Obsessive Compulsive Disorder

Obsessive-Compulsive Disorder Defined

Obsessive-compulsive disorder is an anxiety disorder in which people have recurring, unwanted thoughts, ideas, or sensations (obsessions) that make them feel driven to do something repetitively (compulsions). For people with OCD, thoughts are persistent and unwanted routines and behaviors are rigid, and not doing them causes great distress. Many individuals with OCD have dysfunctional beliefs that may include: an inflated sense of responsibility and the tendency to perfectionism, overestimate threat, intolerance of uncertainty, over the importance of thoughts, and the need to control thoughts. Some individuals with obsessive-compulsive disorder may use alcohol or drugs to calm themselves. OCD is treatable, but if left untreated, the course can be chronic.

Obsessive-Compulsive Disorder Causes

The cause of obsessive-compulsive disorder can depend on the environment, genetics, and or brain structure and functioning. Research shows that in many cases individuals who have experienced abuse (physical or sexual) in childhood or other trauma are at an increased risk for developing OCD. Genetically, the risk is higher if the first-degree relative developed OCD as a child or teen. Twin and family studies have shown that individuals with first-degree relatives (such as a parent, sibling, or child) who have OCD are at a higher risk for developing OCD themselves. Research has found a connection between abnormalities in certain parts of the brain and OCD symptoms. These parts include the frontal cortex and subcortical structures of the brain.

Obsessive-Compulsive Disorder Symptoms

To be diagnosed with general obsessive-compulsive disorder, according to the Diagnostic and Statistical Manual of Mental Disorders, the following criteria must be met:

A. Presence of obsessions and compulsions, or both:

Obsessions are defined by (1) and (2):

1. Recurrent and persistent thoughts, urges, or images that are experienced, at some time during the disturbance, as intrusive and unwanted, and that in most individuals cause marked anxiety or distress.
2. The individual attempts to ignore or suppress such thoughts, urges, or images, or to neutralize them with some other thought or action (i.e., by performing a compulsion)

Compulsions are defined by (1) and (2):

1. Repetitive behaviors (e.g., hand washing, ordering, checking) or mental acts (e.g., praying, counting, repeating words silently) that the individual feels driven to perform in response to an obsession or according to rules that must be applied rigidly.
2. The behaviors or mental acts are aimed at preventing or reducing anxiety or distress, or preventing some dreaded event or situation; however, these behaviors or mental acts are not connected in a realistic way with what they are designed to neutralize or prevent, or are clearly excessive.

* Young children may not be able to articulate the aims of these behaviors or mental acts. *

B. The obsessions or compulsions are time-consuming (e.g., take more than 1 per day) or cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

C. The obsessive-compulsive symptoms are not attributable to the physiological effects of a substance (e.g., drug abuse or medication) or another medical condition.

D. The disturbance is not better explained by the symptoms of another mental disorder e.g; excessive worries, as in generalized anxiety disorder, preoccupation with appearance, like body dysmorphic disorder; difficulty with discarding or parting with possessions, as in hoarding disorder; hair pulling, as in trichotillomania (hair picking disorder); skin picking, as in excoriation (skin picking disorder); stereotypes, such as stereotypic movement disorder; ritualized eating behaviors, like eating disorders; preoccupation with gambling or substances, like substance-abuse-related disorders or gambling disorders, repetitive patterns of behavior, as in autism spectrum disorder; thought insertion or delusion, as in schizophrenia; sexual urges or fantasies; as in paraphilic disorders; impulses, as in disruptive, impulse- control, and conduct disorders; and guilty rumination, as in major depressive disorders.

How to Approach a Loved One

There is no perfect way to approach a loved one that you assume or know has obsessive-compulsive disorder. People with obsessive-compulsive disorder may be embarrassed and try to hide symptoms or rituals, and mental rituals can be very difficult to recognize.  Providing support and being aware of what they’re learning in treatment can be helpful.

Types of Obsessive-Compulsive Disorder Treatment

Treating obsessive-compulsive disorder usually includes a combination of medication and therapy. It is important to distinguish the best course of treatment individually with an experienced OCD therapist.

Medications

The most common forms of medication used to reduce OCD symptoms are serotonin reuptake inhibitors (SRIs) and selective serotonin reuptake inhibitors (SSRIs).

Research has also shown that antipsychotic medication can also be effective if the other medications do not work. When using a medication, it is important to talk with a doctor or a pharmacist to make sure the risks and benefits are understood. Do not stop taking the medication without talking to a doctor first.

Psychotherapy

Psychotherapy is also an effective treatment for adults and children with obsessive-compulsive disorder. Research shows that certain types of psychotherapy, like cognitive behavior therapy (CBT), can be as effective as medication for many individuals. Specifically, Exposure and Response Prevention (ERP). This form of treatment, which is used in reducing compulsive behaviors in OCD, is usually the add-on treatment of choice when SRIs or SSRIs medication does not effectively treat OCD symptoms.

Resources

American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders.

(5th ed.) Arlington, VA: American Psychiatric Association.

How to Help Someone with Obsessive-Compulsive Disorder (OCD). (n.d.).

Obsessive-compulsive disorder (OCD).

Obsessive-Compulsive Disorder. (n.d.).

What is OCD? (n.d.).

What is obsessive-compulsive disorder? (n.d.).