Many of us have little behaviors that we repeat for some extra peace of mind–we may double-check that we unplugged the coffee pot before leaving for work, or that the house is locked up for the night. We joke that we are “OCD” or obsessive-compulsive, but for those who truly suffer from obsessive-compulsive disorder, the situation is no laughing matter. It is, however, treatable.
Facts About OCD
What is obsessive-compulsive disorder?
Basically, it is an anxiety disorder characterized by uncontrollable, nagging thoughts and repetitive, ritualized behaviors that a person feels compelled to perform. The thoughts make the person feel afraid, apprehensive or worried. The behaviors may make the person feel less anxious, or he or she may simply be powerless to stop doing them. The most common repetitive behavior is hand washing, but other examples include obsessive cleaning, repeated checking, extreme hoarding, preoccupation with sexual, violent or religious thoughts, dislike of particular numbers, and nervous rituals such as opening and closing doors a certain number of times before entering or leaving a room.
Many people with OCD recognize on an intellectual level that such thoughts and behaviors are irrational, but even so, they cannot break free of them. Their brain gets stuck in a repetitive groove and they find themselves checking the stove 20 times to make sure it’s really turned off, washing their hands until they are scrubbed raw, or spending hours checking the windows over and over to make sure they are truly closed.
OCD is the fourth most common mental disorder and is diagnosed nearly as frequently as asthma and diabetes. In the United States, one in 50 adults suffers from OCD, which affects both children and grownups. In fact, many adult suffers say that they first experienced symptoms during childhood.
Obsessions and Compulsions: What is the difference?
Obsessions: Are involuntary, seemingly uncontrollable thoughts, images, or impulses that occur over and over again in your mind, even though you want them to stop. They are often disturbing and disrupting to your life and relationships.
Compulsions: Are behaviors or rituals that a person with OCD feels he must act out again and again. Usually, compulsions are performed in an attempt to make obsessions go away. For example, a person afraid of germs may develop elaborate cleaning rituals. However, the relief never lasts. In fact, the obsessive thoughts usually return even stronger. Making matters worse, the compulsive behaviors usually end up causing anxiety as they become more demanding and time-consuming. At this point, having a normal life becomes very difficult.
Categories of OCD:
Most people with obsessive-compulsive disorder fall into one of the following categories:
Washers are afraid of contamination. They usually have cleaning or hand-washing compulsions.
Checkers repeatedly check things (oven turned off, door locked, etc.) that they believe could be dangerous.
Doubters and sinners are afraid that if everything isn’t perfect or done exactly right then something terrible will happen or they will be punished.
Counters and arrangers are obsessed with order and symmetry. They may have superstitions about certain numbers, colors, or arrangements.
Hoarders fear that something bad will happen if they throw anything away. They compulsively hoard things that they don’t need or use.
Most people with obsessive-compulsive disorder have both obsessions and compulsions, but some people experience just one or the other.
Just because you have obsessive thoughts or perform compulsive behaviors does NOT mean that you have obsessive-compulsive disorder. With OCD, these thoughts and behaviors cause tremendous distress, take up a lot of time, and interfere with daily life and relationships.
Treatment for OCD
OCD can be successfully treated with cognitive-behavioral therapy, and medication. Cognitive-behavioral therapy for obsessive-compulsive disorder (OCD) involves two components:
1. Exposure and response prevention involves repeated exposure to the source of the obsession. The person suffering from OCD will be asked to refrain from the compulsive behavior they typically perform to reduce anxiety. For example, a compulsive hand washer might be asked to touch the door handle in a public restroom and then be prevented from washing. As time passes, the person’s urge to wash their hands will gradually begin to fade on its own. This shows that the ritual is not necessary in terms of reducing anxiety–the person can control their obsessive thoughts and compulsive behaviors.
2. Cognitive therapy focuses on the catastrophic thoughts and the burden of responsibility that OCD sufferers often feel. With cognitive therapy, those with OCD learn healthy and effective ways of responding to these fears without resorting to compulsive behavior.
- With help, they learn to recognize obsessive thoughts and tell themselves that this is simply an obsession and there is no need to perform the ritual.
- They distract themselves from OCD thoughts by engaging in other tasks and redirecting their attention.
Other steps that can also help control OCD include learning relaxation techniques such as deep breathing, yoga, or tai chi. These actions can help reduce anxiety.
Avoiding alcohol and nicotine is wise, as these can also feed feelings of anxiety. Alcohol may seem to relax you, but as it wears off, anxiety increases. Nicotine is a stimulant and can send anxious thoughts into overdrive.
Getting a good night’s sleep is also important, as being fatigued makes it harder to cope with OCD.
Exercise can be very helpful. The endorphins it produces help reduce anxiety, while the activity engages a person’s mind and body.
There are psychiatric medications which can help control the obsessions and compulsions of OCD. Antidepressants are usually a first choice. They can be helpful for those with OCD because they can increase levels of serotonin, which may be lacking in those who have the disorder. Commonly prescribed antidepressants include Prozac, Paxil, Celexa, Zoloft, Anafranil, and Luvox.
My goal when working with OCD patients is to effectively control signs and symptoms while using a drug at the lowest possible dosage. Which medication works best in alleviating OCD symptoms depends on the individual. In any case, it can take weeks or sometimes months before a patient notices improvement. It is also not unusual for a patient to have to try several medications before finding the one that is the right “fit.” In some cases, a combination approach works best, with the patient taking both an antidepressant and an anti psychotic medication to help control OCD.
When patients are using medication therapy, it is important for them to remember NOT to stop taking their medication without talking to their doctor first–even if they are feeling better. They may have a relapse of OCD symptoms if they stop the medication, and some medications need to be tapered down rather than stopped abruptly in order to avoid withdrawal symptoms.
It is not uncommon for a patient to require medication for one to two years before I suggest tapering down the dosage. If OCD symptoms return at the lower dosage, this can be an indicator that medication may be needed for a longer period.
For those with OCD, a combination of therapy and medication can often prove to be a very effective combination at restoring them to a normal life.