Understanding Obsessive-Compulsive Disorder

By CareerSmart Learning Contributor, December 21, 2015, as published by Healthcare Hot Spot


Cartoon illustration of an obsessive man correcting a crooked ocd letter.

Do you know someone who must physically touch the knobs of their stove multiple times to make sure they are turned off before leaving their home? We joke about these types of people being “so OCD,” but to them, these routines are necessary for their mental assurance. OCD is no joking matter. Obsessive Compulsive Disorder (OCD) is a mental disorder characterized by recurrent unreasonable thoughts and fears (obsessions) that lead the individual to perform repetitive and ritualistic behaviors (compulsions) that may interfere with their daily life and relationships. These compulsive behaviors or rituals are performed to relieve the associated anxiety or distress caused by the obsessions. While the exact cause of OCD is not known, research suggests that differences in the brain function and possibly genes of those affected may play a role3.

OCD affects about 2.2 million adults in America, and The National Institute of Mental Health reports the lifetime prevalence as 1.2%3. The disorder most often begins in childhood, adolescence, or early adulthood with early onset associated with more severe illness1. Patients with OCD are at high risk of having comorbidities such as major depression, other anxiety disorders such as panic disorder or general anxiety disorder, and eating disorders.

There is a distinction between wanting something a certain way and being obsessive-compulsive. For example, you may want your books lined up by size or alphabetized by title; that is your preference, and it’s reasonable. People with OCD have unreasonable triggers and cannot control their unpleasant thoughts and behaviors. There are certain diagnostic criteria within the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) for OCD. Diagnosing OCD by a mental health professional can be complex and challenging because of other conditions with similar behaviors, such as personality disorder, anxiety disorder, or schizophrenia. Clinical evaluation must be completed to rule out other possibilities such as a chemical induced or other organic disease processes. Some of the general diagnostic criteria for OCD include having only obsessions, only compulsions, or both; these things trigger excessive time-consuming behaviors and habits that significantly interfere with daily activities or work. 

Common Obsessions in OCD

  • Contamination (e.g. germs)
  • Losing control (e.g. fear of acting on an impulse to harm oneself or others)
  • Harm (e.g. fear of being responsible for something terrible happening)
  • Perfectionism (e.g. fear of losing or forgetting important information when throwing something out)
  • Religion (e.g. concern about offending God)
  • Other (e.g. superstitious ideas about certain colors or numbers)

Common Compulsions in OCD

  • Washing and cleaning (e.g. washing hands excessively or in a specific way)
  • Checking (e.g. checking that the individual did not make a mistake or that nothing terrible happened)
  • Repeating (e.g. repeating body movements such as tapping or blinking; repeating routine activities such as getting up or down from chairs)
  • Mental Compulsion (e.g. mental review of events to prevent harm to self/others, to prevent terrible consequences)

Treatment

Those who live with OCD are desperately trying to get away from paralyzing, unrelenting anxiety. Treatment includes cognitive behavioral therapy, specifically Exposure and Response Prevention therapy, which studies show to be most beneficial2. . This therapy works to extinguish the anxiety associated with obsessions. The link between the obsession and the performance of the compulsive act is gradually broken.

Medications, such as antidepressants, can also be useful in treating OCD; however, it has been found that their efficacy is less than that of behavior therapy. Medication used in conjunction with behavior therapy can help individuals reduce the intensity of their obsessions, together with the intensity of their urges to perform compulsive acts.

Tips for Providers

Care is often sought when the condition has begun to exact a high toll on the patient’s ability to function on a daily basis. The following are tips for care providers to support those with OCD:

  • Acknowledge the patient’s anxiety and rituals without being judgmental.
  • Help identify situations that increase anxiety and trigger obsessions and compulsions.
  • Identify how the patient’s behavior is affecting their relationships or work roles.
  • Gently encourage the patient to speak about the meaning and purpose of their behaviors.
  • Limit the time they spend on rituals and give positive reinforcement when they are able to decrease or stop them.
  • Develop practical strategies to improve relationships, complete tasks, and be able to work or stay in school.
  • Try to involve the patient’s family members and/or support network. Some of these relationships may have been adversely affected by OCD and so may need some support or even repair.

OCD is a serious and debilitating mental disorder. These obsessions and/or compulsions cause significant distress, are time-consuming, and substantially interfere with important daily functions and/or relationships. Health care professionals play an important role in supporting these patients and providing reassurance that they can make progress in treatment.

Sources:
1. http://ocd.stanford.edu
2. https://iocdf.org
3. http://www.nimh.nih.gov/health/topics/obsessive-compulsive-disorder-ocd/index.shtml

December 21, 2015

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