Many of us, most, have heard of Obsessive Compulsive Disorder(OCD) and think that we understand this illness. Simply lining up the cans in the cupboard, repetitively washing your hands or color coordinating your paper clips does not necessarily mean that you have Obsessive Compulsive Disorder.
Interestingly, Obsessive Compulsive Disorder OCD affects a whopping 3.3 million people (between the ages of 18 and 54 years old) in the United States alone. OCD is a common condition and sufferers outnumber those with schizophrenia, panic disorder and bipolar.
Typically, the age of onset for OCD is before the age of 25 years old. Often OCD will begin in adolescence and early adulthood. However, OCD has been seen inchildren as young as 9 years old.
I have CDO it’s like OCD except all the letters are in alphabetical order – as they should be.
Overview of OCD
Obsessive-Compulsive Disorder OCD, as the name suggests, involves persistent and often, unreasonable thoughts and fears (obsessive). It is an endless cycle of obsession and compulsion.
These obsessive, invasive thoughts lead to anxiety and distress that people with OCD will try to relieve with compulsive, repetitive behaviors (compulsions).
Some OCD sufferers may suffer with only the obsessive thoughts or only the compulsive behaviors.
Obsessive Compulsive Disorder is classified as an anxiety disorder. Due to medical studies making advancements recently in our understanding of the condition, some mental health professionals are beginning to view OCD as a ‘stand-alone’ condition.
I’m a bit of a neat freak. Does that mean I have OCD?
No Moose … and sufferers do get annoyed with people using ‘OCD’ as an adjective.
That’s right! OCD is a serious mental health condition that goes way beyond liking things clean and ordered.
Physical Causes of OCD
Similar to other types of mental illness, a single cause for Obsessive Compulsive Disorder has not yet been identified. A combination of the following factors appear to contribute to the onset of the disease:-
1.) Genetic Factors
Medical studies have indicated that Obsessive-Compulsive Disorder runs in families. That is, if a close family member suffers from the condition then a first-degree relative is more likely to develop it. Still no single gene has been identified as ‘the cause’ but two genes are thought to play a role;
If I had a nickel for every time somebody told me I am OCD I’d have $44.32
2.) Infections
Infection causes inflammation, which is thought to be one of the causes of rapid onset Obsessive-Compulsive Disorder and Tourette Syndrome in children.
Organisms that can cause swelling and dysfunction in the brain are:-
Studies have shown, without a doubt, that a person with Obsessive-Compulsive Disorder has structural brain alterations on imaging studies.
The biological theory of OCD is based around the brain circuit that triggers primitive behaviors such as sexuality and aggression. The thalamus, pre-frontal cortex and the caudate nucleus of the basal ganglia together make up this brain circuit.
In the image here, we can see on the right, the over-stimulated areas of the brain in Obsessive-Compulsive Disorder. Compare this to the image on the left showing normal brain function.
Due to the fact that this area of the brain is thought to be related to primitive behaviours and impulses, a malfunctioning here could explain a lack of impulse control. Thus explaining the compulsive behaviors observed in Obsessive Compulsive Disorder.
Another biological theory suggests that it may be a lack of serotonin that causes this disorder. Although it has been argued that lowered levels of serotonin occur as a result of having Obsessive Compulsive Disorder rather than the cause of it.
At the present time the term Obsessive Compulsive Disorder is applied to anybody and everybody, often in fun.
In fact, this is a serious and often debilitating condition.
Do you have any symptoms of true OCD? Take the test HERE
Symptoms of Obsessive Compulsive Disorder
OCD symptoms are often assessed using the Yale-Brown Obsessive Compulsive Scale. Scientists developed this test using research and practice to assess the severity of OCD symptoms and also to monitor the effectiveness of treatment.
To make a diagnosis of OCD, a therapist will assess three criteria. The first is that a person must have obsessions and the second is that there must be compulsive behaviour. The third criteria is that these thoughts and rituals seriously impede on a person’s life.
There are as many variations on symptoms as there are sufferers of Obsessive-Compulsive Disorder. However, there tends to be four main themes (as well as many, subcategories) that the symptoms of OCD will fall into and these are:-
Checking
We’ve all done it, haven’t we? You leave the house and suddenly think, ‘did I lock the door?’ or ‘did I turn the cooker off?’
However, in Obsessive Compulsive Disorder, these thoughts are intrusive and repetitive ultimately resulting in endless checking, often hundreds of times. The checking (or the compulsive action) can severely impact on everyday life and objects.
So, let’s take a look at a checking example. A common checking thought is that we didn’t blow a candle out. The resulting fear is that the house will burn down. Thus, a person will go downstairs and blow the candle out (compulsive action).
Now, for most of us that would be the end of it, but for the OCD sufferer, the impulsive thoughts return again ending in an endless repetitive cycle of thought, fear and action.
Other less-commonly known ‘checking’ thoughts and fears can include:-
Checking personal effects such as keys, wallets and phones
Constantly phoning or texting a loved one
Driving Routes
Gas or electrical equipment
I’ll just check WebMD for my symptoms …
…Aaaah, I’m dying!
Contamination
Contamination by germs, resulting in illness or even death, is the overriding fear of some OCD sufferers. As a result, the compulsive actions that follow involve washing and cleaning rituals.
Cleaning anything that may be thought to be contaminated, is often repetitive and may be followed by compulsive hand-washing.
Based on contamination fears, an OCD sufferer may have intrusive thoughts based on the following:-
Visiting hospitals and GP surgeries
Going to public places such as cafes, restaurants and toilets
Touching certain objects where there may be germs such as bannisters or telephones
Fear of touching other people, for example being in large crowds or shaking hands with somebody
Cleanliness of kitchen, bathrooms and toilets
Obsessive ideas about the cleanliness of their own body, teeth or hair. Prolonged washing and scrubbing may be a consequence of these ideas.
Coming into contact with bodily fluids
Touching or being around animals
My idea of cleaning is spraying Febreze everywhere.
Well, you’re certainly not OCD then.
Here we go again … OCD is not cute or funny or to be applied to people who keep their houses clean and their things ordered.
Symmetry and Order
A magical type of thinking is often behind the need for symmetry and order. OCD invasive thoughts lead a sufferer to believe that if there is not a perfect order, number or symmetry of things, something bad may happen.
This is more than just liking symmetry and order. It is the intrusive thoughts and compulsive actions that define OCD.
Everything must feel ‘just right’ and there is often an obsessive need to control the environment.
Common Examples include:-
The need to keep everything tidy and in the correct place at all times
Symmetry and alignment of canned foods or pictures may be important
Clothes hanging in the closet may be color coordinated and all facing the same direction
Objects need to be lined up symmetrically
A preoccupation with counting or numbers; there may be a need to have an even number of items, for example
Counting or tapping objects or things ‘a magical’ number of times is another common compulsion
Organizing books or food products by alphabetical order
I like to arrange my chores into categories.
What categories are those, Moose?
‘Things I won’t do now’. ‘Things I won’t do later’ and ‘Things I will never do’!
OCD sufferers can have horrendous, unstoppable, invasive thoughts that are violent or sexual in nature. Notably, harming loved ones or oneself is a particularly disturbing thought for OCD sufferers.
Stopping the possibility of acting out these horrific thoughts is the basis of the compulsive action that follows such thoughts.
For example, a mother may have dark, intrusive thoughts about stabbing her children. Thus, the compulsive action may be to constantly check that all the knives are locked safely away.
Invasive thoughts can literally cover any topic under the sun but more common ones include:-
Sexual thoughts: A fear that you are gay, or have an attraction to children or thoughts that involve incest are all common. Thoughts that focus on sexual taboos are a common feature of obsessive thinking.
Magical Thinking: We have all, at one time or another, avoided the cracks in the pavements; it is the belief that stepping on them will lead to something bad happening that defines OCD. A belief that one’s thoughts or words can bring harm or disaster is common in magical thinking.
Relationships: Constantly doubting your partner’s or your own fidelity or over-analysing every little thing that is said or done. A continuous need for reassurance may all be invasive thoughts related to relationships.
Religious Thoughts: Religious ruminating involves excessive and obsessive praying or other religious rituals. If the prayer or ritual is not carried out exactly, then again, the belief is that there will be devastating results.
Hoarding objects is also considered part of the OCD spectrum.
I prefer the term Collector. Hoarder just sounds so negative
Treatment for OCD
In the past OCD was notoriously difficult to treat, however, with the advancement of medication therapy and cognitive behavioral therapy cbt there is hope for sufferers. It is estimated that 40% to 60% of sufferers can be treated for OCD with medications alone, and considering that behavioral therapy has a better response, the outlook is good.
A recent clinical study compares favourable treatment results in OCD and examines the use of exposure and response prevention (a form of cognitive-behavioral therapy), medication and a placebo.
This study, sponsored by the National Institutes of Mental Health (NIMH), demonstrates that behavioural therapy is 86% effective compared to 48% efficacy for drug therapy alone. The placebo only had a 10% effect, showing just how serious a condition OCD is.
OCD thought focuses on the negative.
Yes, that is true. For example I think to myself, ‘my prayers will help my sick Grand’ma get better’.
An OCD sufferer will think, ‘if I don’t pray my Grand’ma will die’.
Cognitive-Behavioural Therapy: Exposure and Response Prevention
Exposure and response prevention is a form of cognitive behavioral therapy and one of the most effective treatments for sufferers of OCD.
Traditional psychoanalysis is not very effective in the treatment of OCD. With exposure and response prevention, a person with OCD has to face their OCD thoughts, whilst at the same time, resisting the urge to carry out the compulsive behavior, or ritual, that follows.
For example, if an OCD sufferer has obsessive thoughts around germs and contamination they will gradually build up to touching something ‘dirty’ without washing their hands afterwards.
The aim of this OCD treatment is to reduce the distress and anxiety associated with the fearful, obsessive thoughts. It is thought that this type of behaviour therapy works because the repeated exposure to the feared stimuli reduces the urges for the compulsive actions.
So … exposure therapy helps you face your fears to recover.
What if your main problem is running away from your fears?
Medications for OCD
Cognitive therapy is often effective as a stand alone treatment of OCD for those with mild symptoms. Severe OCD may require medication and/or behavior therapy.
Medication therapy, as a treatment of OCD, usually reduces the symptoms by around 40% – 60%.
Clinical research shows that the medications most effective to treat OCD are Selective Serotonin Reuptake Inhibitors (SSRI’s). These drugs work by increasing levels of serotonin in the brain.
Sometimes a tricyclic antidepressant helps reduce symptom of OCD.
Common medications for the treatment of OCD include:-
Fluoxetine (Prozac)
Paroxetine (Paxil)
Clomipramine (Anafranil)
Sertraline (Zoloft)
Citalopram (Celexa)
Venlafaxine (Effexor)
What are the things that sufferers need to think about before taking medications, Doc?
Well, the most important factor is the side effects of some of these drugs, which can be quite extreme.
Always discuss any problems, or worsening of symptoms with your health provider when taking medications.
Living Life and Surviving OCD: A personal tale.
A lot of us have heard about OCD, but many of us are not actually aware of how strongly it can affect our lives and professions. Whilst on the surface, OCD may not seem like a serious and fatal disease, indeed the term is often joked about or used ‘lightly’ to refer to people that like things neat and tidy.
The truth is that OCD can seriously impact on every aspect of life, even leading to depression and thoughts of suicide, in some cases.
Diagnosis and Me
I first heard about OCD a long time ago but then it was just another piece of information for me, like it is for several others now … until it all changed. Looking back, I can’t remember a time when I did not have anxious, invasive thoughts. I think that I may have been a child with OCD that was not diagnosed.
OCD doesn’t have an age limit or any specific criteria. It took me years before I realized that I was actually suffering from a recognisable condition. It was more than just the obsessive thoughts and compulsions and forgetfulness … so much more. Looking back, I think that other people around me were more aware that something was seriously wrong than I was. I had always suffered with anxiety symptoms.
College and the Checking begins …
It all really started to escalate at college, and although on the surface of things, I was just like any other normal teenager student, a few things were different. I lived in a hostel at the time and we all had to share a room with another student.
For as long back as I can remember I have always had a bit of a thing about keeping my belongings secure and switching off appliances properly. Who knew that one day this will grow into something so big that it would nearly destroy my lifestyle and relation with others?
My roommate often used to leave quite early and return home late so it was up to me to lock the room and switch off lights and appliances. Usually, after locking our hostel room, I used to double check whether I had locked the door or not. Soon, the frequency of checking increased. I then, developed in my mind, a number of times (that had to be divisible by 5) that I needed to check switches and the door before I could leave.
After every single class I used to almost run to ensure that the room was properly locked and I had switched off all the lights.
Whilst I was in class or cafeteria, I was totally preoccupied with intrusive thoughts, such as:-
Did I lock the door? I’m sure I did, but what if I didn’t?
Is someone in the room stealing all our things?
What if I left the switch of the hair straighteners on and the building is on fire ?
Did I forgot to switch off any electrical appliances? I think I may have done …
The devastating Effects
The thoughts just wouldn’t stop coming. Even if I did go out, I was constantly focusing on relentless obsessive thoughts and increasing anxiety. I had trouble following conversations or engaging with others as nothing would relieve the anxiety like rushing back and checking.
Later, the obsessions escalated and it wasn’t just about my room being locked and the appliances and switches checked. The thoughts then became about everything associated with locks and checking, including my college locker, my scooter lock, the contents of my bag, where my purse was … etc. etc.
My friends and family used to get irritated and offended because I was always late and it would take me so long to catch up. There were many times when I would rush away early from an outing with my friends to check various locks and switches. Gradually, I stopped being invited to places and this only gave me more time to devote to the relentless checking and counting.
The situation reached a stage where I was barely attending any classes and most of my waking day was devoted to checking and counting things.
Light at the end of the tunnel
It was actually my roommate who first noticed how bizarre my behavior had become and how seriously it was affecting my daily life. I used to leave everything mid-way to come back to my room.
Initially, my roommate was not too concerned and would make jokes about my odd checking, however, when I left my final exam paper half way through to go and check the light switches and locks, she became increasingly concerned.
After the catastrophic final results came out, my roommate made an appointment for me to speak with a psychiatrist that she had heard specialises in this sort of behavior. Unknown to me, my family were already looking at a pch treatment center for me. I went to the psychiatrist for an assessment and I remember leaving my first session halfway through to … yet again … check the locks and switches.
Treatment and Therapy
Finally, I had an OCD diagnosis and a type of cognitive-behavioural psychotherapy called exposure and response prevention was prescribed. My psychiatrist and therapist are superb and very into evidence-based treatment. From where I come from any kind of mental disorder is still associated with stigma. I found my condition difficult to come to terms with myself.
What really helped was looking at resources and learning everything that I could about my OCD. I also joined an online forum and found it really helpful to chat with others who truly understood the nature and impact of this condition. I joined a self-esteem group too because my sense of self worth had been shot to pieces with the OCD.
Armed with knowledge, and together with the therapy sessions my condition began to improve. Following around 15 sessions, a lot of anxiety and hard work and quite a number of assignments (homework, cbt worksheet and much more) I began to be able to control the compulsion to check and the disturbing thoughts also significantly lessened.
Me Today …
Am I perfectly cured? No, I am not. A disease like OCD cannot be cured completely, but it can be managed to a high degree. Today, I don’t run all the time to check on locks and switches, the odd intrusive thought will pop in but I can control the impulse to act on it.
OCD changed my life dramatically. However, my life at the moment is better and I am a working professional who lives less in fear and anxiety and more in fun and positivity.
Remember guys, the greater the obstacle, the more glory in overcoming it.
Generalized Anxiety Disorder: Many people suffer with anxiety that is way beyond healthy limits. Find out if your unfounded worries have crossed the line into an anxiety disorder.
Franklin ME, Foa EB. (2011) Treatment of obsessive compulsive disorder. Annu Rev Clin Psychol. 2011;7:229-43 (Retrieved October 9th 2016) https://www.ncbi.nlm.nih.gov/pubmed/21443448
