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Obsessive Compulsive Disorder: A Primer on the True Meaning of OCD

Modern day language throws around the term OCD to refer to anyone who obsesses on something or has perfectionist tendencies. This use of the term sadly diminishes the true nature of obsessive compulsive disorder.

Imagine you feel worried that you left the stove on or the front door unlocked, that there is a certain sense of danger. You go and check the stove, find that it is turned off, and the front door is indeed locked.

Then three minutes later, the same fear surfaces again and you repeat your behavior. You check the stove only to find that it is still off, and yes, the front door is still locked.

And then you repeat this behavior again just a few minutes later and proceed to repeat this behavior 20, 30, or 40 more times throughout the day.

You obsess over being unsafe or feeling the fear that you are in danger, and then have the compulsion to go and check the stove and front door over and over and over again.

This is the true nature of someone who suffers from an aspect of obsessive compulsive disorder (OCD). It is not merely someone intensely focused on an action, or someone who wants things to be perfect, but an individual who cannot control their thoughts and the resulting behaviors.

The Disease of Obsessions and Compulsions

People suffering from obsessive compulsive disorder may have symptoms of obsessions, compulsions or both. These symptoms can interfere with all aspects of life: personal relationships, work and school. It is a chronic, long-lasting disorder where the afflicted are desperately trying to distance themselves from paralyzing, unending anxiety.

Obsessions are impulses, images or thoughts that are recurring and feel outside the person’s control. Individuals who suffer from OCD find these thoughts disturbing and do not want to have them. Intense and uncomfortable feelings of fear, doubt, and disgust generally accompany obsessions. People who have OCD find that these obsessions steal their time and take them away from more important activities they value.

Some of the common obsessions in OCD are:

  • Contamination – environmental contaminants, household chemicals, dirt, body fluids, and germs
  • Losing Control – fear of impulsive behavior to harm oneself or others, fear of violent images, fear of blurting out obscenities
  • Harm – fear of harming others by not being careful, fear of being responsible for a terrible event
  • Perfectionism – concern with a need to know or remember, concern with evenness or exactness, fear of losing things
  • Unwanted Sexual Thoughts – perverse or forbidden sexual thoughts or images, obsessions about homosexuality, forbidden or perverse sexual impulses about others, aggressive sexual behavior towards others
  • Religious Obsessions – excessive concern about morality, concern with blasphemy or offending God

Compulsions are repetitive thoughts or behaviors that a person uses to make their obsessions go away – to neutralize or counteract them. Individuals with OCD understand that compulsive behaviors are only a temporary escape from obsessions, but they use them to decrease their distress or anxiety. These behaviors are time consuming and get in the way of more important activities.

Some of the common compulsions in OCD are:

  • Checking – checking that you will not or did not harm yourself or others, checking that you did not make a mistake, checking that nothing terrible happened
  • Washing and Cleaning – excessive showering, hand-washing, tooth-brushing, grooming or toilet routines; excessive cleaning of household items
  • Repeating – rereading, rewriting, repeating routine activities, repeating body movements
  • Mental Compulsions – praying to prevent harm, mental review of events to prevent harm to oneself or others

Generally speaking, not all rituals or habits are compulsions. However, an individual with OCD cannot, for the most part, control his thoughts or behaviors, even when they recognize it to be excessive. These individuals tend to spend at least one hour per day on these thoughts and behaviors and do not derive any pleasure when performing them. They are driven by the urge to repeat them over and over again.

The Cause of Obsessive Compulsive Disorder

While OCD is a common disorder that affects adults, adolescents and children worldwide, very little is known about the root causes of the disorder. Some risk factors have been pinpointed:

  • Genetics – family studies have shown that individuals with first-degree relatives (parent, sibling, child) who have OCD are at a much higher risk of developing OCD themselves.
  • Brain Functioning – new research has shown that individuals with OCD have differences in their brain structure, especially in the prefrontal cortex and the basal ganglia located deep at the center of the brain. These differences are thought to attribute to the brain’s inability to police thoughts and behaviors properly.
  • Environment – people who have experienced physical or sexual abuse in childhood or other significant trauma are at an increased risk for developing OCD.

Treatment of OCD

Obsessive compulsive disorder is typically treated with medication, psychotherapy or a combination of the two. While most patients with OCD respond positively to treatment, some will continue to experience symptoms.

The most common type of medication used to treat OCD is serotonin reuptake inhibitors (SRIs) and selective serotonin reuptake inhibitors (SSRIs), which help reduce the symptoms. SRIs often require higher daily doses in the treatment of OCD and may take 8-12 weeks to start working.

Psychotherapy can be very effective in the treatment of OCD. Certain types of therapy such as cognitive behavioral therapy (CBT) and related therapies like habit reversal training can be as effective as medication for some individuals. Research has shown that a type of CBT called Exposure and Response Prevention (EX/RP) is very effective in reducing compulsive behaviors for sufferers of OCD.