“I think I might have a little OCD. I am pretty sure that my spouse has OCD, they are always cleaning. My neighbor has major OCD, they mow their lawn three times a week.” These are common statements and observations that you and I may have made or heard. But what is OCD? What are the signs of Obsessive Compulsive Disorder?
This article tries to answer those questions. What follows is information provided by the National Alliance of Mental Health and the American Psychiatric Association explaining the overview, symptoms, causes, diagnosis, treatment, and other related disorders.
Signs of Obsessive Compulsive Disorder (OCD)
Obsessive-compulsive disorder (OCD) is a disorder in which people have recurring, unwanted thoughts, ideas, or sensations (obsessions) that make them feel driven to do something repetitively (compulsions). Repetitive behaviors, such as hand washing, checking on things, or cleaning, can significantly interfere with a person’s daily activities and social interactions.
Many people who have OCD know or suspect that their obsessions are not realistic; others may think they could be based on truth (known as limited insight). Even if they know their obsessions are not realistic, people with OCD have difficulty disengaging from the obsessive thoughts or stopping the compulsive actions.
A diagnosis of OCD requires the presence of obsessions and/or compulsions that are time-consuming (more than one hour a day), cause significant distress, and impair work or social functioning. OCD affects 2-3% of people in the United States, and among adults, slightly more women than men are affected. OCD often begins in childhood, adolescence, or early adulthood; the average age symptoms appear is nineteen years old.
Obsessions are recurrent and persistent thoughts, impulses, or images that cause distressing emotions such as anxiety or disgust. Many people with OCD recognize that the thoughts, impulses, or images are a product of their mind and are excessive or unreasonable.
However, the distress caused by these intrusive thoughts cannot be resolved by logic or reasoning. Most people with OCD try to ease the distress of the obsessions with compulsions, ignore or suppress the obsessions, or distract themselves with other activities.
- Fear of getting contaminated by people or the environment
- Disturbing sexual thoughts or images
- Fear of blurting out obscenities or insults
- Extreme concern with order, symmetry, or precision
- Recurrent intrusive thoughts of sounds, images, words, or numbers
- Fear of losing or discarding something important
Compulsions are repetitive behaviors or mental acts that a person feels driven to perform in response to an obsession. The behaviors typically prevent or reduce a person’s distress related to an obsession.
Compulsions may be excessive responses that are directly related to an obsession (such as excessive hand washing due to the fear of contamination) or actions that are completely unrelated to the obsession. In the most severe cases, a constant repetition of rituals may fill the day, making a normal routine impossible.
- Excessive or ritualized hand washing, showering, brushing teeth, or toileting
- Repeated cleaning of household objects
- Ordering or arranging things in a particular way
- Repeatedly checking locks, switches, or appliances
- Constantly seeking approval or reassurance
- Repeated counting to a certain number
The exact cause of Obsessive-Compulsive Disorder is unknown, but researchers believe that activity in several portions of the brain is responsible. More specifically, these areas of the brain may not respond normally to serotonin, a chemical that some nerve cells use to communicate with each other.
Genetics are thought to be particularly important. If you, your parent, or a sibling, have obsessive-compulsive disorder, there’s around a 25% chance that another immediate family member will have it.
DiagnosisA doctor or mental health care professional will make a diagnosis of OCD. A general physical with blood tests is recommended to make sure the symptoms are not caused by illicit drugs, medications, another mental illness, or by a general medical condition. The sudden appearance of symptoms in children or older people merits a thorough medical evaluation to ensure that another illness is not causing these symptoms.
To be diagnosed with OCD, a person must have:
- Obsessions, compulsions, or both
- Obsessions or compulsions that are upsetting and cause difficulty with work, relationships, other parts of life and typically last for at least an hour each day
Treatment for Signs of Obsessive Compulsive Disorder
A typical treatment plan for signs of Obsessive Compulsive Disorder will often include both psychotherapy and medications, and combined treatment is usually best.
Medication: A class of medications known as selective serotonin reuptake inhibitors (SSRIs), typically used to treat depression, can also be effective in the treatment of OCD. The SSRI dosage used to treat OCD is commonly higher than that used to treat depression. Patients who do not respond to one SSRI medication sometimes respond to another.
Other psychiatric medications can also be effective. Noticeable benefit usually takes six to twelve weeks. Patients with mild to moderate OCD symptoms are typically treated with either CBT or medication depending on patient preference, the patient’s cognitive abilities and level of insight, the presence or absence of associated psychiatric conditions, and treatment availability. It is recommended that patients with severe OCD symptoms receive both CBT and medication.
Psychotherapy: In particular, Cognitive-Behavior Therapy (CBT) and exposure and response therapy (ERT) are effective for many people. Exposure-response prevention therapy helps a person tolerate the anxiety associated with obsessive thoughts while not acting out a compulsion to reduce that anxiety. Over time, this leads to less anxiety and more self-mastery.
There are related conditions that share some characteristics with OCD but are considered separate conditions.
Body Dysmorphic Disorder This disorder is characterized by an obsession with physical appearance. Unlike simple vanity, BDD is characterized by obsessing over one’s appearance and body image, often for many hours a day. Any perceived flaws cause significant distress and ultimately impede the person’s ability to function.
In some extreme cases, BDD can lead to bodily injury either due to infection because of skin picking, excessive exercise, or from having unnecessary surgical procedures to change one’s appearance.
This disorder is defined by the drive to collect a large amount of useless or valueless items, coupled with extreme distress at the idea of throwing anything away. Over time, this situation can make a space unhealthy or dangerous to be in.
Hoarding disorder can negatively affect someone emotionally, physically, socially, and financially, and often leads to distress and disability. Besides, many hoarders cannot see that their actions are potentially harmful, and so may resist diagnosis or treatment.
Many people develop unhealthy habits such as nail-biting or teeth grinding, especially during periods of high stress. Trichotillomania, however, is the compulsive urge to pull out (and possibly eat) your own hair, including eyelashes and eyebrows. Some people may consciously pull out their hair, while others may not even be aware that they are doing it.
Trichotillomania can create serious injuries, such as repetitive motion injury in the arm or hand, or, if the hair is repeatedly swallowed, the formation of hairballs in the stomach, which can be life-threatening if left untreated. A similar illness is excoriation disorder, which is the compulsive urge to scratch or pick at the skin.
I hope that you found this information helpful and can sort through the questions you may have about yourself, a loved one, or the neighbor mowing his lawn. OCD is a complicated disorder and if you are struggling with what you believe are signs of Obsessive Compulsive Disorder, please do not hesitate to begin the journey of asking for help. I would be more than happy to walk beside you on your path to wellness.
Obsessive-compulsive Disorder | NAMI: National Alliance on Mental Illness. (2020). National Alliance of Mental Health. https://www.nami.org/About-Mental-Illness/Mental-Health-Conditions/Obsessive-compulsive-Disorder/Treatment
American Psychiatric Association, Hector Colon-Rivera, M.D., CMRO, Molly Howland, M.D. (2020). What Is Obsessive-Compulsive Disorder? Web Starter Kit. https://www.psychiatry.org/patients-families/ocd/what-is-obsessive-compulsive-disorder
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