Many people have certain habits that they are particular about, but they can generally manage just fine without doing them for a while. But when these habits become uncontrollable, and when they’re used to deal with some kind of crippling, relentlessly persistent fear or idea, that’s when obsessive-compulsive disorder (OCD) becomes a concern.
What is OCD?
Obsessive-compulsive disorder refers to a combination of exaggerated thoughts and fears (obsessions) that force you to perform repetitive behaviors (compulsions) in what WebMD calls “endless cycles.”
For example, a common presentation of OCD is the fear of infection. Many people are concerned about protecting themselves from germs and bacteria, so they make sure to wash their hands after using the bathroom, before meals, etc. But someone with OCD is not just concerned about protection – they are obsessed with protection. It may be all they can think about. The idea of bacterial infection keeps them awake at night. They are terrified about going places where they could catch an infection, even if the chances of catching one is highly unlikely (like getting HIV from a shopping cart handle).
In order to make this high level of anxiety bearable, someone with OCD may wash their hands and clean their living space compulsively. Doing these actions just once isn’t enough to make the thoughts about infection going away. So they wash and wash and clean and clean, over and over again, until they are satisfied and the fear of infection recedes. But then it comes back, just as paralyzing as before, even though every surface has been scrubbed and the person’s hands have been repeatedly washed. The only solution is to keep washing and cleaning.
In fact, FOX News says that compulsive hand-washing has become so synonymous with OCD that “washers” has become a widely accepted term for this particular presentation of OCD. In general, OCD affects about 2.2. million Americans, according to the Anxiety and Depression Association of America, and the National Institute of Mental Health says that 50.6 percent of those cases are “severe.”
Someone with OCD may recognize that their obsession is not reasonable, but they are still powerless to take control of their thoughts – which, in turn, makes them powerless to stop the repetitive behaviors they are compelled to do to try and ease those thoughts.
One of the characteristics of OCD is that the compulsive behaviors can last for hours, cutting into everyday activities like sleep and socializing, and negatively affecting academic or job performance.
- Checking behaviors. This might be repetitively, compulsively checking the doors and windows at night to make sure that the house is secure. Such behavior might stem from a traumatic event where an intruder once breached the safety of a house, or an obsessive fear of irresponsibility.
- Unwanted thoughts. Everyone gets stray thoughts in their heads once in a while, but it’s easy to dismiss them. OCD patients will change their behavior because they are convinced that the thoughts have more legitimacy than they actually do. For example, someone might imagine a car crash on a particular street, and then studiously avoid driving near that street even though there was no tangible danger present.These feelings can also extend to thoughts of performing violent or sexual acts on a person. The patient is not compelled to carry out these thoughts but is unable to get past the distress of the idea, no matter how random or remote it might be. To that effect, the patient will go to great lengths to avoid any possibility of the chance of those thoughts coming true, even though such an event would be very unlikely. This might involve completely breaking off any contact with the target of the thoughts – ostensibly for that person’s own safety.
- Relationship intrusive thoughts. A constant fear that the integrity of a relationship is in a state of compromise might lead an OCD sufferer to overanalyze and overthink every interaction in light of trying to determine whether the relationship is truly ending. An offhanded comment or perceived slight becomes a focus of negativity towards the health of the relationship.
- Organization. An OCD patient often cannot function without organization that borders on perfection. This may come from a fear of lack of control, or order, and it manifests with the patient spending hours arranging and rearranging their house or workspace until they have it just so – and then starting all over again because they still feel the obsessive need to arrange and organize to perfection.Sometimes, the organization can border on the seemingly pedantic. Objects have to face a certain way or be arranged in a very particular way. Failure to achieve this level of organization can cause intense feelings of stress and anxiety in the patient.
Other types of OCD might involve unbidden thoughts of behaving inappropriately (which would never be acted out but are so distressing to the patient that they completely avoid the person or place that they associate with those thoughts); silently repeating a prayer, word, or phrase (with a fear that not repeating the phrase will cause something bad to happen); or performing tasks according to a certain numeric pattern (for example, believing that nine is a lucky number, so arranging their life to do things in increments of nine – walking nine steps at a time, have exactly nine sets of clothes, own no more than nine of a particular object, etc.).
This same approach can be applied to other types of OCD. If the compulsive behaviors have to be carried out to prevent the patient from experiencing an anxiety attack, if they are time-consuming and disruptive to social functioning, and if the obsessive thoughts have little to no basis in reality, treatment should be sought for a potential OCD diagnosis.
Other related causes of OCD might be environmentally based. Someone who experienced trauma as a child, or even as an adult, might become obsessed with a detail about the trauma. This obsession then compels them to perform a particular action repetitively and intrusively, which they believe assuages the obsessive thought. The presence of a chemical imbalance in the brain may exacerbate an obsessive-compulsive reaction as a response to the traumatic event.
If a patient has both OCD and a substance abuse problem, treatment will often involve getting rid of their physical dependence on drugs and alcohol before the OCD can be managed. As detox can be a very difficult process, it should be closely monitored by the trained staff at a treatment center who can prescribe anti-anxiety medications with low abuse potential. These anti-anxiety drugs are usually from the family of selective serotonin reuptake inhibitor (SSRI) drugs, which prevent the brain from reabsorbing serotonin. Per the Mayo Clinic, these drugs can help improve communication between brain cells, which boosts the patient’s mood. Around 40 to 60 percent of OCD patients respond well to SSRI medications.
When the patient no longer has a physical need for drugs or alcohol to combat their OCD, their treatment team can start them on a therapeutic course of treatment to address the OCD itself. This can involve cognitive behavioral therapy (CBT), which helps the patient understand the thoughts and actions that preceded and precipitated the cycle of obsessive thoughts and compulsive behaviors. Then, with that understanding in mind, the patient can learn how to change those thoughts and actions into healthier and more positive ways of dealing with their OCD, and they can learn coping skills for how to respond to the situations that might have triggered an OCD attack in the past.
Another form of therapy for OCD (and one that can be used in conjunction with CBT) is exposure and response prevention therapy (ERP). Here, the patient is gradually (and controllably) exposed to the kind of situations that would cause an OCD reaction, like being made to shake hands with a complete stranger. However, the patient is not permitted to respond in their usual way (avoiding the situation, compulsively washing their hands afterwards, etc.). The point of ERP is to show the patient that the situations that cause their obsessive thoughts carry no inherently harmful consequences, and that their obsessive thoughts are not based in reality.
FOX News called OCD “one of the least understood mental illnesses.” That may be true, but what’s also true is that OCD treatment has helped many people regain control of their everyday lives and thought processes. At The Recovery Village, we know how severely a life can be affected by obsessive-compulsive disorder, and we can help you. Please call us today with your questions; we are standing by to offer you effective treatment for OCD.