Obsessive-Compulsive Disorder (OCD)

Obsessive-compulsive disorder, also known as OCD, is a mental disorder that involves obsessive thoughts leading to compulsive acts. It is often characterized by intrusive, irrational and repetitive behavior.

What Is OCD?

Obsessive-compulsive disorder (OCD) is a mental health condition where the sufferer experiences either obsessive thoughts or compulsive behaviour or both. This mental illness results in chronic, unwanted and uncontrollable sensations and thoughts, identified as obsessions, and repetitive, irrational actions and behaviours, identified as compulsions. OCD can occur in individuals of all ages and from different backgrounds. In most cases, people with this condition are aware of their illogical obsessions and compulsions, yet they are usually unable to prevent themselves. This disorder is also associated with various functional impairments.

According to the experts at Minds Help, “people affected by OCD feel motivated and driven to engage in certain activities repetitively (i.e. compulsions) as they have unwanted & recurring, intrusive ideas, thoughts and sensations (i.e. obsessions).” Moreover, these intrusive thoughts and repetitive behaviours can also adversely affect their daily functioning, relationships and social lives. This mental disorder is related to anxiety disorder, tic disorder and even suicidal behaviours.

How OCD Affects Us?

Most people have certain thoughts or habits that they repeat at times. However, a person with OCD will have certain obsessive thoughts and compulsive habits that are uncontrollable, unenjoyable and adversely affect their daily life. Moreover, such thoughts and habits consume at least one hour on a daily basis further affecting their career, relationships and social life. Most of the time, the sufferer doesn’t want to indulge in such intrusive thoughts and actions as they don’t really enjoy them. Although they are usually aware that these urges are illogical and irrational, they are unable to control their need to engage and act on them.

Obsessions may include thinking or believing certain colours or numbers as being lucky or acceptable, while compulsions may include a strong urge to wash their hands a certain number of times after touching anything. In most cases, people with this disorder feel helpless as they generally don’t want to engage in these thoughts and behaviours. They are haunted by persistent thoughts of unwanted behaviours and not performing them causes significant psychological discomfort and distress. Trying to stop these thoughts and habits can even increase the levels of anxiety they experience. Hence, they feel compelled to give in to their obsessive thoughts and engaging in compulsive acts to experience temporary relief. 

People with OCD feel trapped in a dangerous cycle of compulsions, obsessions, anxiety and transient relief that revolves around chronic thoughts and ritualistic habits. Hence, they desperately avoid triggers or try to cope with their anxiety disorder through drugs and alcohol. Although it may seem that sufferers have no way out of their mental limitations, proper diagnosis and treatment can help them recover fully. 

Understanding Obsessions And Compulsions

To get a clear understanding of what OCD is, how it affects the patients and, most importantly, how it can be treated, we need to first understand what obsessions and compulsions actually mean. 

1. Obsessions

Obsessions refer to involuntary, persistent and reoccurring impulses, thoughts, urges and mental images that lead to feelings of anxiety and distress. Many sufferers understand that their obsessions are often unreasonable or extreme. However, they are unable to control these thoughts through sense, reasoning or logic. These intrusive thoughts may include:

• Excessive worrying about their own well being or their loved one’s
• Doubting about their relationships and worrying about infidelity
• Being constantly aware of bodily sensations
• Continually worrying about contamination
• Need for perfection and exactness
• Forbidden thoughts on religion or sex

Although many sufferers try to avoid or counter such thoughts with other actions, ignoring them can make obsessions more intense and harder to avoid. This is one of the reasons why people with OCD feel that their disturbing obsessions are uncontrollable. It can also result in negative emotions like doubt, distress, disgust and the need to do something immediately in a particular way. Obsessive thoughts and urges can consume a lot of time and affect their normal daily functioning. This is one of the crucial aspects of OCD as most normal people also have intrusive thoughts at times. However, people with this condition feel extremely anxious due to frequent obsessive thoughts and it greatly disrupts their day-to-day lives.

2. Compulsions

Compulsions are primarily a response to obsessions. These are repetitive habits, mental acts and behaviours that people with OCD feel compelled to perform. Such behaviours are often carried out with the objective of relieving stress, anxiety and distress. In many extreme cases, a person may feel the need to engage in compulsive rituals constantly and repeatedly. This can affect their normal daily activities and make them difficult to complete. Although performing compulsive habits and actions can result in short-term relief, the cycle begins again as the obsessions reignite. Generally, compulsions include:

• Doing something in a specific way and order for a particular number of times
• Constantly cleaning or washing hands due to fear of contamination
• Feeling a strong urge to repeatedly count things 
• Organizing and arranging items in a particular way
• Fear of touching things, like doors in public toilets
• Checking things repeatedly 
• Mental compulsions like praying or saying things silently

Compulsions may also involve avoiding certain situations that may trigger their obsessive thoughts and urges. However, not all repetitive rituals or habits can be considered compulsions. The context is an important factor. Most of us have certain bedtime or morning routines, religious practices and other activities that require repetitive practice on a regular basis. However, these actions do not disrupt our daily life. But when certain rituals affect the life of the sufferer in a negative way then it can be considered a compulsion.

Important Facts About Obsessive-Compulsive Disorder

According to the APA, around 1.2% of Americans are affected by this condition. Moreover, it is visible more in adult women in the U.S than in men. In fact, one study ¹ revealed that gender is a crucial factor in analyzing this condition.  A 2001 WHO report found that obsessive-compulsive disorder was one of the top 20 reasons for illness-related disability for individuals between 15 to 44-year-olds across the world. The report also found that it was the 4th most common mental health disorder. 

But it is not just limited to teenagers and adults, this disorder can also affect children ². About 1 in 100 American children and 1 in 40 adults in the U.S. are affected by it. Research even shows that about 30% of patients started experiencing the symptoms of this disorder during their childhood. Studies ³ have also revealed that OCD leads to occupational disability in adults. Around 33% of sufferers claim that OCD substantially affects their ability to perform their duties at work and leads to occupational disability.

OCD Vs OCPD

Although some people tend to confuse obsessive-compulsive disorder (OCD) and obsessive-compulsive personality disorder (OCPD) ⁴, these are distinct and separate mental disorders. OCD primarily includes obsessive thoughts and compulsive behaviours. However, OCPD is a personality disorder and refers to particular personality traits. This condition is characterized by a strong need for control, perfection and orderliness. As people with OCPD have an intense need to impose their thoughts, will and standards on other people and external situations, it can affect their lives and their interpersonal relationships.

People with OCD are often aware of their irrational obsessions and their need to perform compulsive behaviours for temporary relief from anxiety. But people with OCPD are mostly unaware of their personality issues and don’t consider their need for perfection and orderliness as a problem, even if it significantly affects their own well being.

Types Of OCD

There are different types of obsessive-compulsive disorder. However, majority of patients can be categorized under the 4 major types of OCD:

1. Checking
2. Contamination
3. Symmetry & ordering
4. Ruminations & intrusive thoughts

Let us take a quick look at each of these major categories of this mental disorder:

1. Checking

OCD patients feel an intense need to check certain things repeatedly to make sure they avoid accidents, harm, leakage or damage. It is common for sufferers to repeatedly check doors, locks, light switches, appliances etc. However, they can also have a tendency to check themselves and their loved ones for medical conditions as well. This sort of checking can occur innumerable times over and over again, even if the other person may have other important commitments. Checking can also include confirming the genuineness of their memory repeatedly like validating documents and photographs.

2. Contamination 

Contamination refers to feeling an intense need to wash and clean body parts or things due to a persistent fear that it might be dirty or contaminated. Patients are constantly worried that they or an item may get contaminated upon contact with a foreign object and become ill. Hence, they feel compelled to clean and wash things and themselves repeatedly.  In extreme cases, they may even avoid social gatherings or crowds out as they are afraid of contracting germs.

Mental contamination is another aspect of this OCD type where the sufferer feels unworthy or dirty after getting embarrassed or mistreated. The affected person may try to get rid of this “dirty” feeling by bathing and showering excessively and repeatedly.

3. Symmetry and orderliness

People with the obsessive-compulsive disorder feel a strong need to line up things in a specific way in order to avoid anxiety, distress and discomfort. They may decorate the table or adjust furniture or other items in the house in a symmetrical fashion so that everything is lined up straight. Excessive orderliness is one of the common signs of this condition.

4. Ruminations & intrusive thoughts

This refers to an obsession with a line of thought. Some of these thoughts might be violent or disturbing. These thoughts are often on wide-ranging philosophical themes like the meaning of life, the existence of God etc. However, sufferers can also pay focused attention to the causes & consequences of their problems, instead of thinking about probable solutions. While ruminating, patients often appear in profound thought and detached from their surroundings. But they are usually unable to reach any rewarding conclusion.

Intrusive thoughts ⁵ are usually obsessive, violent thoughts about hurting someone, mostly a loved one, either physically or sexually. As these thoughts are not usually deliberate or intentional, it can lead to severe anxiety & discomfort in the sufferer. Intrusive thoughts generally include thoughts about murder, suicide, relationships, superstitions and other horrific thoughts.

Apart from these, there are various other types of OCD like hoarding or the inability to get rid of useless materials. However, obsessions and compulsions can be generally categorized under these four major types of this disorder.

Symptoms Of OCD

Having obsessive thoughts or engaging in compulsive behaviors doesn’t necessarily mean that you have OCD. When you have this disorder, these obsessions and compulsions will consume at least one hour each day, cause excessive anxiety and distress and substantially affect your relationships and daily life. People with this condition often experience either obsessions or compulsions or both of them. 

Here are some of the most common symptoms of obsessive thoughts:

• Fear of contamination or contaminating others
• Fear of losing control
• Fear of harming oneself or others
• Fear of losing possessions or items
• Having intrusive, unwanted thoughts and images of sexual and violent nature
• Excessive focus on morality, blasphemy and religion
• Constantly worrying about orderliness and perfectionism
• Excessive attention on superstitious thoughts or luck
• Desperately avoiding trigger situations

Here are some of the most common symptoms of compulsive behaviours:

• Repeatedly checking things like doors, switches and locks
• Excessive concern about loved one’s health and well being
• Excessive washing and cleaning of self and objects
• Doing illogical activities like repeating certain phrases, tapping, counting etc
• Arranging things in a specific way
• Repeatedly performing a particular task for a certain number of times
• Excessively engaging in rituals or praying repeatedly
• Hoarding and collecting useless items like old newspapers

OCD Symptoms In Children

Obsessive-compulsive disorder can occur in children with onset observable in adolescents and young adults. Children with OCD ⁶ can have certain symptoms that can seem like other conditions like Tourette’s syndrome, autism or ADHD. However, such symptoms may also look like obsessive-compulsive disorder as well. So it is best to seek professional help for a psychological exam and proper diagnosis. Young adults are usually diagnosed by the age of 19 as earlier onset of the condition is observed more in males than females.

Causes Of OCD

Although adequate research ⁷ has been conducted on this mental condition, the actual causes of obsessive-compulsive disorder are still not known. However, it is believed that there are various factors that may lead to the development of OCD in an individual. Let’s take a look at some of the most common factors believed to cause this disorder.

1. Genetic factors

Genetic factors ⁸ play a prominent role in the development of this condition and is believed to be a familial disorder. Studies show that someone is highly likely to get affected if one of their immediate family members has OCD ⁹. In fact, a person is 25% more likely to develop the obsessive-compulsive disorder when they have a parent or sibling with this condition. As it runs in the family, it can affect generations of first-degree family members.

Moreover, twin studies conducted of adults reveal that symptoms of this familial disorder are likely to be inherited. In fact, with 27% to 47% ¹⁰variance in OCD symptoms score, genetics is a significant factor in the development of this condition. However, studies have not yet been able to identify any specific gene as the cause.

2. Autoimmune factors

Some cases of this disorder in children is believed to be a result of Group A streptococcal infections. These cases are generally referred to as Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcus infections (PANDAS) ¹¹. However, recently these cases are grouped and renamed as Pediatric Acute-onset Neuropsychiatric Syndrome (PANS) as other pathogens, like the H1N1 flu virus and Lyme disease, can also cause OCD in children. 

3. Neurological factors

By studying certain regions of the brain, researchers ¹² have discovered that the frontal cortex and subcortical structures of the brain are different in sufferers of this disorder when compared to normal people, according to the National Institute of Mental Health (NIMH). However, how such differences are associated with the development of OCD is still unknown.

A 2013 study ¹³ focused on the regional gray matter volume alterations of sufferers with autogenous and reactive obsessions. It revealed that reactive sufferers had a larger gray matter volume in the right Rolandic operculum when compared to autogenous patients. Moreover, chemical imbalances in the brain, especially glutamate and serotonin, can also be contributing factors in the development of this condition.

4. Behavioral factors

According to the behavioural theory ¹⁴, individuals with this condition associate negative emotions like anxiety and fear with certain situations or objects. In order to reduce these negative feelings, patients often perform certain compulsive rituals or avoid the feared objects and situations. When the relationship between fear, object and ritual is established, the individual desperately tries to avoid the situation or object of fear, instead of facing their fears or overcoming it.

This cycle of rituals, avoidance and fear generally begins during stressful life events (SLEs), like a breakup, unemployment, a major illness, hospitalization of a loved one etc. However, such events may not cause OCD directly, but it can certainly trigger this disorder. A 2012 study ¹⁵ found that 60.8% of patients among 200 respondents reported that the onset of OCD was preceded by at least one stressful life event.

5. Cognitive factors

According to the cognitive theory ¹⁶, people with obsessive-compulsive disorder often misinterpret and misconstrue their own obsessive thoughts ¹⁷. All though most of us have some unwanted intrusive thoughts at times, people with this condition provide unnecessary and excessive attention and importance to such thoughts, which in turn become exaggerated. As these intrusive thoughts are magnified and overemphasized, they are unable to get rid of it. Moreover, they consider such thoughts as a threat and respond to it accordingly, leading to intense anxiety and discomfort. Due to their misinterpretation of these thoughts as important and true, sufferers engage in avoidance and compulsive habits.

Read More About Cognitive Biases Here

6. Environmental factors

Researchers believe that environmental stressors can also act as a trigger and contribute towards the development of OCD in some people. Evidence shows that trauma exposure ¹⁸ is linked with negative psychological outcomes like anxiety and obsessive-compulsive symptoms. According to NIMH, childhood trauma can be a significant contributing factor in the development of obsessive-compulsive disorder symptoms.

One 2011 study ¹⁹ found that there is an indirect relationship between childhood trauma and OCD. The study discovered that childhood trauma is positively correlated with attachment avoidance, leading to alexithymia. In turn, Alexithymia is substantially linked with the number and severity of obsessive-compulsive disorder symptoms. Another 2002 study ²⁰ childhood trauma plays an important role in the development of this disorder. Moreover, a 2008 study ²¹ revealed that there is the interrelation between childhood trauma, personality traits and OCD. The researchers found that about 13-30% of the respondents had experienced physical & emotional abuse and neglect during their childhood. 

7. Other factors 

Obsessive-compulsive disorder can also develop due to the influence of other mental health conditions and disorders like –

• Anxiety disorders
• Depression
• body dysmorphic disorder (BDD)
• Tourette syndrome
• tic disorders
• substance abuse 
• Others

According to a 2010 study ²², different neuropsychiatric disorders, like anxiety and mood disorders can lead to the development of OCD. Moreover, traumatic brain injury (TBI) in children and adolescents can also increase the chances of onset of OCD. Studies ²³ have discovered that around 30% of children between 6-18 years of age developed obsessive-compulsive disorder symptoms within 12 months of a traumatic brain injury.

Read More About Major Depressive Disorder ( Depression ) Here

Diagnosis Of Obsessive-Compulsive Disorder 

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), an individual must experience obsessions, compulsions or both to be diagnosed with this condition. A proper medical diagnosis of OCD must be performed by a health professional like a psychiatrist, psychologist or licensed mental health professional. According to the American Psychiatric Association (APA), while diagnosing a patient with this mental disorder, a health professional may evaluate the following factors ²⁴:

• The patient has obsessions
• They engage in compulsive behaviors, habits and rituals
• The obsessions and compulsions consume at least 1 hour every day, causes distress and disrupts crucial daily activities like studying, working, socializing and other important areas of functioning
• The symptoms are not a result of substance abuse like alcohol, drugs or medication
• The problems cannot be explained through any other mental disorder

The doctor may conduct some physical tests and blood tests to ensure that the symptoms are not a result of some other illness or disorder. They may even personally interact with the patient through a semi-structured interview process to understand their thoughts, emotions and habits. The Yale-Brown Obsessive Compulsive Scale ²⁵ (Y-BOCS) is widely used by health professionals to analyze common obsessions & compulsions and the severity of the symptoms of OCD. 

Treatment For OCD

There is no specific treatment for obsessive-compulsive disorder. However, with effective therapy and medication, a person with this condition can relieve the symptoms significantly and live a normal, healthy life. OCD is generally cured with therapy, medication or a combination of both. Research shows that most patients respond positively to treatment but some may still continue to experience certain symptoms. Around 60-70% of children ²⁶ with obsessive-compulsive disorder respond well to therapy and medication & show signs of improvement. Moreover, 40-60% of sufferers ²⁷ respond positively to medication and experience about 40-50% reduction in OCD symptoms.

Let us take a look at some of the treatment options available for curing symptoms of obsessive-compulsive disorder:

1. Psychotherapy 

Research ²⁸ shows that cognitive behavioural therapy (CBT) is an effective treatment method for this disorder. CBT can help patients transform their thought patterns and learn new ways to respond to obsessions and compulsions in a more positive way. Moreover, it has also been found that CBT can increase the efficacy of medications. In fact, around 75% of sufferers treated with CBT have responded positively.

Exposure and response prevention (ERP) ²⁹, a specific CBT technique, is now considered to be the first-line psychotherapy for this condition. According to a 2012 study ³⁰, exposure with response prevention (EX/RP) has proved to be the psychological treatment of choice for both children and adults with OCD, as observed by a number of clinical trials. This therapy technique enables patients to learn how to intentionally expose themselves to triggers without engaging in typical compulsive acts related to obsession. The process teaches people with the disorder to tolerate distress and anxiety without performing ritualistic habits through exposure and response prevention.

Other psychotherapy techniques like cognitive therapy (CT) can help patients to gradually overcome compulsive behaviour. This requires patients to recognize and re-evaluate the obsessive thoughts and understand the consequences of their compulsive ritualistic habits. Although the extensive study is required, limited research on CT has found it to be an effective treatment option for OCD.

2. Medications

According to the NIMH, medicines like serotonin reuptake inhibitors (SRIs) and selective serotonin reuptake inhibitors (SSRIs) can significantly help to reduce symptoms of obsessive-compulsive disorder. Although it usually requires 2-3 months for the medication to show results, some people may experience improvements earlier. According to a 2014 study ³¹, selective serotonin reuptake inhibitors (SSRIs) are the first-line treatments in pharmacotherapy for OCD. The study also found that around 70% of patients can experience impressive symptomatic relief through SSRIs. Moreover, a 1998 study showed that SSRIs like fluvoxamine are effective in treating this disorder.

Common SSRIs include:

• Citalopram 
• Fluoxetine 
• Clomipramine
• Paroxetine 
• Fluvoxamine
• Escitalopram
• Sertraline
• Paroxetine hydrochloride

However, higher doses of SSRIs for longer periods of time are necessary for the treatment of obsessive-compulsive disorder than for depression. One 2010 study ³² found that medium to large dosages for at least 3 months are required to assess the effectiveness of SSRIs for this condition. However, antipsychotic medication ³³ can also be recommended by therapists, if SSRIs fail to help improve the symptoms. Antipsychotic drugs, like aripiprazole and risperidone, have also proved to be effective for people with OCD. A 2019 study ³³ found that around 33% of SSRI-resistant patients respond positively to antipsychotics. In case, if a patient is unable to experience any improvements in the symptoms, then they must contact their doctors immediately.

3. Neuromodulation

In rare instances, when psychotherapy and medication are unable to improve the symptoms, then the doctor may suggest neuromodulation for obsessive-compulsive disorder. According to a 2014 study ³⁴, neuromodulation is increasingly proving to be an effective treatment option for OCD. Another study ³⁵ found that techniques like transcranial direct current stimulation (tDCS), electroconvulsive therapy (ECT), deep brain stimulation (DBS) and transcranial magnetic stimulation (TMS) can provide a transient, yet substantial improvement of obsessive-compulsive symptoms.

According to NIMH, Transcranial Magnetic Stimulation (TMS) was approved by the FDA in 2018 and can act as “an adjunct in the treatment of OCD in adults.” This technique stimulates nerve cells by using magnetic fields to improve electrical activity in certain regions of the brain. According to a recent 2019 study ³⁶, TMS showed consistently positive effects on symptom reduction for patients with obsessive-compulsive disorder.

4. Group therapy

Interacting with other OCD sufferers can often help a patient find support and motivation to cope with their condition. Group therapy enables people to reduce feelings of isolation as they undergo treatment. Cognitive-behavioural group therapy (CBGT) can be an effective treatment for obsessive-compulsive disorder, stated a 2005 study ³⁷. Researchers found that the benefits of CBGT can be sustained for 1 year. Moreover, another 2003 study ³⁸ revealed that CBGT can be highly effective in reducing the severity of symptoms and decreasing the impact of exaggerated thoughts and ideas. Moreover, it can help to improve the quality of life for OCD patients in a short period of time.

Read More About Group Therapy Here

5. Relaxation 

A number of relaxation techniques like breathing exercises, yoga, meditation, mindfulness practices and even massage can help to decrease symptoms of obsessive-compulsive disorder. According to a 2016 study ³⁹ , a yoga-based intervention can help to decrease symptoms after practising yoga for at least a period of 2 weeks. Moreover, a study from 1999 ⁴⁰ revealed that kundalini yoga techniques can be highly effective in the treatment of OCD.

A 2012 study ⁴¹ on mindfulness-based cognitive therapy found that it can help patients effectively cope with their OCD. The study found that around 66% of patients reported an improvement in symptoms as it enabled them to “live more consciously in the present”. Another study ⁴² conducted in 2008 found that mindfulness-based intervention results in a significant reduction in symptoms.

Overcoming obsessive-compulsive disorder

Having obsessive thoughts and compulsive habits is not just about uttering certain phrases constantly or washing your hands repeatedly. OCD can lead to severe stress, anxiety, distress, depression and even suicidal tendencies, depending on the intensity of the condition and the individual. People suffering from this disorder should not feel embarrassed, guilty or ashamed of their thoughts and behaviours.

If your obsessions and compulsions start to affect your relationships and disrupt your day-to-day functioning, then it becomes crucial to seek help from family and friends and see a mental health professional. With effective treatment and support, you can improve your symptoms and even overcome the condition eventually to live a more positive, healthier life.

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