Obsessive-compulsive disorder is an aptly named and challenging condition that can incapacitate the ability of some sufferers to manage their day-to-day lives and interact socially, says Scott Bea, a clinical psychologist at the Cleveland Clinic’s Center for Behavioral Health. The chronic, long-lasting condition involves the experience of “intrusive, unwanted, anxiety-provoking thoughts, repetitive actions or thoughts to reduce anxiety, or both,” Bea says.
OCD affects millions of people in the U.S. and cuts across socioeconomic classes, according to the Anxiety and Depression Association of America. About 1.2% of adults in the U.S. suffer from OCD; that works out to more than 3 million people. Slightly more women than men are affected by OCD. However, boys are more commonly affected in childhood.
Signs of OCD
OCD symptoms vary among individuals, says Mayra Mendez, a licensed psychotherapist and program coordinator for intellectual and developmental disabilities and mental health services at Providence Saint John’s Child and Family Development Center in Santa Monica, California. OCD is defined by two basic types of symptoms, Mendez says: obsessions and compulsions. “Obsessions are defined as thoughts that persist and recur, experienced as intrusive and identified by the individual as unwanted thoughts,” she says. “Compulsions are behaviors enacted repetitively, persistent and rigidly.”
OCD symptoms fall into these categories:
- Persistent and repetitive worrisome thoughts.
- Fearful thoughts.
- Distressing anticipation.
- Irrational beliefs and negative anticipations.
- Worry that the thoughts are unwelcome, undesirable and intrusive.
- Feeling powerless to control the worry and negative anticipations.
- Inability to shift negative thoughts and worry.
- Self-doubt and distrust of thoughts and actions.
- Adherence to irrational self-imposed rules in attempt to manage anxiety.
- Ritualistic behaviors.
- Drive to do things over and over such as checking, fixing, ordering or cleaning.
- Doing tasks in a specific order, counting, needing to follow a strict organizational pattern.
- Repeating steps.
- Inability to prevent or stop repetitive behaviors despite a desire to do so.
These are common specific sources of obsessional distress associated with OCD, Bea says:
- Fears of contamination.
- Unwanted sexual obsessions.
- Excessive concern with right and wrong.
- Fears of harming one’s self and others.
- Fear of acquiring bed bugs.
Specific common compulsions of OCD include:
- Ritualized acts like excessive and repeated hand-washing.
- Excessive cleaning.
- Checking behaviors (inspecting the locks on doors and windows).
- Constantly asking for or demanding reassurance from relatives and health care professionals.
- Rearranging objects to put them in a specific order.
- Counting behaviors, such as counting letters, words or cars on the highway.
Causes of OCD
There’s no one cause of OCD, Mendez says. Some research suggests there’s a genetic component to the condition. “The disorder has a higher likelihood of manifesting if there are family/genetic links,” Mendez says. “The closer the link to immediate family members (parents, siblings), the greater the likelihood of symptom manifestations.” Research suggests that people who have anxiety and/or depression are at higher risk of presenting with OCD symptoms. Also, research indicates that people who have experienced trauma or abuse may show OCD traits, Mendez says. “In the case of trauma, OCD may develop as coping mechanisms, whether functional and adaptive or reactive,” she says. “The outcome is the same: to manage the stress and anxiety associated with the traumatic experience.”
OCD can only be diagnosed by a trained therapist, according to the International OCD Foundation. In evaluating a patient, a therapist would look for whether the patient:
- Has obsessions.
- Engages in compulsive behaviors.
- Whether the obsessions and compulsions consume a lot of time and interrupt important activities, like working, going to school or spending time with friends.
Treatments for OCD
There’s no cure for OCD, but there are treatments that can help you manage the symptoms. Here are the leading treatments for OCD:
1. Exposure therapy
Exposure therapy is a form of cognitive behavioral therapy, or talk therapy. It’s the “psychotherapy of choice for the treatment of OCD,” according to the ADAA. In this kind of therapy, patients who have OCD are placed in situations where they are gradually exposed to their obsessions. They’re asked to not act on the compulsions that would typically ease their anxiety and distress. This therapy is done at the patient’s pace. The therapy being with the patient describing all of his or her obsessions and compulsions. Together, the patient and therapist arrange them into a list. The therapist will ask the patient to develop a task that exposes him or her to that specific fear. For example, if the patient typically washes his or her hands immediately after touching a doorknob, the therapist would ask the person being treated to wait before washing. “Over time, this gradual exposure and delayed response will lead to fewer and less intense fears or obsessions about germs,” according to the ADAA. This type of therapy has proven “to be very effective for many patients, though it does induce a great deal of discomfort in a purposeful manner in the individuals suffering with OCD,” Mendez says. “This is done in order to help the patient get used to feeling uncomfortable without fixing their circumstance using excessive and interfering rituals. This allows the brain to recover on its own in a manner that is known to be quite lasting.”
2. Imaginal exposure
For patients who may be hesitant to try a real-life situation, imaginal exposure – which is also known as visualization – can be a useful way to transition to exposure therapy. With this treatment, the therapist helps create a scenario that may cause the patient anxiety. For example, if the patient fears walking down a hallway if the path diverts from his or her “perfect” pattern, the therapist could have the patient imagine walking in that divergent pattern for several minutes every day. The therapist would ask the patient to record his or her levels of anxiety during the exercise. Over time, the patient would become more familiar with his or her discomfort and more willing to engage in exposure therapy.
3. Habit reversal training
This therapy includes an array of techniques, including “awareness training, introduction of a competing response, social support, positive reinforcement” and often, relaxation techniques. For example, awareness training could consist of the patient practicing a habit or tic in front of a mirror, “focusing on the sensations of the body and specific muscles bore and while engaging in the behavior, and identifying and recording when the habit or tic occurs,” according to the ADAA. “These techniques increase awareness of how and when the urges develop, making it more likely that an individual will be able to intervene and make a change.” The patient and therapist work together to find ways to “ride out the urge” and prevent the tic.
4. Cognitive therapy
Cognitive therapy – a type of talk therapy – helps the patient understand that his or her brain is sending error messages. A therapist can help a person with OCD identify such messages and develop new ways to respond to control the patient’s obsessions and compulsions.