Although everyone with OCD will experience some forms of obsessions and compulsions, they will take different forms depending on what subtype of OCD a person has. The list of subtypes is not all-inclusive – many people with OCD do not exactly fit any of these subtypes.
This type of OCD appears before puberty – the National Institute of Mental Health (NIMH) reports that it affects about one-third of people with OCD. In early-onset OCD, the compulsive behaviors often present before the obsessions begin to appear. Compulsions can be more severe and frequent than in adult-onset OCD, found research in the American Journal of Psychiatry
American Family Physician found that early-onset OCD is linked with increased likelihood of the child also experiencing tics (see below) and other psychiatric conditions, compared with OCD that presents in adolescence or adulthood. The article reports that early-onset OCD has a strong familial link, suggesting genetic ties – if someone has OCD, there is a 17 percent chance they will have a first-degree relative who does as well.
Early-onset OCD may be less responsive to first-line treatments like clomipramine and SSRIs, per the American Journal of Psychiatry. Combining an SSRI with an atypical antipsychotic proves much more effective, according to Focus.
As many as 10 to 40 percent of people with early-onset OCD may also have tic-related OCD, reports Dialogues in Clinical Neuroscience. A tic is a small, sudden, involuntary muscle spasm that produces a twitch, jump, jerk, or vocal utterance. Tics can be simple, like a twitching hand, or more complex, such as shouting, cursing, skipping, or jumping. These behaviors are compulsive and involuntary. Tic-related OCD has a high rate of co-occurrence with Tourette syndrome, reports Psychiatry (Edgmont). NAMI notes that they may have related mechanisms in the brain. Other common co-occurring disorders are ADHD, body dysmorphic disorder, hair-pulling, social anxiety, and depression.
Dialogues in Clinical Neuroscience also reports that tic-related OCD is most common among males. People with this form of OCD show elevated symptoms related to symmetry, forbidden thoughts, and hoarding, but fewer symptoms related to cleaning.
Like non-tic-related early-onset OCD, a combination of SSRIs and atypical antipsychotics is currently the most promising treatment, reports American Family Physician.
Hoarding is a compulsive pattern of behavior in which a person collects and keeps a vast collection of apparently useless clutter, to the detriment of their daily functioning. Hoarding-related OCD is often more severe than other types of OCD, and people who have it may have a greater degree of globally impaired functioning, according to an article in the Journal of Anxiety Disorders. While many people with OCD often have a great deal of insight into the nature of their condition and how it causes their symptoms, people who have primarily hoarding-type OCD may have less awareness and may not recognize the reality of their problems. They are also at higher risk for having social anxiety disorder, substance use disorder, bipolar I disorder, and binge eating disorder.
Unfortunately, the paper also noted that hoarders are less likely to respond to both psychological therapy and medication, although a study in the Journal of Psychiatric Research suggests there are no such differences for paroxetine.
For some people, OCD manifests with religious or moral symptoms, such as:
- Seeing sin everywhere
- Unwanted sacrilegious thoughts, such as about the devil
- Excessive doubt about whether or not you have committed a sin, such as daydreaming while praying
- Taking a religious ritual to an extreme, such as going to confession too frequently
Another paper in the Journal of Anxiety Disorders noted that about 6 percent of people with OCD reported that religious obsessions were their most common symptoms, and that 24 percent of people experienced some form of obsession related to religion. Their symptoms were no more severe than other types of OCD, but symptoms were more likely to focus on sexual, violent, or somatic obsessions.
For people who have scrupulosity-related OCD, optimal outcomes may result if therapists can work with clergy to fully address each person’s mental and spiritual needs.
Although many people with OCD may feel that they want to get things “just right,” for some people, this is the primary symptom set. Having things be “not just right” is uncomfortable, and they feel driven to repeat a certain action until they can perfect it and thus ease the discomfort. A study in Behavior Research and Therapy found that not-just-right experiences were more related to the symptoms related to checking, ordering, and control sets of OCD than to contamination- or hoarding-related symptoms. They were also more closely tied to the personality trait perfectionism.
A review article in Clinical Psychology Review found that about 25 percent of people with OCD experience distressing obsessions without any accompanying compulsive rituals. In actuality, they may have mental compulsions or rituals. People with primary obsessional OCD may find themselves plagued by sexual, violent, or religious thoughts. They may then feel compelled to perform mental rituals to “neutralize” these distressing thoughts, such as counting, praying, or reciting “good” words. Primary obsessional OCD can be treated with a combination of cognitive behavioral therapy and exposure and response prevention therapy.
Pediatric autoimmune neuropsychiatric disorders associated with streptococcus (PANDAS)
Although rare, it is possible for an infection to trigger an autoimmune response that attacks the brain, causing OCD symptoms. According to Dialogues in Clinical Neuroscience, brain imaging studies of PANDAS have found that this autoimmune response causes swelling in the basal ganglia, a region of the brain that is responsible for the generation of actions and that is implicated in OCD. Streptococcus isn’t the only infection that can cause OCD symptoms – other reported causes have included pneumonia and the common cold.
Another article in Dialogues in Clinical Neuroscience noted that OCD can appear among people who have experienced brain injury, usually in accidents. People who experienced head injuries were more than twice as likely to have OCD as people who did not. OCD symptoms have also been linked to brain tumors and stroke lesions. They were also more common in Parkinson’s disease, which affects many brain regions, including the basal ganglia.
There have been a number of reports that have found people spontaneously showing OCD symptoms after treatment with antipsychotic drugs like clozapine and ritanserin for schizophrenia. One possible explanation for this is that the drugs are causing OCD to develop where it was not previously present. Another possible explanation is that the schizophrenia was masking the symptoms of OCD, and once the schizophrenia was successfully treated, it permitted the pre-existing OCD symptoms to emerge. Yet another article in Dialogues in Clinical Neuroscience suggests that the latter is true, as 5 to 20 percent of people with schizophrenia also have comorbid OCD.
OCD and substance abuse
Although treatments do exist for OCD, they don’t offer a perfect solution. NAMI reports that medication is only effective for about half of the people who try it, and that people who do find effective behavioral or pharmacological treatments can only expect to see the severity of their symptoms reduce by about 40 to 50 percent. This can make it tempting for many people with OCD to turn to substance use in an attempt to self-medicate their symptoms. Another study in the Journal of Anxiety Disorders found that 27 percent of people with OCD experienced a substance use disorder at some point in their lifetimes.
Our specialists at The Recovery Village want to help you or your loved one get clean from substance abuse and learn new strategies for managing your OCD. Give us a call or send us an email to learn more about our full continuum of care.