Obsessive-Compulsive Disorder (OCD)

Obsessive Compulsive Disorder

According to the National Institute of Mental Health (NIMH), an estimated 1.2% of the general population had Obsessive Compulsive Disorder (OCD) in the past year, although the prevalence is higher in women (1.8%) than men (0.5%). The NIMH says that about 51% of people with OCD are seriously impaired, while the rest are moderately or mildly impacted by the condition. The average age of the onset of OCD is 19 years old.

OCD and ADHD

Sometimes, an underlying ADHD diagnosis can make obsessive thoughts more pervasive and harder to change one’s focus. A person with ADHD may feel that they are overwhelmed by thoughts. They may have trouble organizing their thinking or staying on task. Sometimes the ability to focus on one thing may help bring order to this chaos. Unfortunately, OCD may provide the vehicle to focus on one thought, albeit an unpleasant one. While the chaos may temporarily be alleviated, the individual with both OCD and ADHD is left more sharply focused on an unpleasant thought.

What it looks like

Many people with OCD believe they must constantly check things; for example, they must check the front door to make sure it is locked, even after they have checked the door multiple times. Another common obsession followed by a compulsive action is worrying whether they will light the kitchen on fire and then repeatedly checking whether the stove was turned off. Others worry about becoming ill or contaminated, and wash their hands repeatedly, sometimes until red and raw. In some cases, people with OCD frequently count items or are compelled to place items in a certain order for fear that something negative will happen if left disorganized.

Individuals with OCD may also engage in complex rituals, such as hopping three times before leaving or entering a building, and then spinning around four times. This also usually follows a scary thought that the ritual is meant to “undo.” Sometimes, a person with OCD seeks repeated reassurance from family that they won’t get sick or that tragedy won’t befall a family member. If the person is prevented from performing the behavior that neutralizes the thought, or is unable to get the requisite reassurance from others, then the individual with OCD must start over again. This can be frustrating because some rituals may be very complicated and time-consuming.

With OCD, the recurring and unwanted thoughts constitute the obsessive part of obsessive-compulsive disorder, while the actions the thoughts generate represent the compulsive aspect of the diagnosis. By performing the ritual or action, the person with OCD may feel as if they are negating the thought. OCD can be extremely disruptive to the person’s life and also can be very embarrassing.

People with OCD often spend at least an hour per day on their obsessive thoughts and compulsive behaviors. They don’t receive much gratification from their obsessions or rituals other than a temporary feeling of relief from the anxiety of their constant obsessive thoughts. Any relief from the anxiety is usually fleeting; soon thereafter, a new thought can cause the distress to reoccur. OCD can lead to significant problems at home, work, and school as a result of these repeated thoughts and behaviors.

Most people with OCD realize their behavior is irrational but they feel helpless (without treatment) to change their actions. OCD is often very troubling for the people who have it due to the uncontrollable thoughts the person has, as well as the compulsive actions they exhibit.

Some examples of common obsessions among people with OCD include the following:

  • The fear of forgetting to do something, such as locking the door or unplugging an appliance or securing an animal
  • The fear that negative thoughts can harm the health or safety of loved ones
  • The fear that a clerical error will lead to a disastrous outcome
  • The fear of contamination or germs
  • Aggressive thoughts toward others or oneself
  • Unwanted thoughts about religion, sex, or harm

As a result of the obsessive thoughts, the person with OCD may engage in compulsive behaviors. Common examples include:

  • Washing hands or cleaning excessively to prevent contaminating oneself or others
  • Compulsive counting to ensure order and control
  • Frequent checking to ensure that a certain task was done properly and completely or that they have safely prepared their home before leaving
  • Repeated checking of locks and electrical outlets to ensure that one's home is safe from fire or burglary
  • Asking a friend or loved one for reassurance that a thought or action won’t lead to a tragic outcome
  • Performing a ritual not related to the thought, such as repeating a phrase or mantra meant to undo the negative thought

A person with OCD often performs these behaviors to alleviate their anxiety. Most often, they understand that these behaviors don’t have a rational relationship to their feared outcome. When the feared event doesn’t materialize, however, this may trick the brain into believing that the ritual worked. For example, a person with OCD may know that using half a bottle of liquid soap is not necessary to make their hands clean; The fact that they don’t get sick for long periods, however, may reinforce the irrational behavior.

According to NOCD, an organization of therapists who treat OCD with exposure therapy (a technique that helps people overcome their OCD symptoms), OCD can manifest in many different ways. For example, some people have intrusive thoughts about losing control of free will and harming themselves or other people. Some obsess over conversations they had with loved ones or acquaintances and whether they offended them. Others may experience intrusive thoughts about physical health and whether a minor medical symptom is actually indicative of a deadly disease.

OCD can be quite complex in terms of how it appears, which is a reason why a combination of therapy and medication often is the best solution for individuals with this distressing diagnosis.

Having OCD is nobody's fault

People who struggle with OCD may have blamed themselves for years for not being able to control their thoughts or compulsions. But, OCD is no one’s fault, and is extremely difficult to control without therapy or medications. Blaming oneself for OCD is like blaming oneself for being too tall or having freckles. At the same time, OCD is not necessarily attributed to a point in time or the result of a childhood traumatic event. It is common for people suffering with OCD to look for a reason for developing the disorder. This is understandable, as an explanatory narrative helps provide context and may make the individual feel like they can control the course of the illness. Most evidence does not support a “cause” for the disorder. Instead, it looks to biology, genetics, and the likelihood that others up the family tree complain of the same symptoms.

Outlook

Without treatment, the obsessions and repetitive thoughts likely will remain, and may become much more frequent or distressing. But, with treatment, many individuals with OCD can control their symptoms.

In good company

Many prominent people reportedly have/had OCD, such as business mogul Howard Hughes, comedian/TV personality Howie Mandel, and singer/actor Justin Timberlake.

The current thinking on what causes OCD

Researchers have suggested several hypotheses about what causes OCD, such as a possible genetic link to it. Scientists have also found differences in the brains of those with OCD, specifically within the prefrontal cortex. OCD-related research continues to be an area of great interest.

It is important to note that most therapists do not concentrate on why or how the symptoms of OCD began; instead, they emphasize helping the person with OCD overcome their symptoms.

Next: Finding The Right Treatment