Obsessive Compulsive Disorder (OCD)

Obsessive Compulsive Disorder (OCD) is made up of two parts the ‘obsession’ and the ‘compulsion’. The obsession can vary in its form, but is persistent, intrusive, unwanted thoughts, images or impulses (urges). Obsessions are recognized by the person who performs them to be irrational, senseless, intrusive or inappropriate, but they are not able to control them.

The compulsion side of the illness is the repeated behaviours, which the person performs in order to reduce the anxiety associated with the obsession. These activities vary from person to person, but some common compulsions including: counting, touching, washing and checking.

Obsessions and compulsions can range in intensity to the point where they interfere with daily functioning and can cause the individual, and those around them, a great deal of distress.

Obsession and compulsions are sometimes mistaken for psychotic behaviours, but they are completely different. Someone experiencing OCD is aware that the thoughts they are having are their own, and the actions they are performing have a reason that they are being done.

What may have started as a tiny concern, suddenly feels like it has snowballed out of control.

 

Who Is At Risk For OCD?

OCD often begins in adolescence or early adulthood, although it can start in childhood. There are strong links between genetics and OCD, which means that individuals with a first degree relative with the disorder have a higher rate of developing it.
 

What Causes OCD?

The cause of OCD is still being investigated, however researchers currently feel that both genetic and environmental factors may play a role.  While genetics is important some young people develop OCD without any known family history.  A rare form of OCD can begin after a bacterial infection.  Research studies have found evidence  of disregulation in different parts of the brain including the orbital frontal cortex, cingulate cortex and caudate nucleus of the basal ganglia (in charge of self regulation, control), in people who have OCD.

 

How Do You Know If Someone You Love Has OCD?

A person experiencing OCD will have significant symptoms either associated with obsessions, compulsions or both. These symptoms are severe enough to cause marked distress, are time consuming (take up more than one hour per day) and significantly interfere with a person’s normal activities (work, school, social, family, etc).

Obsessions (Cognitive Component)
• Recurrent and persistent thoughts, impulses or images that are experienced as intrusive and not appropriate and cause significant distress or anxiety.
• These symptoms can not be simply excessive worries about everyday life
• The person with these symptoms tries to suppress or ignore them.
• The person may try to neutralize, decrease or suppress the thoughts with some thought or action.
• The person knows that the thoughts are coming from his/her own mind.

Compulsions (Behavioural Component)
• Repetitive behaviours (such as checking, washing, ordering) or mental acts (such as counting, praying, repeating words silently) that the person feels driven to perform in response to an obsession or according to rigid rules
• These repetitive behaviours can only be resisted with great difficulty
• Rituals are often performed in private because the individual thinks that no one will understand them or their actions
• If a person does not perform the compulsive act, they may experience tremendous anxiety and perhaps a panic attack
• These behaviours or mental acts are aimed at preventing or reducing distress or preventing some dreaded event or situation BUT are not realistically connected to the obsessions that they are meant to neutralize.

What Are Some Examples of OCD?

While obsessions and compulsions vary from person to person, some common pairings include:

OBSESSIONS
Contamination: a person may be obsessed with germs or dirt and have beliefs that doing certain things (shaking someone's hand) will give them a disease
Doubt: A person may be filled with doubt and persistently wonder whether they have done something or not (i.e.. left the stove on)
Exactness and Order: A person may require that things be organized in very particular ways or according to unusual rules.
Aggressive thoughts: fear of harming self or others.
Sex: a person may have persistent thoughts of performing sexual acts that are repugnant to him or her.
Violence: a person may experience repeated violent thoughts towards love ones or see repeated gruesome images that they cannot get out of their mind.


COMPULSIONS
Washing: repeatedly washing hands, cleaning house, bathing
Checking: repeatedly checking to ensure the doors are locked, stove is turned off
Ordering : repeatedly putting thins in a particular order or symmetry, putting things in their place
Mental rituals: praying, counting to a number, repeating words until everything is ok
Hoarding: excessive gathering of possessions (and failure to use or discard them), even if the items are worthless, hazardous, or unsanitary

Performing the compulsion action often provides a brief sense of relief. However, this performing of the actions can actually strengthen the OCD thoughts encouraging them to return. The more someone does the compulsions the stronger the compulsions become.

What is the difference between Obsessive Compulsive Disorder (OCD) and Obsessive Compulsive Personality Disorder?

OCD should not be confused with obsessive-compulsive personality disorder even though the two disorders have similar names. Obsessive-compulsive personality disorder is not characterized by the presence of obsessions and compulsions; rather, it is a lifelong pattern of insistence on control, orderliness, and perfection that begins no later than the early adult years. It is possible, however, for a person to have both disorders.

 

How Do You Differentiate between OCD and Psychosis?

In general, patients with OCD have insight into the senselessness of their thoughts and actions and often try to hide their symptoms. This distinguishes OCD from psychotic disorders such as schizophrenia, because those patients lack the insight into the senseless nature of their symptoms.

What Can You Do?

If you suspect someone in your life has OCD, you can help them to identify their obsessions and compulsions by asking them some questions such as:
• Are you having thoughts that are coming 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?
• Please 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?

As a parent, friend, sibling or love one, you can help this individual by educating yourself on OCD, supporting them, and not encouraging their rituals or agreeing with them about their obsessions.

 

Someone in Your Life is Diagnosed With OCD, Now What?

• 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 rituals.

Statistics

• about 2 - 3 % of people experience OCD and is common in all gender and racial groups

What Treatment Options Exist?

• Medication: SSRI's (Serotonin Specific Reuptake Inhibitors such as Fluoxetine)
• Cognitive Behavioural Therapy: This therapy works with patients to ‘unlearn’ their mistaken beliefs and change their patterns of thought. It eliminates association with thoughts and discontinues compulsive behaviours.
• Behavioural Therapy: This therapy technique helps the patient confront their fear and reduce anxiety without performing avoidance/ritual behaviours.
• Group Therapy: meeting with other individuals to share and support each other
 

 

Other Types of Mental Disorders That May Commonly Occur Alongside OCD Include:

Depression
• Other Anxiety Disorders such as: PTSD, Social Anxiety or Panic Disorder

Resources for Teens and Families

•  Teen Brain
•  Teen Behaviour
•  Evidence Based Medicine

Other Helpful Resources

Centre for Addiction and Mental Health 
Kids Health
OCD Ottawa

 


 

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