Understanding OCD

Key Takeaways

·      Obsessions in obsessive compulsive disorder (OCD) are unwanted, repetitive thoughts that cause anxiety or fear, e.g., contamination/germs, fear of harming others, symmetry, perfectionism, etc.

·      Compulsions are behaviors done to relieve anxiety from obsessive thoughts. e.g., excessive cleaning, checking, counting, and arranging.

·      The symptoms can be managed via therapy and medications.

Amelie had obsessive-compulsive disorder for as long as she could remember. She traces OCD symptoms back to early childhood. No one, her parents, teachers, or friends, noticed anything amiss. As a kid, she used to walk in a straight row, one foot after another. Her bathroom accessories stayed in a straight line. She had to put glasses in the "correct" order in the kitchen, not mix vegetables with fruits in the fridge. The dripping water noise from the water dispenser was painful to bear. She repeatedly checked the locks on the house doors before going off to sleep, walking up and down. When she was 25, her friend's mother was killed in an accident. She spent hours curled up in bed, listing the names of everyone she knew to protect them, even as she cried because she just wanted to stop.

Amelie’s therapist confirmed what she already knew. She had OCD. She learned that OCD is here to stay and will likely wax and wane throughout her life, though medicine and therapy help. The key for her has been learning how to accept it and finding ways to manage symptoms. At its most severe, OCD can fully disrupt life. It can get in the way of relationships, everyday activities, and even leaving the house. 

What is OCD?

Obsessive–compulsive disorder (OCD) is a mental disorder in which an individual has intrusive thoughts (an obsession) and feels the need to perform certain behaviors (compulsions) repeatedly to relieve the distress caused by the obsession, to the extent where it impairs general function.

Obsessive-compulsive disorder (OCD) is a chronic, long-lasting condition.

The age of onset between males and females, with the average age of onset of OCD being 9.6 years for boys and 11.0 years for girls.

Children with OCD often have other mental disorders, such as ADHD, depression, anxiety, and disruptive behavior disorder. Children are increasingly likely to struggle in school and experience difficulties in social situations. Adults with OCD have exhibited more symptoms of attention deficit hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) than adults without OCD.

Symptoms

OCD can present with a wide variety of symptoms. Certain groups of symptoms usually occur together as dimensions or clusters, which may reflect an underlying process.

1.    Symmetry: becomes fixated on the position and arrangement of certain objects and will feel uncomfortable and distressed.

2.    Forbidden thoughts: consist of intrusive, distressing thoughts regarding sexual, religious, or aggressive themes.

3.    Cleaning: driven by intense contamination fear rather than a desire for neatness. It involves excessive, time-consuming rituals, like washing for hours to reduce distress from intrusive thoughts. About 75% of people with OCD have cleaning compulsions, which often become more severe during periods of high stress.

4.    Hoarding: involves intense, obsessive fears regarding the loss of possessions, leading to compulsive saving and severe clutter that impairs daily life.

Why does one suffer from OCD?

The causes of OCD are quite varied. They include genetic factors, environmental stressors like childhood trauma, differences in brain structure and how neurotransmitters work, certain medications or drugs, possible autoimmune responses in some children, and maybe even evolutionary influences that affect compulsive behaviors.

Treatment

Key steps include working with a clinical psychologist with good experience in treating OCD, practicing daily ERP homework, using medication (SSRIs) if recommended, and reducing reassurance-seeking. It is a process of retraining the brain to tolerate anxiety. 

·      Exposure and Response Prevention (ERP): The "gold standard" for OCD treatment is a gentle approach that guides individuals to gradually confront situations they fear (exposure) while encouraging them to resist the urge to perform rituals (response prevention). This supportive method helps build confidence and ease anxiety over time.

·      Cognitive Behavioral Therapy (CBT): Concentrates on addressing unhelpful, obsessive thoughts and gently breaking the cycle of compulsive behaviors.

·      Medication (SSRIs): Common medications encompass Fluoxetine, Sertraline, Fluvoxamine, Paroxetine, and Escitalopram. These oftentimes necessitate higher dosages than those used for depression and require a longer duration to exhibit effects, with notable progress generally observed after several weeks to months.

·      Clomipramine: A tricyclic antidepressant is frequently employed when selective serotonin reuptake inhibitors (SSRIs) prove ineffective.

·      Acceptance and Commitment Therapy (ACT): Focuses on embracing intrusive thoughts without feeling the need to act on them, encouraging gentle acceptance and understanding.