What is OCD?

For a comprehensive guide about OCD – What You Need Yo Know About OCD  from the  International OCD Foundation iocdf.org.  To access in other languages click here.

 

If you or someone you care about has been diagnosed with Obsessive-Compulsive Disorder (OCD), you may feel you are the only person facing the difficulties of this illness. But you are not alone. In the United States, 1 in 50 adults have OCD, and twice that many have had it at some point in their lives. Today very effective treatments for OCD are now available to help you regain a more satisfying life. Here are answers to the most commonly asked questions about OCD.

What Is Obsessive-Compulsive Disorder?

Obsessive Compulsive Disorder (OCD) is a mental health disorder that affects people of all ages and walks of life and occurs when a person gets caught in a cycle of obsessions and compulsions. Obsessions are unwanted, intrusive thoughts, images or urges that trigger intensely distressing feelings. Compulsions are behaviors an individual engages in to attempt to get rid of the obsessions and/or decrease his or her distress.

Most people have obsessive thoughts and/or compulsive behaviors at some point in their lives, but that does not mean that we all have “some OCD.” In order for a diagnosis of obsessive-compulsive disorder to be made, this cycle of obsessions and compulsions becomes so extreme that it consumes a lot of time and gets in the way of important activities that the person values.

 

What are the symptoms of Obsessive-Compulsive Disorder?

OCD involves having both obsessions and compulsions.

Obsessions are thoughts, images or impulses that occur over and over again and feel outside of the person’s control.  Individuals with OCD do not want to have these thoughts and find them disturbing. In most cases, people with OCD realize that these thoughts don’t make any sense.  Obsessions are typically accompanied by intense and uncomfortable feelings such as fear, disgust, doubt, or a feeling that things have to be done in a way that is “just right.” In the context of OCD, obsessions are time consuming and get in the way of important activities the person values. This last part is extremely important to keep in mind as it, in part, determines whether someone has OCD — a psychological disorder — rather than an obsessive personality trait.

Unfortunately, “obsessing” or “being obsessed” are commonly used terms in everyday language. These more casual uses of the word mean that someone is preoccupied with a topic or an idea or even a person. “Obsessed” in this everyday sense doesn’t involve problems in day-to-day living and even has a pleasurable component to it.  You can be “obsessed” with a new song you hear on the radio, but you can still meet your friend for dinner, get ready for bed in a timely way, get to work on time in the morning, etc., despite this obsession.  In fact, individuals with OCD have a hard time hearing this usage of “obsession” as it feels as though it diminishes their struggle with OCD symptoms.

Even if the content of the “obsession” is more serious, for example, everyone might have had a thought from time to time about getting sick, or worrying about a loved one’s safety, or wondering if a mistake they made might be catastrophic in some way, that doesn’t mean these obsessions are necessarily symptoms of OCD.  While these thoughts look the same as what you would see in OCD, someone without OCD may have these thoughts, be momentarily concerned, and then move on. In fact, research has shown that most people have unwanted “intrusive thoughts” from time to time, but in the context of OCD, these intrusive thoughts come frequently and trigger extreme anxiety that gets in the way of day-to-day functioning.

Common obsessions are contamination fears of germs, dirt, etc., imagining having harmed oneself or others, imagining losing control or having aggressive urges, intrusive sexual thoughts or urges, excessive religious or moral doubt, forbidden thoughts, a need to have things “just so,” and a need to tell, ask, or confess.

Click here for a list of some common obsessions in OCD.

 

Compulsions are the second part of obsessive compulsive disorder. These are repetitive behaviors or thoughts that a person uses with the intention of neutralizing, counteracting, or making their obsessions go away. People with OCD realize this is only a temporary solution but without a better way to cope they rely on the compulsion as a temporary escape. Compulsions can also include avoiding situations that trigger obsessions. Compulsions are time consuming and get in the way of important activities the person values.

Similar to obsessions, not all repetitive behaviors or “rituals” are compulsions.  You have to look at the function and the context of the behavior. For example, bedtime routines, religious practices, and learning a new skill all involve some level of repeating an activity over and over again but are usually a positive and functional part of daily life. Behaviors depend on the context. Arranging and ordering books for eight hours a day isn’t a compulsion if the person works in a library. Similarly, you may have “compulsive” behaviors that wouldn’t fall under OCD, if you are just a stickler for details or like to have things neatly arranged. In this case, “compulsive” refers to a personality trait or something about yourself that you actually prefer or like. In most cases, individuals with OCD feel driven to engage in compulsive behavior and would rather not have to do these time consuming and many times torturous acts. In OCD, compulsive behavior is done with the intention of trying to escape or reduce anxiety or the presence of obsessions.

Common compulsions are washing, repeating, checking, touching, and counting.  A less familiar type is mental compulsions which are compulsions which take place in someone’s head so are not visible, sometimes referred to as Pure O.    Examples of Mental Compulsions are praying, reviewing thoughts/feelings/actions/conversations, making mental lists, reassuring oneself, undoing something in your mind, erasing unpleasant images.

Click here for a list of some common compulsions in OCD

 

Not all Obsessive-Compulsive behaviors represent an illness.  Some rituals (e.g., bedtime songs, religious practices) are a welcome part of daily life. Normal worries, such as contamination fears, may increase during times of stress, such as when someone in the family is sick or dying.  Only when symptoms persist, make no sense, cause much distress, or interfere with functioning do they need clinical attention.

Other features of Obsessive-Compulsive Disorder
OCD symptoms cause distress, take up time (more than an hour a day), or significantly interfere with the person’s work, social life, or relationships.  Most individuals with OCD recognize that their obsessions are coming from their own minds and are not just excessive worries about real problems. They realize that the compulsions they perform are excessive or unreasonable. When someone with OCD does not recognize that their beliefs and actions are unreasonable, this is called OCD with poor insight. OCD symptoms tend to wax and wane over time. Some may be little more than background noise; others may produce extremely severe distress.

When does Obsessive-Compulsive Disorder begin?

OCD starts at any time from preschool age to adulthood (usually by age 40). One third to one half of adults with OCD report that it started during childhood.

Unfortunately, OCD often goes unrecognized. On average, people with OCD see three to four doctors and spend 9 years seeking treatment before they receive a correct diagnosis. Studies find that it takes an average of 17 years from the time OCD begins for people to obtain appropriate treatment.

OCD tends to be underdiagnosed and undertreated for a number of reasons. People with OCD are secretive about their symptoms or lack insight about their illness. Many healthcare providers are not familiar with the symptoms or are not trained in providing the appropriate treatments. Some people don’t have access to treatment resources. This is unfortunate because earlier diagnosis and proper treatment, including finding the right medications, can help people avoid the suffering associated with OCD. This lessens the risk of developing other problems, such as depression, marital and work problems.

Is Obsessive-Compulsive Disorder Inherited?

No specific genes for OCD have been identified. Research suggests that genes do play a role in the development of the disorder. Childhood-onset OCD runs in families (sometimes in association with tic disorders). When a parent has OCD, there is a slightly increased risk that a child will develop OCD, although the risk is still low. When OCD runs in families, it is the general nature of OCD that is inherited, not specific symptoms. Thus a child may have checking rituals, while his mother washes compulsively.

What causes Obsessive-Compulsive Disorder?

There is no proven cause of OCD. Research suggests that OCD involves problems in communication between the front part of the brain (the orbital cortex) and deeper structures (the basal ganglia). These brain structures use the chemical messenger serotonin. It is believed that insufficient levels of serotonin are involved in OCD. Drugs that increase the brain concentration of serotonin often help improve OCD symptoms.

Pictures of the brain at work also show that the brain circuits involved in OCD return toward normal in those who improve after taking a serotonin medication or receiving cognitive-behavioral psychotherapy. Although it seems clear that reduced levels of serotonin play a role in OCD, there are no laboratory tests for OCD. The diagnosis is made based on an assessment of the person’s symptoms. When OCD starts suddenly in childhood in association with strep throat, an autoimmune mechanism may be involved, and treatment with an antibiotic may prove helpful.

What are other problems sometimes confused with OCD?

Some disorders closely resemble OCD and may respond to some of the same treatments.  They are trichotillomania (compulsive hair pulling), body dysmorphic disorder (imagined ugliness), and habit disorders, such as nail biting or skin picking. While they share superficial similarities, impulse control problems, such as substance abuse, pathological gambling, or compulsive sexual activity, are probably not related to OCD in any substantial way.

The most common conditions that resemble OCD are the tic disorders (Tourette’s disorder and other motor and vocal tic disorders). Tics are involuntary motor behaviors (such as facial grimacing) or vocal behaviors (such as snorting) that often occur in response to a feeling of discomfort. More complex tics, like touching or tapping tics, resemble compulsions. Tics and OCD occur together much more often when the OCD or tics begin during childhood.

Depression and OCD often occur in adults, and, less commonly, in children and adolescents. However, unless depression is present, people with OCD are not sad or lacking in pleasure. People who are depressed but do not have OCD rarely have the kinds of intrusive thoughts that are characteristic of OCD. Stress can make OCD worse. Although most people with OCD report that the symptoms can come and go on their own.

OCD is easy to distinguish from a condition called posttraumatic stress disorder, because OCD is not caused by a terrible event.  Schizophrenia, delusional disorders, and other psychotic conditions are usually easy to distinguish from OCD.  Unlike psychotic individuals, people with OCD have a clear idea of what is real and what is not.  OCD may worsen or cause disruptive behaviors in children and adolescents, exaggerate a pre-existing learning disorder, cause problems with attention and concentration, or interfere with learning at school. In many children with OCD, these disruptive behaviors are related to the OCD and will go away when the OCD is successfully treated.

Individuals with OCD sometimes have substance-abuse problems, as a result of attempts to self-medicate. Specific treatment for the substance abuse is usually needed.  Children and adults with pervasive developmental disorders (autism, Asperger’s Disorder) are extremely rigid and compulsive.  They have stereotyped behaviors that often resembles very severe OCD.  Those with pervasive developmental disorders have difficulty relating to and communicating with other people, which do not occur in OCD.

Only a small number of those with OCD have the collection of personality traits called Obsessive Compulsive Personality Disorder (OCPD). Despite its similar name, OCPD does not involve obsessions and compulsions, but rather is a personality pattern that involves a preoccupation with rules, schedules, and lists; perfectionism; an excessive devotion to work; rigidity; and inflexibility. However, when people have both OCPD and OCD, the successful treatment of the OCD often causes a favorable change in the person’s personality.

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Information courtesy of the International OCD Foundation(IOCDF)