Obsessive-Compulsive Disorder (OCD) Explained
I couldn’t escape the spiral of my thoughts, I felt they were coming from outside.— John Green
What Is Obsessive-Compulsive Disorder?
Characterised by obsessions and/or compulsions, OCD is an extreme anxiety disorder that, if left untreated, can have an adverse effect on your quality of life. Sadly, it is one of the most misunderstood mental health conditions today, yet it affects between 1–3% of adults, many of whom show symptoms before the age of 18. It has to be acknowledged that people with this condition are compelled to carry out these ritualistic compulsions, which they do in abject misery. The levels of stress and utter devastation that accompanies these constant compulsions can never be underestimated or ignored.
In most cases, OCD will have a central theme such as a fear of germs and their contamination. In order to ease the fear of contamination, many sufferers will compulsively wash their hands until they become sore and bleed. Trying to ignore or stopping these obsessions will only increase anxiety levels, which will result in acute stress. Consequently, in order to ease their stress levels they are driven to perform these compulsive acts, ultimately finding themselves caught up in a vicious cycle. This ritualistic behaviour may increase over time causing extreme distress, making it very difficult to cope with on a daily basis.
In order to treat this debilitating condition, which presents itself in many guises, we need to fully understand it.
Causes of OCD
To date, scientists have not been able to come up with a definitive cause as to why a person will develop OCD. There are however a number of theories and many explanations which, although helpful, at present are just theories. Although finding a cause is important, what is equally important is fighting and tackling OCD, as even identifying a cause may not offer any insight into how to overcome it. Theories and explanations include:
- Genetic: Various studies have shown that OCD sufferers are more predisposed to the condition if they have a family member who has OCD. However, it could also be argued that in some cases OCD may in fact be learned behaviour. There is also the theory that if anxiety is prevalent within the family then there is a slight chance that a family member may develop OCD. There is no real evidence to suggest that genetics play a major part, however, it cannot be completely ruled out.
- Psychological: It is thought that OCD symptoms may have developed due to learned behaviour and negative thought patterns. Research has shown that a number of factors, including environmental, cognitive and behavioural, could play a role.
- Stress: There is very little evidence to show that stress causes the onset of OCD; however, traumatic life events may trigger OCD in someone already predisposed to the disorder.
- Depression: Research has shown that even though depression will make the symptoms of OCD worse, it is thought that depression is a consequence of OCD rather than a cause.
Types of OCD
Impacting on any thought, person, fear or subject, there are infinite types of OCD. However, most people who suffer with this mental illness will fall into one of the following categories, which may also overlap.
Causing a variety of intrusive thoughts, rumination occurs in all forms and subtypes of OCD where the person will indulge in constantly ruminating on the topic of their obsessions. A core feature of OCD, rumination will cause the person to spend incredible amounts of time worrying about how to understand a question or theme which is invariably unproductive and undirected. The person’s life can be significantly impacted as so much time is spent on these intrusive thoughts that they may withdraw from their relationships, work and other obligations. Dwelling on topics such as religion, morality or the universe, ruminations, unlike other intrusive thoughts, are not objectionable, and as a result, are indulged, not resisted.
Compulsions of rumination within OCD include:
- The avoidance of certain places or people to prevent being triggered
- Long periods of time spent reviewing memories and past events
- In order to ensure cleanliness, the person will constantly go through a mental checklist
- Lengthy periods thinking about various philosophical topics
- Constantly ruminating about heaven or hell
A fear of germs after coming into contact with what the person views as dirty objects, or being in a potentially dirty environment, will result in repetitive hand or body washing. The ritual of washing until the person feels clean or the object is clean can take many hours. As a result, being able to hold down a job or have a proper relationship is extremely difficult. Additionally, the constant scrubbing, very often with the use of bleach, is detrimental to the person’s health and often results in damage to the skin.
Fear of contamination, which might cause harm to the person or a loved one, becomes the obsessive worry which can include:
- Door handles
- Shaking hands
- Eating in public places
- Handling money
- Public toilets
- Hospital/GP surgery
This type of OCD is less obvious than the more familiar type of contamination and researchers are just beginning to form an understanding of its complexities. Mental contamination is an internal sense of feeling dirty and therefore cannot be washed away. One of the main features of mental contamination is that the source is usually human. This internal feeling of mental contamination may surface due to memories where the person felt bullied or abused, often taking the form of painful criticism, humiliation, verbal or physical abuse and degradation. Engaging in compulsive and repetitive behaviour such as showering and washing in order to feel clean again can be a direct result of contact with the person responsible, or as a result of the memories, images and thoughts the person may have when alone.
The constant need to check stems from uncertainty or doubt over feared consequences for the person or others, and its main purpose is to reduce stress. However, there is no peace of mind for the person as research has shown that what they experience is increased levels of doubt relating to the fact that they have not avoided a perceived danger. Some sufferers feel that even thinking about a traumatic event will increase the likelihood of the event actually happening. This can take the form of them imagining their house will burn down and, as a result, they will continually drive past their house to ensure there isn’t a fire.
These obsessive worries and compulsions may include:
- Alarms in the house or place of work
- Electric or gas oven and hob
- Door locks
- Window locks
Symmetry and Perfection
Experiencing strong urges to rearrange items in order to position them in an acceptable and perfect manner characterises this type of OCD. Very often, the person will become fixated on the position and arrangement of objects and will feel distressed if those items are not aligned correctly. The compulsion is the need to get the symmetry exact, and the fear is to prevent feelings of distress caused by an object or objects being out of order. In order to achieve this result, the person may spend hours obsessively checking, resulting in them being late for work or appointments. Mentally and physically draining, the person may even avoid socialising at home just in case the order and symmetry would be disrupted.
Examples may include:
- Tinned cans
- Books, pencils and pens
- Ornaments, pictures and cushions
Pure O: Purely Obsessional OCD
This lesser known type of OCD is characterised by repeated, intrusive and uncontrollable thoughts (obsessions) where the person does not engage in outward behavioural compulsions related to their intrusive thoughts. As a result, the compulsions take place internally where they manifest as unwanted and inappropriate thoughts, impulses or mental images, which tend to fall within certain themes: faith, health, relationship, violence and sexuality. Most of us will experience unwanted thoughts at some time, however, people with Pure O experience extreme levels of anxiety which become attached to these thoughts, causing severe distress. Ironically, the more the person tries to control or repress the thoughts, the greater the frequency of the thoughts resurfacing.
Characteristic symptoms that may distinguish Pure O from other types of OCD are:
Constantly Seeking Reassurance
Problematic in itself as many people do not recognise it as a compulsion, constant reassurance from family and friends can actually make the OCD worse. Unfortunately, this form of reassurance will only provide momentary relief as over time the thoughts tend to strengthen.
Repetitive Mental Rituals
In order to reduce anxiety and stress levels, the person will carry out mental rituals which can include: the repetition of certain words, mentally reviewing information, and mentally reviewing memories.
There are a range of OCD symptoms that people who experience Pure O will exhibit without the obvious compulsions. Obsessions very often revolve around sexual, religious or aggressive thoughts, but can include concerns regarding checking, symmetry, and contamination.
These obsessions involve:
- Attempting to suppress and ignore the obsessive thoughts
- Intrusive thoughts, images and impulses causing extreme distress
- Intrusive thoughts which are unrelated to worries and stress in real life
Diagnosis/Treatment of OCD
OCD is not always easy to diagnose as symptoms are similar to those of other mental health disorders, such as anxiety disorders, depression, obsessive-compulsive personality disorder and schizophrenia. It is also possible to have OCD plus another mental disorder. In order to reach a diagnosis, the following steps may include:
- Physical examination: A full physical examination will rule out any other problems which may be causing the symptoms.
- Psychological evaluation: Will involve discussing the person’s thoughts, symptoms, feelings and behaviour patterns, and if helpful may include talking to family members, as long as the person is comfortable with this.
- Lab tests: A full blood count along with screening for drugs and alcohol, as well as checking the person’s thyroid function will be carried out.
Once a diagnosis has been made, treatment can begin which will take the form of a combination of psychotherapy and medications. This treatment may not always result in a cure, but it is beneficial in bringing the symptoms under control so they do not interfere with a person’s daily life.
Cognitive Behaviour Therapy (CBT)
This therapy is a talking treatment which will focus on how a person’s thoughts, beliefs and attitudes affect their feelings and behaviour. Involving the use of two techniques—Exposure and Response Prevention Therapy (ERP), and Cognitive Therapy (CT)—it is the only scientifically-supported and effective treatment for OCD and can be used in conjunction with appropriate medication.
- ERP: This type of therapy will involve the therapist conducting a series of sessions aimed at gradually exposing the person to those situations that act as a trigger to their obsessions/compulsions. Usually beginning with the least difficult symptoms, the person will avoid performing compulsive behaviours for increasingly longer periods of time. As these exposures are repeated, over time the anxiety associated with them decreases until it is barely noticeable. More challenging exposures are then dealt with in the same way, until they also become manageable. The purpose of ERP is for people to learn that nothing bad will happen to them when they no longer perform these rituals.
- Cognitive Therapy: Used in conjunction with ERP, this type of therapy will help an individual identify and modify those patterns of thought that cause distress, anxiety or negative behaviour. The person will eventually understand that the brain is sending “wrong” messages. In time, the person will learn to recognise these “wrong” messages and, by confronting the obsessions, will respond to them in new ways.
CBT treatment will take time and some people may require more sessions; in certain cases, some may need residential treatment. Homework consists of daily exposures which need to be completed between therapy sessions. Recent surveys have shown that 85% of people who complete a course of CBT experience a significant reduction in OCD symptoms.
For more extreme conditions of OCD, medication can help control the obsessions and compulsions. Initially, antidepressants are usually prescribed with the goal being to effectively control symptoms at the lowest dosage. However, several drugs may be tried before finding one that works well. Medication is normally used in conjunction with CBT treatment.
Obsessive-compulsive disorder is an extremely challenging and debilitating mental illness. For many, OCD will always be a part of their life, requiring long-term treatment. However, the more knowledgeable a person is about their condition, the more empowered and motivated they will become. Recovery is an ongoing process, but staying focused on those recovery goals will make the process worthwhile.
There are many holistic ways to manage stress such as meditation, yoga and breathing techniques, just to name a few. Joining a support group where you reach out to others who are facing similar challenges will give you that much needed reassurance that you are not alone, ultimately helping you to cope with your own challenges.
This content is for informational purposes only and does not substitute for formal and individualized diagnosis, prognosis, treatment, prescription, and/or dietary advice from a licensed medical professional. Do not stop or alter your current course of treatment. If pregnant or nursing, consult with a qualified provider on an individual basis. Seek immediate help if you are experiencing a medical emergency.
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© 2019 Lorna Lamon