Obsessive-compulsive disorder (OCD) affects many people in many different ways. The major indication is usually a particular pattern of thoughts and behaviors.
OCD is reported to affect two to three percent of individuals in the United States. In the adult population, women are slightly more affected than men. OCD is commonly found to start in childhood, adolescence or early adulthood. Some individuals may possess symptoms of OCD but may not meet the full criteria for this disorder.
What is OCD?
People with OCD often feel driven to do certain activities repetitively, sometimes called compulsions. These repetitive behaviors can include hand washing or cleaning, constantly checking on things, or repetitive thoughts like counting, all of which can greatly interfere with an individual’s day-to-day activities and social interactions.
People with OCD tend to have thoughts that are persistent and intrusive, and their behaviors are rigid. When people with OCD do not act on their thoughts or behaviors, it can cause distress, which is may be attached to a fear of dire consequences to themselves or the people around them.
Many people who are clinically diagnosed with OCD know or suspect their obsessional thoughts are not real. However, even so, they may have difficulty disengaging from their obsessive thoughts and preventing themselves from acting compulsively.
When diagnosing a person with OCD, there is usually a presence of obsessional thoughts and/or compulsions that are oftentimes time-consuming (usually more than one hour a day), causing significant distress, and impairing work or social functioning [1].
What is the difference between OCD and OCPD?
Although they sound similar, obsessive-compulsive disorder (OCD) and obsessive-compulsive personality disorder (OCPD) are two entirely different mental health conditions.
OCPD refers to a personality disorder that may cause an extensive preoccupation with perfectionism, organization and control. On the other hand, individuals with OCD are commonly aware that their obsessions and compulsions are problematic. OCD sufferers are often aware that they need professional medical help in order to treat the condition. In contrary, people with OCPD do not think there is anything wrong with their behaviors and beliefs.
Signs and symptoms of OCD
In determining the signs and symptoms of OCD, there are three main elements:
- Obsessive behavior – refers to unwanted, intrusive and often distressing thoughts, along with mental images or urges that repeatedly enter the mind.
- Heightened emotions – when the obsessive behavior is experienced, it may cause a feeling of intense anxiety or distress.
- Compulsive behavior – repetitive behaviors or mental acts that an individual with OCD experiences that are driven to perform. It is a result of the anxiety and distress caused by the obsession.
While the compulsive behavior may temporarily relieve the anxiety, the obsession and anxiety may come back, which causes the cycle to begin again. It is possible to only experience either obsessive thoughts or compulsions, but most patients with OCD experience both [2].
Obsessive thoughts
While anyone may have unpleasant or unwanted thoughts at some point in their lives, if a person experiences persistent unpleasant thoughts that dominate their thinking to the extent it interrupts other thoughts, they may have an obsession.
The content of obsessive thoughts vary widely, but some common obsessions that affect individuals with OCD include:
- Harming yourself or others – for instance, the fear you may attack somebody, like children around you.
- Harming yourself or others by mistake – for example, the fear you may set your house on fire by leaving your gas stove on.
- Contamination – the fear of contamination by disease, infection or an unknown substance like germs or dirt.
- A need for alignment, symmetry or orderliness – for instance, you may feel the urge to ensure all the labels on the tins in a cupboard face similarly.
- Offensive or obscene acts – fear of saying something offensive or obscene to someone.
- Sexual or violent thinking – having constant explicit sexual or violent thoughts. This may also include questioning one’s sexual desires or orientation.
- Worrying about small things – for example, you have worries about throwing things away.
Take note: Anyone may have thoughts of a violent or sexual nature, which they may find repulsive or frightening. However, they are only thoughts and having them does not mean you will act on them.
Compulsive behavior
Compulsions can be a way of trying to lower or prevent anxiety caused by obsessive thoughts. Even though the behavior is often either excessive or unrealistically connected.
For instance, an individual who fears contamination with germs may constantly wash their hands repeatedly, or a person with a fear of harming their own family may have the strong urge to repeat an action many times to neutralize the thought.
Many people with OCD realize that compulsive behavior is irrational and illogical. However, they cannot stop acting on it and have the urge that they need to do it “just in case.”
Some common types of compulsive behavior in OCD sufferers include:
- Excessive cleaning – constantly and excessively bathing, cleaning and hand washing.
- Constant checking – such as checking if doors are locked or if the gas is off.
- Arrangement – including counting, ordering and arranging. People with OCD may also arrange things in a specific way, such as items on a desk.
- Hoarding – for example, buying unnecessary amounts of groceries or pantry supplies just in case.
- Reassurance – people with OCD oftentimes need to ask for reassurance from others.
- Neutralizing – people with OCD may think that neutralizing thoughts is a useful way to counter obsessive thoughts.
- Avoid places and situations – some OCD sufferers avoid places and situations that may trigger obsessive thoughts.
Take note: Not all compulsive behaviors are apparent in a person’s day-to-day behavior.
What causes OCD?
Health experts have not found the exact causes of OCD; however, they believe in the contributions of certain factors in its development, including:
- Genetics or family history – some studies show that a person who has been diagnosed with OCD has a first-degree relative with OCD from a biological parent or sibling. As a result, they are at a higher risk of developing the condition. Moreover, the risk is even higher if the relative developed OCD during childhood or teenage years [3].
- Brain changes – imaging health studies have discovered varying frontal cortex and subcortical structures of the brain in individuals who have OCD. The mental disorder is also linked to other neurological conditions that affect the same areas of the brain, such as Parkinson’s disease, Tourette’s syndrome and epilepsy [4].
- PANDAS syndrome – PANDAS is the abbreviated term for “pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections.” Basically, PANDAS defines a group of medical conditions that can affect children who have had strep infections, including strep throat or scarlet fever, and OCD is one of the conditions.
- Other mental health conditions – OCD may often occur with other mental health conditions, such as:
- Attention deficit hyperactivity disorder (ADHD)
- Eating disorders
- Major depressive disorder
- Social anxiety disorder
- Tourette syndrome
In fact, around 90 percent of individuals who have been diagnosed with OCD co-exist with another mental health condition, and anxiety conditions are the most common. Given this, having one of these mental health conditions does not make you suffer from OCD.
- Experienced trauma – trauma can also cause OCD, whether experienced in childhood or adulthood. Some studies show an association between childhood trauma, such as abuse or neglect, and the development of OCD [5].
Among the trauma that people with OCD may experience are the following:
- Stress or trauma – significant stress in different environments of a child, including home, school, work or personal relationships, can contribute to increasing your chances of developing OCD or worsening existing symptoms.
- Personality – some personality traits, like difficulty handling uncertainty, heightened feelings of responsibility or perfectionism, may become factors in developing OCD. Although being accepted as a factor, there is still a medical debate over whether the mentioned personality issues can actually be fixed traits or more flexible learned responses that can be modified.
- Abuse in childhood – children who were in an abusive environment or experienced other traumatic childhood encounters, such as bullying or severe neglect, have an increased risk of developing the mental condition.
- Traumatic brain injury – some symptoms of OCD may appear for the first time after experiencing a head injury, according to a 2021 study [6].
Take note: It is possible to have a family history of OCD, along with other risk factors mentioned, and never develop the mental condition yourself. And people without any obvious risk factors may still also develop OCD.
Identifying symptoms of OCD
Unfortunately, there are no simple tests for OCD. You may need to seek out a healthcare professional to make the diagnosis. Health professionals use criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders in order to diagnose a person with OCD.
The criteria they use as a guide includes the following:
- Experiencing constant obsessions, compulsions or both.
- The identified obsessions or compulsions may take up a lot of time, which is more than an hour every day.
- The identified obsessions or compulsions can cause distress or affect one’s participation in social activities, work responsibilities or other life events.
- The identified signs and symptoms are not because of substances, alcohol, medications or another medical condition.
- The identified signs and symptoms are not explained by another mental health condition, including generalized anxiety disorder, eating disorder or body image disorder.
As mentioned earlier, some symptoms of OCD may appear first in childhood. In fact, about half of the people suffering from the condition are seen with the symptoms during their childhood years.
However, the symptoms of OCD often start gradually; hence, they are difficult to spot and are less noticeable at first. Many people live with OCD for years before seeking help.
Mental health professionals
Rest assured that a mental health professional will not laugh or judge your condition. These medical professionals are trained to objectively listen to your signs and symptoms with compassion and help you start to address them.
A mental health professional may start by asking questions about your obsessions or compulsions you experience, including the following:
- How much time do your obsessions or compulsions take up every day?
- What do you do to try and ignore or suppress your obsessions or compulsions?
- Do you think your obsessions or compulsions are realistic?
- What effects do obsessions and compulsions have on your relationships and daily life?
They may also ask about your current medications and any other mental health or medical symptoms you experience in order to help rule out possible medication side effects or other conditions.
Other mental health conditions can involve symptoms that resemble OCD:
- Body dysmorphic disorder – this mental health condition may involve fixated thoughts or repetitive behaviors related to your physical appearance.
- Trichotillomania – this mental health condition involves constant and uncontrollable urges to pull hair out.
- Depression – this mental health condition gives looping unwanted thoughts to its sufferers; however, the thoughts generally don’t lead to compulsive behaviors.
- Hoarding disorder – this mental health condition is associated with an act of collecting an excess of unneeded items and having difficulty throwing things away. However, the possessions don’t trigger distress. Individuals with OCD might only collect or keep items because of their compulsion to complete a set or they believe not saving those items might lead to harm.
- Generalized anxiety disorder – this mental health condition also involves frequent and persistent worries or anxiety. The concerns often relate to day-to-day life. While the concerns may lead you to avoid certain people or situations, they generally don’t lead to compulsive actions.
- Tics, or sudden, repeated movements – people with OCD may also suffer from tics. It is common for people with OCD to also experience disorders like Tourette syndrome. However, one can also have a tic disorder without having OCD.
A mental health professional may need to know all the useful information they gather to determine whether OCD is the most accurate diagnosis, and may explore other diagnoses if needed.
Treatment of OCD
If you have obsessions or compulsions, a trained mental health professional can help identify your diagnosis and explore the best treatment options.
The considered best treatment plan for OCD involves psychotherapy and medication. If the treatment does not help with the OCD symptoms and they are severe, your provider may recommend transcranial magnetic stimulation (TMS).
Psychotherapy for OCD
Psychotherapy refers to a term for a variety of treatment strategies that aim to aid in identifying and changing unhealthy emotions, thoughts and behaviors.
There major types of psychotherapy, and the most common and effective kinds for treating OCD, include:
- Cognitive behavioral therapy (CBT) – as with other mental health conditions, cognitive behavioral therapy can help with OCD. During CBT, a professional therapist will help you examine and run down your regular thoughts and emotions.
With several sessions, CBT can be helpful in altering harmful thoughts and stopping negative habits, perhaps substituting them with healthier ways to cope. - Exposure and response prevention (ERP) – ERP refers to a type of CBT wherein a professional therapist intentionally exposes you to your feared situations or images. The goal is for you to resist the urge to perform a compulsion while being exposed.
For instance, your professional therapist may ask you to touch dirty objects but prohibits you from washing your hands. As you stay in your feared situation without any negative experiences, you slowly learn that your anxious thoughts are not realistic. - Acceptance and commitment therapy (ACT) – is a treatment that helps you learn to accept obsessive thoughts as simple thoughts, taking power away from them. A professional ACT therapist can help you have meaningful and quality life despite your OCD symptoms.
Also, sufferers may find mindfulness techniques like meditation and relaxation help to ease their OCD symptoms.
Medication for OCD
Medications including serotonin reuptake inhibitors (SRIs), selective SRIs (SSRIs) and tricyclic antidepressants, may help treat OCD.
Among the medications, health experts most often recommend SSRIs for OCD and prescribe them at much higher doses compared to those for anxiety or depression. The United States Food and Drug Administration (FDA)-approved SSRIs include:
- Fluoxetine
- Fluvoxamine
- Paroxetine
- Sertraline
Take note: The medications for OCD usually take up to eight to twelve weeks to start working.
Research of OCD
A study was conducted into evidence-based OCD treatments and future directions. For future avenues of research, the scholars suggested focusing primarily on increased dissemination of effective therapies, augmentation of treatments for those with residual symptoms, both for psychotherapy and pharmacotherapy and the impact of comorbid disorders on treatment outcome [7].
OCD patients treated with CBT during COVID-19
In another study focused on OCD patients treated with cognitive behavioral therapy during the COVID-19 pandemic, the researchers found that some previous research reported the worsening of OCD.
Also, in many studies, the type of OCD treatment, the detection time and the intervention period are not well-specified. They concluded that the effectiveness of CBT, particularly exposure and prevention of response protocol (ERP), is an elective treatment for OCD by a specific intervention procedure.
The findings were derived after involving eleven OCD patients and their psychotherapists in which all patients had a specific psychodiagnostic assessment for OCD conducted between December 2019 and January 2020.
The eleven OCD patients also undertook cognitive behavioral therapy (CBT) and ERP before the lockdown. The psychodiagnostic assessment was re-administered to all eleven patients, along with a group of qualitative questions gathered through an online survey. [8].
Stuck in a loop of ‘wrongness’ – a study
A recent research study may help guide future OCD treatment. A group of researchers was able to pinpoint and discover the root cause of OCD development, specifically the brain areas and processes associated with the repetitive behaviors common to patients with OCD.
In a larger study, the researchers focused on brain scans from hundreds of individuals who have been diagnosed with OCD, as well as the scans of people who did not develop the mental condition.
The study suggests that the brains of OCD patients are stuck in a loop of “wrongness” that prohibits sufferers from stopping the behaviors even if they are that they should.
From pooled brain scan data, the health experts collected information when OCD patients and healthy individuals were asked to perform particular tasks while lying in a powerful functional MRI scanner [9].
A family study about OCD
In an OCD study focusing on family history, researchers derived the conclusion that obsessive-compulsive disorder is a familial disorder, and obsessions are considered unique to the phenotype compared to compulsions. Age at the onset of OCD is also found valuable in characterizing a familial subtype [10].
Summary
Obsessive-compulsive disorder (OCD) is a mental disorder in which a person has recurring, unwanted thoughts, ideas or sensations or obsessions. The mental disorder can be determined by three major elements, such as obsessive behavior, heightened emotions and compulsive behavior.
The main cause of OCD is still unknown but there are several factors that can contribute to its development, including family history, existing mental conditions–depression, body dysmorphic disorder, trichotillomania, hoarding disorder, generalized anxiety disorder and tics or Tourette syndrome – childhood trauma, childhood infection and other brain changes.
OCD can be treated with cognitive behavioral therapy like exposure and response prevention (ERP) and acceptance and commitment therapy (ACT) or through taking medications, such as serotonin reuptake inhibitors (SRIs), selective SRIs (SSRIs) and tricyclic antidepressants that may help treat OCD.
If you think you have symptoms of OCD, do not hesitate to seek health professional help.
[1] https://www.nhs.uk/mental-health/conditions/obsessive-compulsive-disorder-ocd/symptoms/
[2] https://www.psychiatry.org/patients-families/obsessive-compulsive-disorder/what-is-obsessive-compulsive-disorder
[3] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2824902/
[4] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5052949/
[5] https://psychcentral.com/ocd/ocd-and-trauma
[6] https://www.scirp.org/journal/paperinformation.aspx?paperid=107822
[7] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3782190/
[8] https://www.frontiersin.org/articles/10.3389/fpsyt.2021.755744/full
[9] https://www.michiganmedicine.org/health-lab/stuck-loop-wrongness-brain-study-shows-roots-ocd
[10] https://jamanetwork.com/journals/jamapsychiatry/fullarticle/205690
