Many of us 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 although it has been observed in children as young as 9 years old.
Overview of OCD
Obsessive-Compulsive Disorder OCD, as the name suggests, is made up of 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.
Physical Causes of OCD
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:-
3.) Biological Factors
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.
Symptoms of Obsessive Compulsive Disorder
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.
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:-
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.
A key feature of obsessive-compulsive personality disorder are obsessive and intrusive thoughts.
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.
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.
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.
Medications for OCD
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 the relentless obsessive thoughts and the 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.
- OCD UK
- International OCD Foundation: A host of help for Obsessive Compulsive Disorder from books, support groups and therapists.
- OCD Action
- American Psychiatric Association
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- 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
- Stein DJ (2002) Obsessive-compulsive disorder. Lancet. 2002 Aug 3;360(9330):397-405. (Retrieved October 22nd 2016) https://www.ncbi.nlm.nih.gov/pubmed/12241794