Obsessive Compulsive Disorder (OCD)
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What Is Obsessive Compulsive Disorder?
Obsessive-Compulsive Disorder, OCD, is an anxiety disorder and is characterized by recurrent, unwanted thoughts (obsessions) and/or repetitive behaviors (compulsions). Performing these so-called "rituals," however, provides only temporary relief, and not performing them markedly increases anxiety.
Obsessions are intrusive, irrational thoughts -- unwanted ideas or impulses that repeatedly well up in a person's mind. Again and again, the person experiences disturbing thoughts, such as "My hands must be contaminated; I must wash them"; "I may have left the gas stove on"; "I am going to injure my child." On one level, the sufferer knows these obsessive thoughts are irrational. But on another level, he or she fears these thoughts might be true. Trying to avoid such thoughts creates great anxiety.
Compulsions are repetitive rituals such as hoarding, or arranging. An individual repeats these actions, perhaps feeling momentary relief, but without feeling satisfaction or a sense of completion. People with OCD feel they must perform these compulsive rituals or something bad will happen. For example if people are obsessed with germs or dirt, they may develop a compulsion to wash their hands over and over again. If they develop an obsession with intruders, they may lock and relock their doors many times before going to bed.
What are symptoms of OCD?
Obsessions often have themes to them, such as:
- Fear of contamination or dirt
- Having things orderly and symmetrical
- Aggressive or horrific impulses
- Sexual images or thoughts
OCD symptoms involving obsessions may include:
- Fear of being contaminated by shaking hands or by touching objects others have touched
- Doubts that you've locked the door or turned off the stove
- Thoughts that you've hurt someone in a traffic accident
- Intense distress when objects aren't orderly or facing the right way
- Images of hurting your child
- Impulses to shout obscenities in inappropriate situations
- Avoidance of situations that can trigger obsessions, such as shaking hands
- Replaying pornographic images in your mind
- Dermatitis because of frequent hand washing
- Skin lesions because of picking at your skin
- Hair loss or bald spots because of hair pulling
As with OCD obsessions, Compulsions typically have themes, such as:
- Washing and cleaning
- Demanding reassurances
- Performing the same action repeatedly
- OCD symptoms involving compulsions may include:
- Hand washing until your skin becomes raw
- Checking doors repeatedly to make sure they're locked
- Checking the stove repeatedly to make sure it's off
- Counting in certain patterns
- Making sure all your canned goods face the same way
Who gets OCD?
People from all walks of life can get OCD. It strikes people of all social and ethnic groups and both males and females. Symptoms typically begin during childhood, the teenage years or young adulthood. OCD is the fourth most common mental disorder and is diagnosed nearly as often as the physiological ailments asthma and diabetes mellitus. In the United States, one in 50 adults has OCD.
What causes OCD?
A large body of scientific evidence suggests that OCD results from a chemical imbalance in the brain. For years, mental health professionals incorrectly assumed OCD resulted from bad parenting or personality defects. This theory has been disproven over the last 20 years. People with OCD can often say "why" they have obsessive thoughts or why they behave compulsively. But the thoughts and the behavior continue. People whose brains are injured sometimes develop OCD, which suggests it is a physical condition. If a placebo is given to people who are depressed or who experience panic attacks, 40 percent will say they feel better. If a placebo is given to people who experience obsessive-compulsive disorder, only about two percent say they feel better. This also suggests a physical condition.
How do people with OCD typically react to their disorder?
People with OCD generally attempt to hide their problem rather than seek help. Often they are remarkably successful in concealing their obsessive-compulsive symptoms from friends and co-workers. An unfortunate consequence of this secrecy is that people with OCD generally do not receive professional help until years after the onset of their disease. By that time, the obsessive-compulsive rituals may be deeply ingrained and very difficult to change.
How long does OCD last?
OCD will not usually go away by itself, so it is important to seek treatment. Although symptoms may become less severe from time to time, OCD is a chronic disease. Fortunately, effective treatments are available that make life with OCD much easier to manage.
How is OCD treated?
If your obsessions and compulsions are affecting your life, see your doctor or mental health provider. It's common for people with OCD to be ashamed and embarrassed about the condition. The two main treatments for obsessive-compulsive disorder are: Psychotherapy, and Medications. Which option is best for you depends on your personal situation. Often, treatment is most effective with a combination of medications and psychotherapy.
Psychotherapy for obsessive-compulsive disorder
A type of therapy called cognitive behavioral therapy (CBT) has been shown to be the most effective form of therapy for OCD in both children and adults. Cognitive behavioral therapy involves retraining your thought patterns and routines so that compulsive behaviors are no longer necessary. One CBT approach in particular is called exposure and response prevention. This therapy involves gradually exposing you to a feared object or obsession, such as dirt, and teaching you healthy ways to cope with your anxiety. Learning the techniques and new thought patterns takes effort and practice. Therapy may take place in individual, family or group sessions.
Medications for obsessive-compulsive disorder
Certain psychiatric medications can help control the obsessions and compulsions of OCD. Most commonly, antidepressants are tried first. Antidepressants may be helpful for OCD because they may help increase levels of serotonin, which may be lacking when you have OCD.
What you can do
Being an active participant in your care can help your efforts to manage your OCD. One way to do this is by preparing for your appointment. Think about your needs and goals for treatment. Also, write down a list of questions to ask.
Write down any symptoms you've noticed, including any that may seem unrelated to the reason for which you've scheduled the appointment. Try to have specific examples.
Write down key personal information, including any major stresses or recent life changes.
Take a list of all medications, as well as any vitamins or supplements.
Questions to ask
Why do you think I have obsessive-compulsive disorder?
How do you treat obsessive-compulsive disorder?
How can treatment help me?
Are there medications that might help?
Will psychotherapy help?
How long will treatment take?
What can I do to help myself?