Many people ask what is Obsessive Compulsive Disorder (OCD)? This condition is an anxiety syndrome in which the victims have obsessions (recurring, unwanted ideas, sensations, or thoughts), which make them compulsive (driven to do something repetitively). Such repetitive behavior, which includes cleaning or checking on things, constant washing of hands, can considerably impede an individual’s daily routines, social interactions, and activities.
For most, they usually have repeated behaviors and focused thoughts. Surprisingly, these new behavior does not disrupt daily life, but rather in some cases, it makes tasks easier or adds structures. Additionally, for most people with this disorder, the thoughts are persistent, and unwanted behaviors and routines are inflexible, and also not doing them can result in great distress. Also, for most of the victims, they have insight or may have suspicions that their obsessions are not real or genuine. However, others may believe that theirs are true a condition known as poor insight. Despite some knowing that their passions are not true, people with the obsessive compulsive disorder often find it hard to stop the necessary action or to keep off their obsessions.
Categories of obsessive compulsive disorder
• Obsessive compulsive disorder causes recurring, unwanted ideas, sensations, or thoughts, which leaves individuals driven to perform some task in a repetitive manner. Such repetitive behavior which includes;
• Constant washing. Individuals are usually afraid of contamination. The victims are generally obsessed with hand washing or extreme cleaning.
• Repeatedly checking things. Individuals have compulsions associated with danger or harm; hence they are always checking whether the door is locked, the oven is turned off, among other things.
• Always doubting or seeing yourself as a sinner. Individuals are still afraid that they will be punished, or everything is not done right, and that something terrible will happen.
• Obsessed with symmetry and order. They are always arranging and re-arranging things. It is also common that they have superstitions about specific colors, numbers, or arrangements.
• Fear of throwing away stuff. Always have concerns that something wrong or a bad omen follows them after they throw away things. These make individuals hoard things they do not use or need. Additionally, these individuals may suffer from mental illnesses like PTSD, depression, kleptomania, skin picking, ADHD, tic disorders, or compulsive buying.
Signs and symptoms of OCD
For one to be diagnosed with obsessive compulsive disorder, it requires the presence of compulsion and / or an obsession that is time-consuming mostly more than an hour in a day, impairs social functions or work, and causes significant distress. According to medical research, in the United States, about 1.2% of the adult population has OCD, with the number of women who are affected being slightly higher than that of men. In most cases, OCD begins in childhood, early adulthood, or adolescence, with the average age in which symptoms appear is 19 years.
These symptoms include:
Obsessions are repeated urges, mental images, or thoughts that cause anxiety. Common symptoms of obsessions include;
• Fear of contamination or germs
• Forbidden or unwanted thoughts involving religion, sex, or harm.
• Aggressive and violent thoughts towards others and self.
• Doing things in perfect order or having things symmetrical.
Compulsions are behaviors that repeat themselves that people diagnosed with OCD feel the need to respond to them. These compulsions can be thoughts or actions. Common compulsion symptoms include;
• Excessive handwashing and /or cleaning.
• Arranging and ordering things in a precise and particular way.
• Checking on things repeatedly. For example, frequently checking whether the door is locked or the taps are off.
• Compulsive counting.
It is also important to note that not all habits or rituals qualify as compulsions. It is typical for people to inspect their itinerary often. However people with compulsions generally;
• They cannot control their behaviors or thoughts, even when those behaviors and thoughts seem excessive.
• They spend more than an hour a day on these behaviors and thoughts.
• They do not get pleasure when performing these rituals or behaviors, but instead, at the time may feel brief relief from the anxiety caused by these thoughts.
• These behaviors and thoughts often cause them to experience substantial difficulties in their daily routines and life.
It is also not unusual for some persons with obsessive compulsive disorder to have a tic disorder. The tic disorder includes the involuntary and repetitive movements that occur briefly and sudden. The most common motor tics include facial grimacing, shoulder or head jerking, shoulder shrugging, and eye blinking, and other eye movements. For vocal tics, it includes repetitive sniffing, throat clearing, and grunting sounds.
Over time, these symptoms may ease, come and go, or even get worse. To find calmness or help themselves, persons suffering from OCD often find themselves avoiding circumstances that trigger their obsessions, while others decide to use drugs or alcohol. Although most individuals suffering from OCD (mostly adults) can recognize that what they are doing isn’t correct or does not make sense, a small number (primarily children) may not realize a change in their behavior or whether their behavior is out of the ordinary.
Obsession-compulsion disorder is a common syndrome that affects young children, adolescents, and adults all over the world. For many, the diagnosis is commonly at the age of 19 years; however, onset at ages over 35 years is not unusual. Additionally, OCD has an earlier age of onset in boys compared to the onset age of girls. Although the leading causes of OCD are still unknown, the risk factors include;
According to studies conducted on family and twins, it has been found that persons with first degree relatives like siblings, children, or parents with OCD are at a higher risk of developing OCD themselves. Additionally, if the first-degree relative developed the disorder as a teen or as a child, the risk of developing OCD is higher. In recent days, ongoing research is continuing to connect OCD and genetics, which may aid in the improvement of OCD treatment and diagnosis.
Brain functioning and structure
With the help of imaging study, we are now able to see the differences in the subcortical structure and the frontal cortex of the brain in persons with OCD. Though the connection is not clear, a relationship between abnormalities in some areas of the brain and obsessive compulsive disorder symptoms seems to appear. Therefore studies are still underway that will help understand the causes, which in turn will help to determine personalized and specific treatments for OCD.
According to research conducted, there seems to be a connection between obsessive-compulsion disorder and childhood trauma. However, it is not yet clear what the relationship is, and hence more studies should be conducted in order to understand the relationship better.
Additionally, in other cases, children often develop OCD symptoms or OCD after a streptococcal infection (Autoimmune Neuropsychiatric Disorder Associated with Streptococcal Infections).
Treatments and therapies
Obsessive-compulsion disorder is often treated with psychotherapy, medication, or a combination of both. For most patients, they respond to treatment, while in other cases, patients continue to experience the symptoms. In other instances, people with OCD develop other mental disorders like depression and anxiety. Additionally, some patients with OCD may develop body dysmorphic disorder whereby a patient erroneously believes that a part of their body is abnormal.
When making a decision about the OCD treatment to go with, it is always important to consider these other disorders.
To help reduce OCD symptoms, SRIs (Serotonin Reuptake Inhibitors) are used. The SRIs used include SSRIs (selective serotonin reuptake inhibitors). Compared to other depressants used in the treatment of OCD, higher doses of serotonin reuptake inhibitors are taken daily. Additionally, SRIs may take between 12 to 8 weeks to start working in some patients, while in other cases, patients experience more rapid improvements.
However, in the case that these type of medication (SRIs) does not improve the symptoms, studies have suggested that also patients respond well to antipsychotic treatment. Additionally, even though studies have indicated that OCD symptoms are managed by antipsychotic medication in some patients, there are mixed thoughts on the effectiveness of the medication to treat OCD. Also, is you are prescribed to any medication it is essential to;
• Make sure you talk with your pharmacist or doctor in order to make sure you understand the benefits and risks of the treatment you are prescribed to.
• Make sure you first consult your doctor before you stop taking any medication. The sudden stop of medication may cause a worsening or rebound of OCD symptoms. Additionally, other potentially dangerous or uncomfortable effects of withdrawal are possible.
• It is important to report to your doctor immediately in case of any concerns about the possible side effects of your medication. These will help determine whether to change the dose or the kind of treatment.
• In case of any serious side effects, report them to the FDA (the United States Food and Drug Administration).
Despite the availability of other medications used in the treatment of OCD, more studies need to be conducted in order to determine the benefits of these medications. If you are interested in this medication you read more on the Mental Health Medication website.
This OCD treatment option is effective for both children and adults with OCD. Health research has proved that different types of psychotherapy can be used as an effective form of medication for many persons with obsessive-compulsion disorder. These modes of psychotherapy include habit reversal training and CBT (cognitive behavior therapy). According to recent research, a form of CBT was found to be effective in reducing compulsive behavior in individuals with OCD. These form of CBT commonly known as EX/RP (Exposure and Response Prevention) proved that being disallowed to carry out the usual resulting compulsions (e.g., washing your hand) after being exposed to the situations that triggers compulsions (e.g., touching dirty surfaces or objects) helps in reducing compulsive behavior in individuals with OCD. The research showed that this treatment was also effective for people who did not respond to SRI treatment.
Similar to most mental illnesses, the treatment may begin with either psychotherapy, or medication, or a combination of the two. Additionally, the treatment is also personalized. For example, in case SSRIs or SRIs medication does not work, Exposure and Response Prevention is used as an add-on treatment for OCD or vice versa if the patient began with psychotherapy.
Other available treatment options
After the FDA approval in 2018, TMS (Transcranial Magnetic Stimulation) is now being used as an adjunct obsessive compulsive disorder treatment in adults. Additionally, further medical research of new treatment approaches for OCD is being supported by NIHM in case the usual therapies are not effective.
These alternative medications include sophisticated techniques such as deep brain stimulation, as well as augmentation (add-on and combination treatment).
As researchers carry out research that looks at new ways of treating, preventing, or detecting OCD, they offer clinical trials. The main purpose of these trials is usually to determine whether the new treatment or test is safe and works appropriately. So individuals participating in these clinical trials should know the aim of the study is to gain scientific knowledge in order for others, or they themselves may benefit in the future. However, the participants of the clinical trials may benefit from getting treatment as research is being conducted.
Also, due to these clinical trials, there are now better treatment options available today.
Obsessive compulsive disorder self-help tip
Identify your triggers
For you to manage your OCD symptoms, the first step you should take is identifying your triggers that are the situations or thoughts that bring your compulsions and obsessions. After you have identified the triggers, record the obsessions they provoke and the triggers you experience. Then first-rate the intensity of anxiety or fear you experienced in each satiation, then the mental strategies or the compulsions you used to ease your fears. For instance, if your fears come from contamination by germs, touching the wall of a community center hall might generate a fear intensity of 4, while touching the washroom floor in the community center may generate a fear intensity of 10 and in order to ease your anxiety, it may require 20 minutes of hand washing.
How does this help you? This will help you anticipate your urges by keeping a touch of your triggers. Additionally, you can ease these urges by anticipating them even before they arise. For instance, if your compulsive urges include checking if appliances are turned off, windows locked, or doors locked, you can try to turn off the appliances or lock the doors with extra attention the first time.
Learn to resist the compulsions
Although avoiding the triggers of your obsessive thoughts might seem to be the smartest choice, but truth be told, avoiding them only makes them feel scarier. Alternatively, by exposing yourself to the situations that trigger your compulsions, it may help in resisting the urges. These are part of a psychotherapy treatment known as Exposure and Response Prevention.
This psychotherapy treatment requires you to expose yourself repeatedly to the situations that trigger your obsessions. Afterward, you try to abstain from the compulsive deeds you’d usually complete to ease your anxiety. For instance, if you are a compulsive hand-washer, it would mean that you should touch the doorknob of a public washroom and then refrain from washing your hands. As you refrain from washing your hands, the urge slowly fades away on its own.
For many, these might seem like a task that is almost next to impossible; however, if you begin with minor fears and work your way up, it will be much easier. By facing lesser fears, and also conquering the anxiety, moving to the more difficult exposure challenges will be much easier.
How do I achieve these?
Moving from lesser fears to more difficult challenges can be achieved by building a fear ladder. How do I come up with a fear ladder? All you need is to think about the end result that you want, then break down it into steps needed in order to reach that desired outcome. Remember the list you recorded on the triggers? Use that record to compile a list of situations from the lesser fears to the scariest ones.
How to use the fear ladder?
- Work your way up the ladder
By starting with the less scary fears, make sure you do not move to the next step until you feel you can tolerate your anxiety. It is advisable to stay in the situation until you are comfortable with it. These are because the more you are exposed to the triggers of your obsessions, the more you get comfortable with them; hence you are less anxious the next time you face them. After you have repeatedly exposed yourself to the same trigger on different occasions, and you find it less anxious, you can progress to the next step. It is important to note that you can also break the steps into smaller steps if there are hard, or alternatively, you can try moving slower.
- Focus on the anxiety feelings
As you try to resist your compulsions, instead of distracting yourself, you should allow the anxiety feeling, which will help you resist your obsessions. Although you may feel the urge to give in to the compulsions if you stick to it, the anxiety will gradually go away. These will also make you feel that you are in control and that nothing will happen if you do not give in.
In order to progress quicker, it is essential to practice more often. However, it not good to rush, but rather you should progress with the pace that does not overwhelm you. Additionally, you should not forget that as you face your fears, you will still feel anxious and uncomfortable, but it is also important to remember that the feeling is temporary. As you progress, you will realize that the more you are exposed to these triggers, the more your anxiety lessens.
- Challenge the obsessive thoughts
From time to time, each person has worries or troubling thoughts. However, OCD causes the brain to focus on a particular anxiety-aggravating thought which repeatedly plays in your head. The more distressing or unpleasant the thought is, the more you will likely try to curb it. However, it is close to impossible to try and repress the thought. Usually, if you try to repress the thought, it is most likely that you will have the opposite effect, which will make the thought more bothersome. The unpleasant, though, will also resurface more frequently.
Similar to resisting compulsions, Exposure and Response Prevention therapy can help you overcome obsessive and disturbing thoughts by learning to tolerate them. Do not beat yourself up; having unpleasant thoughts does not necessarily make you a bad person. Remember that even intrusive, violent, or unwanted thoughts are normal and what makes them damaging obsessions is the importance you attach to them. Below are some strategies to help you regain control over your anxieties;
- Noting down your obsessive thoughts
By either typing in your smartphone or writing on a pad using a pencil, noting down your obsessive thoughts is important. Immediately you start obsessing, note down all the compulsions or thoughts.
• Even if you are repeating the same urges or the same phrases over and over, it is essential to record what you think as the obsessive compulsive disorder urges continue.
• When you keep on writing down all your thoughts, it will help you understand and see how monotonous your thoughts are.
• It helps in loosening the power of the urge by writing down the same urge or phrase over and over again.
• Recording your thoughts will help in getting rid of the obsessive thoughts as writing down all of your thoughts is much difficult than thinking them.
- Create your own compulsion-compulsions disorder worry period
Instead of always trying to repress your compulsions or obsessions, sometimes try rescheduling them. How is this possible?
• On each day, create one or two, ten-minutes periods devote to obsessing.
• Only during these periods are you supposed to focus on the negative urges or thoughts. These periods are for only negative thoughts, and you should not try to correct them. After the allocated time for the worry period has ended, get rid of the obsessive thoughts, take a few deep breathes, and go back to your normal routines. Additionally, after the worry period is over, the rest of the day should be free of obsessions.
• In case the obsessive thoughts come to your head at any other time, other than the worry period, you should note the down and reschedule them to your worry time.
- Challenge your obsessive thoughts
The worry period should also be used to challenge the intrusive or negative thoughts by constantly asking yourself;
• What is available proof there to show that the thought is true? Is there any chance that I may have confused this thought with a fact?
• Could there be a more realistic or positive way to view this satiation?
• Will, what am scared actually happen? If it may happen, what is the probability of it happening? What are the possible outcomes if there is a low probability?
• Is really this thought helpful? How will obsess about this thought hurt me, and how will it help me?
• If a friend had a similar thought, what would I say to them?
- Record a tape of your intrusive thoughts or OCD obsessions
Ensure your focus is on a specific obsession or thought, then record it using a smartphone or tape recorder.
• Make sure you exactly recount every obsessive sentence, story, or phrase as it comes in your minds.
• For around 45 minutes every day, playback the tape for yourself over and over until you suppress the obsessions.
• Continuously confront your obsessions or worries will gradually lower the anxiety. Then you can recap the exercise for other obsessions.
- Reach out for support
Sometimes, obsessive-compulsion disorder can get worse, and when this happens, and you feel alone and powerless, it is essential for you to have a strong support system. To avoid feeling so vulnerable, you need to be connected to other people. Additionally, talking to other understanding people about your urges and worries, it makes it easier to deal with.
• Make sure you are connected to friends and family.
• Alternatively, you can join an obsessive compulsive disorder support forum or group.
- Manage stress
Although OCD is not caused by stress, it can make it worse or trigger symptoms. Some effective ways to stay calm and stress-free include face to face connection with other people and physical exercise. Other ways include;
Practicing relaxation techniques such as yoga, mindful meditation, and deep breathing.
Making use of your physical sense, including smell, sight, touch, taste, or hearing.
- To ease OCD make lifestyle changes
If you want to keep OCD fears, worries, and compulsions at bay, try living a balanced and healthy lifestyle. A healthy lifestyle also helps in easing anxiety. Other lifestyle changes should include;
• Avoiding nicotine and alcohol. Although alcohol temporarily reduces worry and anxiety, as it wears off, it actually causes anxiety. Similarly, smoking leads to not lower, but higher levels of anxiety as nicotine is actually a very powerful stimulant.
• Getting enough sleep.
• Exercising regularly.