Author: Keeley Joyce
WHAT IS OCD?
Obsessive-Compulsive Disorder (OCD) is a disorder in which a person experience’s intrusive and uncontrollable thoughts referred to as obsessions and/or an urge to partake in a repetitive behaviour referred to as compulsions. People without OCD often have distressing thoughts or engage in repetitive behaviours, although for people with OCD these thoughts and behaviours disrupt daily functioning. OCD can center around certain themes, for example, an individual’s fear of being contaminated by germs (i.e., an obsession), and to decrease the stress and fear of this idea, they constantly participate in behaviours that they believe will prevent the fear, such as washing their hands excessively (i.e., a compulsion). OCD usually begins in teenage or young adult years and can change in severity throughout life, although it can start in childhood. The type of obsessions and/or compulsions one experiences can change over time. OCD Symptoms tend to get worse when an individual is experiencing large amounts of stress.
OCD usually contains both obsessions and compulsions simultaneously, although some individuals may only experience one of them.
Obsessions are unwanted thoughts and fears that are loud persistent and repetitive. These thoughts are intrusive or disturbing images that evoke stress and anxiety.
Examples for Obsession symptoms:
- Fear of contamination: touching objects others have touched
- Doubting and trouble accepting uncertainty: questioning if the door has been locked or stove turned off
- Extreme concern with order, symmetry, or precision: severe stress when objects are not in order or in a particular format
- Disturbing thoughts or images about hurting oneself or others
Compulsions are behaviours an individual may feel necessary to perform to combat the obsessions. These compulsions are done in an effort to ease anxiety surrounding obsessive thoughts.
Symptoms may include:
- excessive hand washing
- cleaning household items
- arranging or rearranging objects in a specific order
- constantly checking locks or appliances
- silently repeating numbers, phrases, or words
People with OCD often have extensive rituals for them to cope with obsessions and attempt to move on thinking about something else. For example, someone with OCD may not be able to sleep or have trouble relaxing because they cannot stop wondering if the door is locked even though they have already checked it, so they have a routine to check the door 5 times every night to ensure that it is locked.
Some other conditions closely related to OCD include Body Dysmorphia Disorder (BDD) and Trichotillomania (hair-pulling disorder). BBD often can be misdiagnosed as OCD. Similar to OCD, people with BDD experience recurring obsessions that are distressing and uncontrollable. These obsessions are about perceived flaws in their appearance. BDD also involves behaviours that resemble compulsions such as constantly looking in the mirror to monitor their self-image. Although similar, the difference between OCD and BDD is that symptoms of BDD are specific to one’s body image or appearance rather than the common themes noticed in OCD (contamination, symmetry, violence, etc.)
People with OCD may also have other disorders such as Hair pulling disorder (trichotillomania). A disorder that involves recurrent urges to pull out hair from the scalp, eyebrows, or other areas. Individuals may use hair pulling to cope with negative or uncomfortable feelings. Hair pulling can give individuals a sense of relief and satisfaction when dealing with intrusive or disabling thoughts.
how is OCD diagnosed?
Sometimes the diagnosis of OCD can be challenging because symptoms that are experienced often are noticed in other disorders such as anxiety disorder, depression, or other mental health disorders. The process of diagnosis starts off with a psychological evaluation which includes determining the individual’s thoughts, feelings, and behaviours to identify if the symptoms have interference with daily functioning. Criteria in the Diagnostic and Statistical Manual of Mental Health Disorders (DSM-5) published by the American Psychiatric Association may also be used for diagnosis. In addition, a physical exam can also be done to rule out any other problems or other complications that could be causing OCD like symptoms (i.e., neurological problems, traumatic brain injuries).
Exposure and Response Prevention (ERP), a type of Cognitive behavioral therapy (CBT) is an effective treatment method for OCD. During a typical session, the individual will be exposed to the feared thoughts or images that they obsess over and are guided to not partake in their usual compulsions that decrease their anxiety. By experiencing what they fear without the result of anything bad happing, the individual gradually learns that the intrusive thoughts will not result in the fear happening in the absence of compulsions.
Depending on the severity, medications can be prescribed to help with obsessions and compulsions.
Research shows the most effective medication for higher severity OCD are Serotonin reuptake inhibitors (SRI), which also can be prescribed as an anti-depressant.