Obsessive Compulsive Disorder: Raising awareness, understanding of a common psychiatric disorder
This week is International Obsessive Compulsive Disorder Awareness Week, the purpose of which is to raise awareness and understanding about this rather common psychiatric disorder.
OCD is the fourth most common psychiatric disorder, with 2.3 percent of Americans meeting criteria for the diagnosis at some point in their lives. That’s over 5 million Americans, or approximately 1 in 40 adults. More than half of adults with OCD are women; 500,000, or about 1 in 200, children and teens in the U.S. also have OCD.
What is OCD?
The “O” in OCD stands for obsessions. Everyone has “weird” or “bad” thoughts occasionally. In a community sample, 90 percent of individuals admitted to having such thoughts now and then. Most people will notice the “inappropriate” or “bizarre” thought and move on.
People with OCD, however, notice the thought and become highly distressed and anxious about it. Then, the thought takes on an obsessional quality, as it gets stuck and loops in the person’s head.
Common obsessions include:
Obsessions of becoming infected or infecting others, after coming in contact with germs, dirt or bodily fluids. The fear is typically about illness and death as a result of contamination.
OCD used to be called the “doubting disease” because it causes people to doubt many things about themselves and their lives. Those diagnosed with OCD may feel unsure whether certain common actions have been completed, such as locking the door or turning off the stove.
Needing objects lined up “perfectly,” or body movements symmetrical on left and right sides, in order to feel “just right” or to prevent some catastrophe from occurring.
Thinking that an action needs to be done a certain number of times to avoid harm or feel “just right,” or that certain “bad” or “unlucky” numbers must be avoided to prevent something bad from happening. Some people with OCD also have “lucky/unlucky” or “good/bad” colors, images, thoughts, etc.
Fear that you have sinned or are a bad person. Obsessions may include that one is praying wrong, is not a true believer, is inadvertently worshipping the devil, that one will become possessed or that one will go to hell.
• Harm to self or others:
Fear of causing harm to self or others may include intrusive looping thoughts of stabbing oneself with a kitchen knife or hitting someone with a car while driving.
• Losing control:
Fears of losing control may include the fear of yelling out obscenities in the middle of a quiet library or giving the middle finger to children on a school bus. There might also be concerns about losing control and shoplifting from a store, or seeing a set of matches and then worrying about taking them and burning down a house.
• Sexual themes:
Intrusive thoughts, images, or doubts of a sexual nature. These may include doubts about sexual orientation, recurrent images of a family member naked or fear of becoming a pedophile.
People plagued by the above intrusive, looping thoughts tend to be in great distress. They feel upset by the obsessions and do not want to act on them. To counteract these “bad” thoughts, they often engage in compulsions (the “C” in OCD) in order to neutralize the thoughts or “magically” prevent some harm from occurring.
Common compulsions include:
• Washing and cleaning:
This might include excessive hand-washing. There may also be elaborate rituals for brushing teeth, combing hair, applying makeup or using the toilet. Household items might also have to be cleaned in a specific, excessive way.
Behaviors may include checking and rechecking doors and window locks or that an appliance has been unplugged. If a person is concerned about hitting pedestrians with his car, he might “check” for “dents” in his car when he gets home to ensure he did not hit anyone.
Behaviors are repeated to excess. For example, a person may reread this article numerous times to ensure 100 percent understanding. A student may take hours to rewrite notes she has taken in class until all the letters look “perfect.” Some with OCD repeat body movements (e.g., blinking, tapping) until the movement feels “just right.”
Behaviors may include exiting a room the same way it was entered. One person with OCD might accidentally bump his left hand, and then feel the urge to bump his right hand to “even it out.”
This may include counting in one’s head while completing everyday tasks, or counting random objects, like stairs, floor tiles or telephone poles.
• Reassurance seeking:
Telling, asking or confessing to others in order for them to provide reassurance. A child may ask her mother incessantly if her stomachache means she is going to die, or a woman may question her partner’s faithfulness repeatedly.
Avoiding people, places and things that might trigger obsessions. If there is a fear of losing control and stabbing someone, the person with OCD might remove all knives from the home. Someone with “hit-and-run” OCD may stop driving altogether in order to avoid hitting a pedestrian.
Other forms of OCD
The above lists of obsessions and compulsions are not exhaustive. There are many other forms of obsessions and compulsions. OCD is unique for each person.
The content of OCD is irrelevant; what’s important for treatment is addressing an obsessional thinking style and compulsive behaviors.
Unfortunately, research indicates it takes about seven years on average from the onset of symptoms for sufferers to seek treatment. This may be due to shame, stigma or fear.
For 80 percent of those with OCD, it tends to be chronic and lifelong, with a waxing and waning course that is exacerbated during times of stress. Fortunately, effective treatment is available in the form of psychotherapy.
The most extensively researched treatment of OCD is Exposure and Response Prevention, a form of Cognitive Behavioral Therapy.
Good psychotherapy for OCD will encourage the patient to face his fears, decrease avoidance, resist compulsive behavior, challenge thinking errors, reconsider how seriously he takes his thoughts, better tolerate anxiety and other strong emotions, shift his attitude about OCD to one of acceptance and even humor, and embrace the uncertainty of life.
Treatment should also include psychoeducation about OCD, because the more one knows about OCD, the better one can manage it.
Psychotherapy should be individualized to the unique patient, and proceed at a pace in which the patient feels comfortable.
Psychotropic medications have also been shown to be effective in reducing symptoms and include: Serotonin Specific Reuptake Inhibitors (such as Zoloft), Serotonin Norepinephrine Reuptake Inhibitors (such as Effexor), and tricyclic antidepressants (such as Clomipramine).
These medications typically need to be prescribed in higher dosages than when they are prescribed for depression and other anxiety disorders, and typically take 10-12 weeks at this higher therapeutic dose in order to be effective.
Research shows that individuals who combine psychotherapy and medication tend to have the best outcomes.
Dr. Amanda Sellers is a licensed psychologist with a private practice in Allentown. She specializes in the treatment of anxiety and OCD in women, children, and teens. Visit her website www.DrAmandaSellers.com to learn more.