessions, which are unwanted thoughts, urges and images, often have a specific focus, and the compulsions are usually related. For instance, a common theme of OCD is a fear of germs, and the behavior that often follows is compulsive hand washing. Someone with this fear may wash his/her hands until they’re chapped and painful to alleviate the anxiety about germ contamination. Obsessions typically go hand-in-hand with intense feelings of fear, uncertainty, doubt, or discomfort.
Some common themes of OCD obsessions are:
● Fear of germs or dirt
● A need for symmetry/order in one’s surroundings
● Difficulty with uncertainty
● Thoughts about losing control or harming oneself or others
● Unwanted thoughts that may be aggressive or sexual
● Worry that something isn’t complete, such as the door not being locked
● Thoughts about behaving inappropriately in public
● Offensive religious thoughts
Compulsions
The compulsions that occur in OCD are repetitive actions that one feels obligated to do in order to decrease the anxiety that one’s obsessions cause. These compulsions often feel like the only way to prevent something terrible from happening. Acting out these compulsions isn’t enjoyable for those with OCD, but it offers temporary relief from the anxiety caused by the obsessions.
Someone with OCD might create elaborate rituals to combat the anxiety of the obsession, which can often seem unrelated to the fear or issue that the obsession centers on. Just like with obsessions, there are common themes of compulsions.
Some typical themes of OCD compulsions are:
● Checking (e.g., windows, doors, text messages, lights, stove)
● Counting
● Neatness or symmetry
● Cleanliness or washing
● Needing reassurance (e.g., asking a partner if they love repeatedly)
● Strict routines
● Repeating a word or phrase
Along with engaging in these repetitive behaviors to ease anxiety, those with OCD might avoid situations that bring anxiety or trigger their obsessions. This can be an added disruption to their daily life that makes it difficult to meet their obligations. Along with obsessions and compulsions, a number of people with OCD also have a tic disorder, which can involve movement-based motor or vocal tics.
Risk Factors of OCD
Scientists haven’t determined the direct causes of OCD, but they have found that there are a number of risk factors that make it more likely to develop. Some risk factors include:
● Genetics- someone with a close relative who has OCD has a higher likelihood of developing it.
● Brain structure- studies have shown that people with OCD have abnormalities in the frontal cortex and subcortical structures of the brain.
● Environment- some studies have discovered a link between childhood trauma and symptoms of OCD. However, research to understand this connection is still underway. Along with this, ongoing stress or a specific traumatic event can trigger OCD.
Treatments for OCD
Although OCD is considered one of the most debilitating mental illnesses to live with, it can be managed with a variety of treatments. OCD interventions can improve one’s quality of life, daily functioning, and personal relationships. Some popular treatments for OCD are:
● Exposure and Response Prevention (ERP)- this type of cognitive-behavioral therapy (CBT) is the gold standard for treating OCD and involves exposing patients to the images and situations that their obsessions focus on, then helping patients to resist the urge to follow their compulsions. Patients eventually learn how to cope with their thoughts and anxieties without engaging in compulsive behaviors. Despite the initial difficulty of this treatment, it’s the leading intervention for OCD.
● Medications- Medications called SSRIs, selective serotonin reuptake inhibitors, are one treatment option for OCD. SSRIs are often used for depression, but they have also been shown to help patients with OCD. For those suffering from severe OCD, the best treatment is a combination of medication and CBT including ERP.
● Neurosurgical treatment- TMS, or transcranial magnetic stimulation, is a new treatment for OCD that patients may be recommended to use if medications and CBT aren’t effective. TMS is a way to change brain activity using magnetic fields, which can stimulate the specific areas of the brain that are involved in OCD.