O bsessive-Compulsive Disorder (OCD) consists of two parts: the ‘obsession’ and the ‘compulsion’. Obsessions are persistent, intrusive and unwanted thoughts, images or impulses (urges). Someone with OCD usually knows that that their obsessions are irrational, senseless, or inappropriate, but they are not able to control them. This causes very high degrees of anxiety.
Compulsions are repeated behaviours that the person performs in order to decrease the anxiety caused by the obsession. These activities vary from person to person. Some common compulsions include: counting, touching, washing and checking.
Obsessions tend to be thoughts, whereas compulsions are usually behaviours. Some compulsions can also be done as thoughts – such as counting. They can vary in intensity but for a diagnosis of Obsessive-Compulsive Disorder, the obsessions and compulsions must significantly interfere with the person’s ability to live their life and cause a great deal of distress.
Obsessions and compulsions are sometimes confused with psychosis, which is incorrect. People with OCD are aware that the thoughts they are having are their own, whereas someone experiencing a delusion or hallucination (symptoms of psychosis) will think that the thoughts they are having are coming from someone or somewhere else. Obsessive-Compulsive Disorder is also not the same thing as being a perfectionist or having anxiety-decreasing rituals (like baseball players do during championship games). It is also usual and normal for people to check things to make sure all is okay (such as checking to make sure the door is locked or the stove is off).
In a 12-month period, about 1 percent of the population will have OCD. It often begins in adolescence or early adulthood, although it can start in childhood. The disorder is often more severe and persistent if it begins in childhood, although approximately 40% of people with childhood-onset OCD will recover by the time they are adults.
Research studies have found irregularities in the brains of people with OCD, specifically in the parts of the brain that handle regulation and control (the orbital frontal cortex, cingulate cortex, and caudate nucleus of the basal ganglia). We don’t know exactly what causes these brain irregularities yet but we do know that both genetic and environmental factors may play a role. People who have an immediate family member (sibling, parent, or child) with the disorder have a higher rate of developing OCD themselves. Although genetics are important, some young people develop OCD without any known family history of the disorder and in some rare cases, OCD can begin after a bacterial infection.
Obsessive-Compulsive Disorder, and other mental disorders, should only be diagnosed by a medical doctor, clinical psychologist, or other trained health provider who has spent time with the person and has conducted a proper mental health assessment. Diagnoses are complicated with many nuances. Please do not attempt to diagnose someone based on the symptoms you read in magazines or on the internet. If you are concerned, speak to a trained health professional.
Someone with OCD will experience obsessions, compulsions, or both. These obsessions and compulsions are severe enough to cause considerable distress, are time consuming (take up more than one hour per day), and significantly interfere with the person’s normal activities (school, work, social life, family, etc). Although some people with OCD realize that their obsessions and compulsions don’t make logical sense, some people may not – especially if they’re young.
Obsessions
Obsessions are recurrent, persistent, intrusive, and inappropriate thoughts, impulses or images that cause significant distress or anxiety. They are not just excessive worries about everyday life and they may or may not be a realistic concern. Some common obsessions include:
- Contamination: Obsession about being in contact with germs (e.g., by shaking hands, touching a doorknob/keyboard, etc.), leading to intense anxiety about disease/death resulting from those germs
- Doubts: Obsession about whether or not some action was performed (e.g., door was locked; oven was turned off), leading to intense anxiety about the disastrous consequences if the action wasn’t done (e.g., house will be burgled; house will catch fire and someone will die).
- Exactness and Order: Obsession about having things in a particular order (e.g., pencils perfectly lined up; morning routine followed in precise order), leading to intense anxiety about devastating and usually unrelated outcomes (e.g., their grandmother will die; the school will burn down; they will fail an exam) when things are moved, are not placed in a specific way, or are generally disordered.
- Violence/Aggression: Obsession about impulses to commit a violent, aggressive, or horrible action (e.g., to hurt someone; to swear loudly in class), leading to intense anxiety about what would happen if this impulse cannot be controlled and they were to act on the impulse.
- Sex: Obsessions about performing a particular sexual act that the person finds repulsive.
Compulsions
Compulsions are persistent, excessive, repetitive behaviours (such as checking, washing, ordering) mental acts (such as counting, praying, repeating words silently), or rituals that someone feels driven to perform in response to an obsession or according to a rigid set of rules they have created to ease anxiety. The purpose of compulsions is to prevent distress or prevent a dreaded event or situation; however the compulsions often appear unrelated or unrealistically connected to the obsessions they are meant to address. Because the individual often believes that others will not understand, rituals are often performed in private.
Compulsions are very difficult to resist and if the person is not able to perform the compulsion, they will likely feel very anxious. Performing the compulsion often provides a brief sense of relief. Unfortunately, performing a compulsion can also strengthen the obsessive thoughts, encouraging them to return. The more frequently someone performs the compulsions, the stronger the compulsions become.
Some common compulsions include:
- Washing: Repeatedly washing or cleaning, often of the hands. This compulsion is often related to contamination obsessions.
- Checking: Repeatedly checking to make sure a task was performed, such as locking the door or turning off the oven. This compulsion is often related to obsessions about doubts.
- Ordering: Repeatedly putting things in a particular order or requiring that things have a certain symmetry. This compulsion is often related to obsessions about order and control.
- Counting: Repeatedly counting things to reduce anxiety (e.g., floor tiles, cars in the parking lot, numbers in general). This compulsion may be related to obsessions about violence or other horrific thoughts. The individual may believe that if they count all of the items or count to a predetermined number for every thought, it will prevent the obsession from coming true.
- Repeating Actions: Repeatedly performing a specific behaviour in order to counteract the obsession. For example, a person who has obsessions about doing something inappropriate in school may tap their desk repeatedly in an attempt to prevent the obsession from coming true.
- Asking for Reassurance: Repeatedly asking others for reassurance that everything is okay or that they performed some task (e.g., turning off the oven). This compulsion often accompanies obsessions about doubts.
In accordance with the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition.
Remember, you cannot diagnose someone with Obsessive-Compulsive Disorder without a proper mental health assessment conducted by a properly trained health provider.
- Encourage the person to seek help (or take them to a trained health professional yourself, if appropriate).
- Ask the person a few questions to get a better sense of what is going on:
- Do you have thoughts come into your mind that you do not want to be there?
- Do these thoughts make you feel uncomfortable, anxious or upset?
- Do you think these thoughts are true?
- What do these thoughts stop you from doing that you would otherwise be doing?
- Can you describe the things you are doing that are causing distress to you or other people?
- Can you tell me why you are doing those things?
- What do you think will happen if you do not do these things?
- How much time do you spend doing these rituals?
OCD should not be confused with Obsessive-Compulsive Personality Disorder, in spite of their similar names. Someone with Obsessive-Compulsive Personality Disorder does not have obsessions and compulsions; rather, they have a rigid way of interacting with the world that insists on control, orderliness, and perfection. It is possible for a person to have both OCD and Obsessive-Compulsive Personality Disorder.
People with OCD usually realize that their obsessive thoughts and compulsive actions don’t make sense to anyone else. Consequently, they often try to hide their symptoms. This and other features distinguish OCD from psychotic disorders such as Schizophrenia. People experiencing psychosis lack insight into the senseless nature of their symptoms; they often do not understand that what they are experiencing is unusual, problematic, or concerning. Someone with OCD recognizes that the obsessions are their own thoughts. Obsessions are not the same thing as hearing voices.
If someone in your life has been diagnosed with OCD, here’s what you can do:
- Be well-informed. Learn about OCD and the treatment options available. Read books, trusted websites (like this one!), and discuss any concerns or questions with a health care provider. Check out Evidence Based Medicine for information on how to critically evaluate the information you read and Communicating With Your Health Care Provider for a list of questions to ask your health care provider.
- Encourage the person to seek help from their family doctor. Obsessive-Compulsive Disorder is treatable.
- Listen. Listen to their thoughts, worries and problems. Be supportive but ultimately be helpful by not enabling or supporting negative thoughts.
- Give positive feedback. Notice when the person is doing a good job. Praising them in situations that you know make them nervous will help boost confidence and reduce avoidance behaviours.
- Don’t judge. Judging the person could make them withdraw from sharing their emotions. Not having someone to turn to could make them feel alone and make their symptoms worse.
- It is important to accept the perceptions and emotions of the person as genuine and valid. Even if their fears don’t make sense to you, the anxiety is very real.
- Help the person learn time management skills. Planning out your time and understanding what you have to do and how long you have to do it can help keep you from feeling overwhelmed.
- Pay close attention to the person’s behaviour. Some people with OCD may develop Clinical Depression and be at risk for suicide. Others may abuse alcohol or drugs in an effort to help control their symptoms. These problems can become quite serious and should be addressed by a health professional.
- Be supportive of the person but don’t encourage the obsessions or enable the compulsions. Remember that their anxiety is very real, even if their behaviour seems irrational to you.
- Sometimes individuals with severe OCD will try and involve others around them in their compulsions. Educate yourself about OCD and the importance of not participating in the OCD compulsions. Do not participate in, support, or encourage compulsions.
A variety of treatment options exist for OCD. Most often, OCD is best treated by a combination of CBT and medication. Symptom improvement can often take about 12-14 weeks before improvement is clearly visible. Determining which course of action is appropriate for each individual should be done with the guidance of a mental health professional who has special training in the diagnosis and treatment of OCD.
- Medication: SSRIs (Serotonin Specific Reuptake Inhibitors, such as Fluoxetine) are commonly prescribed to treat OCD. For more information on how to properly use medications, check out MedEd.
- Psychological Treatments: Psychotherapy or “talk therapy” works by helping your brain better control your thoughts and emotions. The type of psychotherapy that has been found to be most effective for treating OCD is called Cognitive Behavior Therapy (CBT). CBT helps people learn how to overcome their obsessions and compulsions by changing the way they think. It has several components, including Cognitive Restructuring (e.g., changing the way someone thinks about their fears), Exposure (e.g., gradually exposing the person to their obsessions), and Response Prevention (e.g., not allowing the person to act out their compulsions during Exposure, while teaching them effective strategies for coping with anxiety). Sometimes this therapy is provided in groups.
- School Supports: Sometimes certain adaptations can be made by the school to assist a student in coping with and managing their symptoms.
- Community Supports: Community supports can include peer support groups, support groups for families, and other helpful resources.
- Arousal Decreasing Techniques: Numerous techniques for decreasing physical arousal (that means: anxious feelings, rapid heart rate, rapid breathing) can help. These include: biofeedback, mindfulness, deep muscle relaxation, meditation, etc.
- Regular Routine: Maintaining a healthy, regular daily routine is very important for a person with OCD. For help maintaining the kind of healthy lifestyle that should accompany professional treatment for OCD, check out Taking Charge of Your Health.
It’s not uncommon for people to have more than one mental illness. Other common co-occurring disorders (also called comorbid disorders) include:
- Depression
- Bipolar Disorder
- Other Anxiety Disorders such as: Social Anxiety Disorder or Panic Disorder
