According to the International OCD Foundation OCD and related disorders affect 1 out of every 100 people around the world. Obsessive-Compulsive Disorder, or OCD for short is frequently misunderstood by many. People often comment, “I’m so OCD,” without really knowing what it is. Even in the mental health professions the condition is often mis-diagnosed. So, what is Obsessive-Compulsive Disorder (OCD)? And, how do you know if you have it?
OCD has its own spectrum in the new DSM 5 (Diagnostic & Statistical Manual). OCD is specifically characterized by obsessions and compulsions. Obsessions are unwanted, repeated intrusive thoughts, images, or impulses that feel outside of the person’s control and often lead to intense feelings including anxiety and distress. Among the many different types, common themes include contamination, perfectionism, harm, and losing control. Compulsions include the urge for the individual to engage in repeat behaviors in an effort to neutralize the unwanted obsessive thoughts.
These are often times behaviors that the individual would rather not participate in but feel compelled to do so. Common examples include hand washing/cleaning, checking, repeating, and mental rituals. With both obsessions and compulsions, the determining factor is whether these thoughts and behaviors consume increased amounts of time and interfere with social and educational/employment responsibilities. For proper diagnosing, please consult a licensed provider who can assess your thoughts, behaviors, and any interruption of healthy functioning.
How Does OCD Typically Play Out?
Generally, a person with OCD has intrusive beliefs/thoughts that cause distress, and they find momentary relief by completing what is called a neutralizing behavior. Because intrusive, unwanted thoughts are just that – they continue to return. With the repetitive use of the neutralizing behavior, OCD becomes a cycle where people often describe feeling “stuck”. The momentary relief you feel from doing the behavior reinforces your fear. It makes it stronger. And you are unable to move forward; paralyzed with fear or anxiety unless participating in the identified neutralizing behaviors. Depending on the severity, some individuals may go through this cycle all day long. It begins to snow ball and interfere with your ability to go to work or school, to attend community events, to be with family and friends, and to enjoy life in general.
Here’s an example from the well-known book, “Brain Lock” by JeffreySchwartz: Picture a 5-speed transmission in a car and you’re trying to shift between gears 1 and 2. You keep trying, but it doesn’t work. You’re stuck and you continue to repeat the behavior in an attempt to get to the next gear. With OCD, this might mean missing work because you’ve spent hours showering and grooming until “it feels right”.
Although OCD is becoming more widely understood, it is also important to know that there are many sub-types of OCD including harm OCD, perfectionism, contamination, pedophile OCD, scrupulosity, relationship OCD, along with others. Although there are commonalities in presentation, each person’s symptoms are unique to him or her. It is important to note that individuals may fear coming forward with their thoughts for fear of how another person will respond if they don’t truly understand it to be OCD. For example, a new mother fearing that she’ll drop her baby down the stairs. Or a person scanning their body for any signs of arousal while around children because they fear they are a pedophile. Thus, the ability of a practitioner to understand each person’s obsessions/compulsions and provide proper diagnosis is important.
What are the options for someone who has OCD? What is the prognosis with treatment? These are questions individuals and families often inquire about. Backed by research, Exposure and Response Prevention (ERP) is a cognitive-behavioral and evidence-based treatment used to treat OCD. Behind every obsession is a core belief or fear. ERP essentially entails facing your ultimate fear. Then by doing the exact opposite of what your OCD tells you, it helps to break the cycle. By doing this, you are taking away the power of the OCD. This treatment teaches you to tolerate the distress you experience without completing a ritual to neutralize the feeling, therefore changing the relationship you have with OCD. You learn to live with the anxiety.
ERP is often conducted in outpatient settings, although there are higher levels of care for more severe cases. It is encouraged to practice daily for at least an hour as it typically takes that long to see a reduction in anxiety. Medication is often used in conjunction with ERP as well as additional treatment modalities such as ACT (Acceptance & Commitment Therapy). It’s recommended that you consult a licensed professional who specializes in one or both of these methods. For more information on resources, please visit https://iocdf.org/find-help/.
OCD is a chronic condition that is fairly dynamic, often changing from time to time. There may be periods with minimal symptoms or periods where new symptoms arise. Symptoms are commonly exacerbated by stressful situations. There are no definitive known causes at this time, however, we are able to understand the symptoms in order to treat it successfully using the interventions discussed in this article. With the assistance of treatment, it is possible to get your specific symptoms under control and take back your life.