Obsessive-compulsive Disorder
Obsessive-compulsive disorder or OCD is a term that found its way into everyday language. It’s not unusual to hear people refer to themselves or a friend as “OCD” because they like order, cleanliness or routine. However, these personal preferences do not constitute OCD, a mental health disorder associated with significant distress and anxiety for the children, adolescents, and adults affected.
The disorder is characterized by a cycle of obsessions and compulsions that can be debilitating. Obsessions are intrusive, persistent thoughts, images or impulses that cause significant anxiety. Persons experience the obsessions as inappropriate and beyond their control and engage in behavioral or mental compulsions to reduce or neutralize the anxiety. Compulsions, such as checking, reassurance seeking, washing, praying, and counting, are repetitive rituals that are neither pleasurable nor realistically connected to the fear. Moreover, people with OCD often avoid situations, objects or people that they fear will trigger obsessions and compulsions. For example, a person who has an obsession that he or she may be a pedophile will try to avoid contact with children. Most people with OCD recognize that their obsessions are irrational and untrue and see their compulsions as silly and embarrassing. For a diagnosis of OCD, symptoms must result in significant distress or anxiety and impair functioning.
Obsessive-compulsive disorder occurs in many different forms, and some people experience different symptoms over time. The following is a non-exhaustive list of categories of obsessions and compulsions with a few examples of each from “The OCD Handbook” by Bruce Hyman and Cherry Pedrick. Occurrences and preoccupations must be excessive and distressing to be OCD.
Obsessions
- Contamination (e.g., bodily secretions, dirt, germs, insects, diseases)
- Hoarding, Saving, Collecting
- Ordering (e.g., symmetry, order, excessive concern with perfect handwriting)
- Religious Obsessions, Scrupulosity (e.g., blasphemous thoughts, morality, religious beliefs)
- Body/Health (e.g., illness, appearance)
- Sexual Obsessions (e.g., sexual thoughts or images, homosexuality, pedophilia)
- Fear of saying something wrong or certain words
- Worry about making mistakes
- Lucky and unlucky numbers
- Sense of incompleteness or “not right”
Compulsions
- Cleaning and Washing (e.g., handwashing, bathing, housecleaning, grooming)
- Checking (e.g., harm to self or others, mistakes, health, doors)
- Hoarding, Saving and Collecting
- Repeating, Counting, Ordering (e.g., rereading, worry didn’t understand read material, rewriting, counting)
- Seeking Reassurance
- Prayers
- Touching or Tapping
- Eating according to rigid rules
- Confessing wrong behavior
Most people with OCD are diagnosed by age 19. Causes of the disorder are unknown but genetics research indicates a higher risk for people with first-degree relatives with OCD, especially if the relative developed the disorder as a child or teen. There are differences in brain structure and functioning among people with OCD, but research is ongoing. In some cases, children may develop OCD symptoms after a streptococcal infection. (See https://www.nimh.nih.gov/health/publications/pandas/index.shtml.)
The first line-line option for treatment of OCD is cognitive-behavioral therapy (CBT), specifically exposure and response prevention (ERP). Often a combination of ERP and a serotonin reuptake inhibitor (SRI), e.g., sertraline (Zoloft), is the most effective approach (See https://iocdf.org/about-ocd/treatment/meds/.) depending on the severity of the symptoms.
