Obsessive Compulsive Disorder
Obsessive compulsive disorder (OCD) consists of two parts: obsessions and compulsions.
The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) defines obsessions as “recurrent and persistent thoughts, impulses, or images that are experienced, at some time during the disturbance, as intrusive and inappropriate and that cause marked anxiety or distress.” Examples of obsessions include: a vision of your house burning to the ground because of a forgotten burner on the stove or the development of a dreadful disease due to the germs on a door knob.
A compulsion is “a forced behavior repeated in spite of its inappropriateness or unreasonableness and associated discomfort in response to an obsession.” Relating back to the stove and door knob examples, the associated behaviors would be repeatedly turning the burner on and off and scrubbing your hands excessively until they become cracked and bleed.
Obsessions and compulsions occur simultaneously. An obsession causes enormous anxiety (“the house will burn down!”) and the compulsion (“If I check and recheck the stove, the house won’t burn down”) reduces that anxiety.
It is very important to understand that these thought processes and actions occur in the conscious mind. When you have an obsessive-compulsive disorder, you are fully aware that your thoughts and behaviors may be irrational, but you have no control over them. This disorder disrupts your life when the stress of an obsession and the repetitive behavior of a compulsion take over your life for hours or even most of the day. The obsessive-compulsive behaviors cause a disruption in your daily life, job and/or relationships.
Common Traits of Obsessive Compulsive Disorder
Obsessions can center on just about anything. However, the most common form of OCD is based on a fear of contamination (the obsession), followed by excessive, ritualistic washing (the compulsion).
The second most common obsession is self-doubt, such as “Did I remember to lock the door?” or “What have I forgotten?” Hours can be wasted checking and rechecking the door, the stove, etc. Also, repetitious thoughts, especially involving sex or aggression, can endlessly linger in the mind and cause shame.
It is also very common for OCD to involve the need for symmetry. For example, if you have a need for symmetry, you may spend hours tying your shoes until they are the exact tightness and the shoelaces line up perfectly. The need for symmetry could manifest itself in other ways as well, such as always alternating between right and left sides during activities.
The film “As Good as It Gets” starring Jack Nicholson, provides an excellent example of OCD behavior. Jack Nicholson’s character demonstrates the unending intricacies of living with this disorder.
How Many People Are Affected?
Approximately 2 million Americans are diagnosed with OCD each year. Men and women diagnosed in equal numbers. Children and adolescents can also be diagnosed with this condition. There is evidence that about one-third of diagnosed adults in the U.S. displayed OCD-like symptoms when they were children. These numbers are similar to those found in Europe and other countries.
What Causes Obsessive-Compulsive Disorder?
Biological and behavioral factors contribute to the development of obsessive-compulsive disorder. Behavioral scientists believe that obsessions are fixated thoughts associated with particular objects, thoughts, feelings, behaviors, desires, images and/or objects, while compulsions are objects and/or experiences that have become associated with fear, anxiety or danger. A compulsion is similar very similar to an obsession, in the fact that they are both considered to be a conditioned response to specific stimuli. In other words, certain activities that helped lessen a particular fear, in the past, can become part of a repertoire of anxiety-reducing strategies.
Researchers have found that medications that promote the production of serotonin are more effective than medications that affect other neurotransmitters in the brain. In addition, people with OCD appear to have increased brain activity in various parts of the brain, thus suggesting a biological component to OCD.
Symptoms of Obsessive Compulsive Disorder
Obsessive-compulsive disorder can be diagnosed rather quickly once the symptoms begin to manifest. Approximately 50% of people with OCD experience symptoms immediately following a stressful event. However, very few individuals immediately seek help. Many people delay OCD treatment for 5 to 10 years following the first symptoms.
Signs of Obsessive Compulsive Disorder
- You avoid public places and social events.
- You hoard or excessively collect various objects.
- You are frequently late to work/school/appointments because of an overwhelming urge to recheck or redo certain acts.
- You become anxious if your routine is disrupted or something is out of place.
The signs of OCD vary drastically depending on how the disorder manifests. The most prominent OCD symptom is illogical, repetitious behaviors that disrupt your life. An example of an OCD symptom is excessive hand washing.
What Treatments Are Available For Obsessive-Compulsive Disorder?
Cognitive behavior therapy has shown to be one of the most effective psychological treatments for obsessive compulsive disorder. The cognitive aspects of therapy focus on pointing out how the obsessive and compulsive behaviors are negatively impacting your life. The behavioral aspects of therapy help you overcome the maladaptive behaviors and replace them with healthy behaviors. Behavior therapy can include exposure training. An example of exposure training is: a patient with a germ obsession and washing compulsion may be required to touch something “dirty” and wait for a period of time before washing his/her hands. Gradually, the amount of time before the patient is permitted to wash his/her hands is increased until he/she no longer feels the need to compulsively wash every time he/she comes in contact with something perceived as “dirty.” Psychological therapy may be combined with medications such as antidepressants. It usually takes about 4-8 weeks for the medications to take effect. In many cases, OCD medications along with therapy are required indefinitely to reduce the effects of OCD symptoms.
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, D.C.
Morey, B. & Mueser, K. T. (2007). The family intervention guide to mental illness: Recognizing symptoms & getting treatment. Oakland, CA: New Harbinger Publications.
Morrison, J. (2002). Straight talk about your mental health: Everything you need to know to make smart decisions. New York: Guildford Publications.
National Institute on Mental Health. (n.d.). Anxiety disorders. Retrieved from www.nimh.nih.gov/health/publications/anxiety-disorders/obsessive-compulsive-disorder.shtml
Preston, J. & Johnson, J. (2008). Clinical psychopharmacology made ridiculously simple. Miami, FL: MedMaster, Inc.