Understanding Obsessive-Compulsive Disorder

Introduction

Understanding Obsessive-Compulsive Disorder is an important mental health topic. It has been estimated by the National Institute of Mental Health that more than 2 percent of the population in the United States will experience OCD (Obsessive-Compulsive Disorder) symptoms at some point in their lives. That is almost one out of every 40 people. OCD is thought to be two to three times more common than BiPolar Disorder and Schizophrenia (Nami Michigan).

Case examples

A young woman frequents the grocery store to stock up on canned goods. Her kitchen cupboards are very neat and tidy. All of her canned goods are arranged and matched in groups of four, e.g. four cans of green beans, four cans of tomato soup, four cans of peas, etc. She has a limited income and her budget for food is tight. Although these frequent shopping trips are causing her financial difficulty, she cannot stop buying. In order for her to feel under control she must have four cans of whatever she eats; no more and no less.

A middle-aged man, who works in the produce department of a grocery store, has been reprimanded by his supervisor several times for taking too much time on his bathroom breaks. Once he begins to wash his hands, he finds he must wash them repeatedly (at least 15 times per his count) in order to feel clean. His hands are severely chapped as a result. This hand-washing behavior is ultimately having occupational and health consequences in his life.

An older woman finds herself apologizing repeatedly to people when she believes she has either interrupted them or said something wrong. Once she begins apologizing she is often unable to stop, even when people attempt to reassure her or even terminate the conversation. She often complains to others that she is a “bad person.”

A young man explains that he likes to exercise daily and that he must follow a specific exercise routine. He shares that he exercises in his bathroom, often with the shower running to create steam in the room. His exercise routine lasts for three or four hours, usually until the point of exhaustion or collapse. When asked why he feels he must exercise as he does, his reply is that if he doesn’t exercise he will “die.”

These people suffer from OCD (Obsessive-Compulsive Disorder).

What is Obsessive-Compulsive Disorder (OCD)?

What are obsessions?

“Obsessions are intrusive, irrational thoughts – unwanted ideas or impulses that repeatedly well up in a person’s mind. Again and again, the person experiences disturbing thoughts, such as “My hands must be contaminated; I must wash them”; I may have left the gas stove on”; I am going to injure my child.” On one level, the sufferer knows these obsessive thoughts are irrational. But on another level, he or she fears these thoughts might be true. Trying to avoid such thoughts creates great anxiety.” (NAMI Michigan)

What are compulsions?

“Compulsions are repetitive rituals such as handwashing, counting, checking, hoarding, or arranging. An individual repeats these actions, perhaps feeling momentary relief, but without feeling satisfaction or a sense of completion. People with OCD feel they must perform these compulsive rituals or something bad will happen.” (NAMI Michigan)

Who gets Obsessive-Compulsive Disorder?

Most of us at one time or another in our lives will experience obsessive thoughts and/or compulsive behaviors. This does not mean that we have the OCD diagnosis automatically. In understanding Obsessive-Compulsive Disorder, it’s important to note again two of the most pertinent factors in determining the presence of OCD. The first is that the obsessions and/or compulsions experienced have to occur for more than one hour a day. And the second is that the obsessions and/or compulsions must interfere with our lives. That means that the symptoms must cause significant distress or impairment in occupational, social, or other important areas of functioning.

That being said, all people, no matter what gender, social, or ethnic group, can have OCD, if they meet the diagnostic criteria.

What does OCD look like over the course of time?

Obsessive-Compulsive Disorder usually first manifests in teen or early adult years, however it can begin in childhood as well. Sometimes it is mistaken at first for autism, pervasive developmental disorder, or Tourette’s syndrome. Symptoms usually begin gradually and will tend to vary in severity throughout life. Increased stress may worsen symptoms as well. OCD is usually considered a life-long disorder. Some people will have mild to moderate symptoms. For others, symptoms are very time-consuming and significantly impact one’s ability to function in life.

What are the causes of OCD?

What are the risk factors?

Can Obsessive-Compulsive Disorder be treated?

Although OCD is considered a life-long disorder, there are definitely treatments that can help to minimize symptoms and improve overall level of functioning. The two primary forms of treatment include use of mental health medications and behavior therapy.

There are numerous psychotropic medications now available by prescription that may be helpful in decreasing symptoms of OCD. To learn more, consult with your primary care physician or psychiatrist.

Behavior therapy indicated for the treatment of OCD is known as exposure and response prevention. In this type of treatment clients are deliberately exposed to a feared object, situation, or thought, either in reality or in their imagination. The idea of this controlled exposure is for the client to not engage in the compulsive behavior in response to the feared stimuli. For example, someone who ritualistically checks to see if the stove is turned off before leaving the house is asked to make sure the stove is turned off before leaving the house…and then leave the house (without returning to check). They may at first only leave the house for a minute or two, but gradually progress to being able to leave the house (without returning to check) for longer and longer periods of time.

Conclusion and further study

If you experience obsessions or compulsions that are impacting the quality of your life, I encourage you to see your doctor or mental health professional. Understanding Obsessive-Compulsive Disorder is important.

If the symptoms of OCD seem to resonate with you a bit, but you feel you are more of a perfectionist and prefer having order and control in your life, you may be interested in reading about Obsessive-Compulsive Personality Disorder (OCPD). For more detailed information and a look into the differences between OCD and OCPD, see the related blog post on The Heart’s Way for Creative Clinicians: OCD vs OCPD: Differential Diagnosis.

This post contains links to additional resources (highlighted in blue above.)