Obsessive Compulsive Disorder

What is obsessive-compulsive disorder?

Obsessive-compulsive disorder is a relatively common and poorly understood chronic mental health disorder.

OCD is defined via the regularity of obsessive thoughts, sometimes called ruminations or intrusive thoughts, and the level to which they distress the person or stop them from getting on with day-to-day life.

Some people with OCD will also experience compulsions – a need to act on a specific behavior, often ritualistic, to deal with their thoughts and how they make them feel.

It is important to remember that neither set of symptoms are a choice - most people with OCD do not want to experience them.

How does OCD affect people?

People with obsessive-compulsive disorder often live in a heightened state of anxiety when left untreated. This is because their obsessions focus on fears that are believed to be stopped by doing certain behaviors (or compulsions) repeatedly and in a specific way.

For example, someone with OCD might obsess over the idea that someone will break into their house but believe that if they check the locks a certain number of times and test them in a specific way, they can stop this from happening.

Even for people who don’t have severe obsessive-compulsive disorder, these symptoms can be incredibly exhausting and time-consuming, taking up hours of their day. This makes it hard to get on with daily life and connect with the world around them.

Symptoms of obsessive-compulsive disorder

OCD symptoms vary, but the diagnosis is characterized by experiencing obsessions, compulsions, or both. There is some debate among researchers about people who only experience obsessions, which is sometimes called 'Pure O'. ^[1]

Obsessions

Obsessive thoughts might include, but are not limited to, any of the following:

• Violent or disturbing ideas or images about you or the people you love being hurt, for example, picturing your family in a car crash on the highway.
• Being suspicious of a romantic partner and becoming very focused on the idea that they might have cheated on you without evidence.
• Becoming very concerned about contamination or hygiene, for example, believing you might become infected with a disease or virus like HIV.
• Feeling very worried about your safety, for example, whether the doors in your home are secure or appliances will catch fire, and questioning whether you have securely left them.
• Having hyper-sexualized thoughts about the people around you, regardless of whether you are sexually attracted to them.

Compulsions

Compulsions might include, but are not limited to, any of the following:

• For some people, cleaning and hand-washing rituals mean cleaning their homes for several hours daily.
• Avoiding touching particular objects, like handrails, or other people, because you believe they might contaminate you.
• Repeatedly checking the doors in your home are locked and appliances, like ovens and kettles, are switched off.
• Getting tested for illnesses like coronavirus or HIV multiple times despite negative results.
• Creating order in certain activities, for example, doing them in a sequence and counting how many times you do them. This could be things like how you walk on the sidewalk, avoiding cracks and taking a certain number of steps before a pause, or brushing your hair a certain number of times.

There is evidence that specific obsessive-compulsive symptoms are more commonly experienced among children and young people. If you are concerned your child may be developing OCD, look out for things like:

• Reading and re-reading homework multiple times, and writing then re-writing answers repeatedly.
• Storing things in their bedroom that aren’t worth anything, like items of garbage.
• Spend more time than usual on their grooming and doing it ritualistically, for example, brushing their teeth several times a day and in a specific way.

About half of the people with obsessive-compulsive disorder first experience symptoms in childhood, but it can take a long time before someone is diagnosed. Be careful not to jump to conclusions but be alert to whether your child’s behavior could be a symptom of OCD because the earlier it is treated, the more effective the treatment will be. ^[2]

Causes of obsessive-compulsive disorder

The exact causes of obsessive-compulsive disorder are unknown, but a combination of factors can mean that some people are more likely to experience it than others.

Family history

Some studies have shown that it is common for someone with OCD to be closely related to others who also have it, regardless of their diagnosis.

Development

Some research has shown that people with obsessive-compulsive disorder may have experienced different brain development as children, with some parts of the brain not functioning at the same levels as people without OCD. ^[3]

Biology

Serotonin is a chemical in the brain that plays a role in many psychiatric disorders because it is responsible for helping us regulate our mood, sleep, and manage other vital bodily functions. For example, low levels of serotonin can be a trigger for OCD.

Environment

Sudden life changes can trigger obsessive-compulsive disorder, for example, the break-up of a significant relationship, grief, or work-related stress. In addition, some studies show a link between experiences of abuse and trauma, particularly in childhood, and the development of OCD.

One recent study also showed a link between people experiencing a head injury and developing obsessive-compulsive disorder symptoms. ^[4]

Other illnesses

Some research suggests children are more likely to develop OCD symptoms after having ‘strep’ (a streptococcal infection), but no study has yet been able to identify why this happens. ^[5]

Diagnosing obsessive-compulsive disorder

The exact causes of obsessive-compulsive disorder are unknown, but a combination of factors can mean that some people are more likely to experience it than others.

Family history

Some studies have shown that it is common for someone with OCD to be closely related to others who also have it, regardless of their diagnosis.

Development

Some research has shown that people with obsessive-compulsive disorder may have experienced different brain development as children, with some parts of the brain not functioning at the same levels as people without OCD. ^[3]

Biology

Serotonin is a chemical in the brain that plays a role in many psychiatric disorders because it is responsible for helping us regulate our mood, sleep, and manage other vital bodily functions. For example, low levels of serotonin can be a trigger for OCD.

Environment

Sudden life changes can trigger obsessive-compulsive disorder, for example, the break-up of a significant relationship, grief, or work-related stress. In addition, some studies show a link between experiences of abuse and trauma, particularly in childhood, and the development of OCD.

One recent study also showed a link between people experiencing a head injury and developing obsessive-compulsive disorder symptoms. ^[4]

Other illnesses

Some research suggests children are more likely to develop OCD symptoms after having ‘strep’ (a streptococcal infection), but no study has yet been able to identify why this happens. ^[5]

Prevention of obsessive-compulsive disorder

There is no way prevent OCD completely, but the earlier you seek help for your symptoms, the more likely you are to be able to manage them well and stop them from becoming severe.

Once you have agreed on a treatment plan with your doctor, do your best to try to follow it for the time you have decided before reviewing it again. Some people find it easier to stick to a plan when they are part of a peer support network where they can talk to others having similar experiences.

As far as possible, try to manage the stresses in your life and limit anything that you know can trigger obsessive-compulsive disorder symptoms, like working lots of overtime.

One type of treatment for OCD focuses on preventing responses to triggers. It is called Exposure and Response Prevention (ERP). It is a talking therapy in which someone is gradually exposed to something that is a focus of their obsession, for example, a toilet that hasn’t been cleaned, and talks about how it is making them feel.

Over time, the person should learn to independently manage the distress that being near the object causes them without acting on the compulsion that accompanies it. Eventually, they should be able to apply this to real-life situations.

Treatment for obsessive-compulsive disorder

The earlier your start treatment for OCD, the more likely it is to work well. Different treatment works best depending on the person. Still, most people with obsessive-compulsive disorder find therapy, medication, or a combination of the two, to be an effective way to manage their symptoms.

Therapy

A typical talking therapy that is prescribed to people with obsessive-compulsive disorder is Cognitive Behavioral Therapy (CBT), which addresses thought patterns and behavior. By addressing how your thoughts play out, your therapist can help you change the behavior that come from them.

Exposure and Response Prevention (ERP) is a type of CBT in which someone is gradually exposed to something that is a focus of an obsession until it becomes normalized.

Medication

You will most likely be prescribed antidepressant or anti-anxiety medication for OCD, alongside therapy. There are different varieties of OCD medication, but a commonly prescribed type is called selective serotonin reuptake inhibitors (SSRIs). These include:

• Citalopram (Celexa)
• Fluoxetine (Prozac)
• Sertraline (Zoloft)

Your doctor will work with you to determine the correct dose for you to start, and it can take several weeks of treatment to be fully effective. Because of this, patience is vital if you don’t see an immediate change. Similarly, do not stop your medication too quickly or without your doctor’s support if you think you no longer need to take it.

If you are concerned about any side effects you are experiencing from the medication, you should speak to your doctor or pharmacist immediately.

Other

Some doctors might prescribe other forms of treatment if therapy and medication are ineffective. These can include:

• Inpatient or outpatient care. This is often an excellent way to help support someone to engage with Exposure and Response Prevention (ERP) therapy.
• Electroconvulsive therapy (ECT). This involves small electrical impulses to the head, prompting the brain to release certain chemicals that are imbalanced.
  
  Other versions of this treatment are called Deep Brain Stimulation (DBS) or Transcranial Magnetic Stimulation (TMS) and work similarly. These treatments are less common, and it is important to ensure you understand the risks before proceeding.

Self-care for obsessive-compulsive disorder

There are lots of things you can do to look after yourself if you have obsessive-compulsive disorder, which will help to manage your symptoms and feel more in control of your diagnosis:

Sharing your journey

Don’t be too hard on yourself if you still find yourself acting on compulsions. Sharing your journey with another person can help to put this into perspective based on where you are at with your treatment.

Sleep

Getting enough sleep has impacts on OCD symptoms, so try to get a similar amount of sleep each night at around the same time.

Diet and exercise

Other things that can make a difference in managing your symptoms are following a balanced diet and regularly exercising. This can begin with simple things like eating an extra piece of fruit each day or taking a walk around the block.

Treatment support

A meaningful way to practice self-care is to stick to your treatment plan. Some people find sharing their plan with a close friend or someone in their family, who will regularly check in on how they are getting on with it, can help with this.

Meditation and mindfulness

Meditation and mindfulness can also be a good way to focus your mind and reduce the anxiety attached to this diagnosis.

Helping someone with obsessive-compulsive disorder

Obsessive-compulsive disorder is a complex mental health condition, and knowing how best to support someone with this diagnosis can be challenging.

The most important thing to remember is that you don’t need to be a clinician or an expert. You simply need to listen to the person, do your best to understand what they are going through and not be judgmental.

If you can, try to work with the person to agree on a joint approach to their symptoms. For example, do they find it helpful for you to challenge them every time they act on a compulsion? Should you agree not to engage with particular questions about some of their obsessions, for example, if you are in a romantic relationship and they question your fidelity?

Though it might seem counterintuitive, helping someone with their compulsions can reduce anxiety around them because they become a shared process. This is called ‘accommodation.’

It is also important to look after yourself if someone close to you is experiencing OCD. Some people find it helpful to find a group of others caring for someone with this diagnosis, as it requires a lot of patience, and treatment can take time.

Frequently asked questions about OCD

What is the outlook for people with OCD?

Obsessive-compulsive disorder can be successfully treated, lessening the impact on someone’s day-to-day life.

According to the DSM-5, people who believe more strongly in their obsessions and compulsions may have worse treatment outcomes. Similarly, without treatment, there is a limit to the extent someone with OCD will be able to engage in day-to-day life, like maintaining relationships and working. ^[7]

People with obsessive-compulsive disorder need to find ways to cope with the symptoms that work for them. This might mean a lot of planning or building up to things like taking public transport, but with the proper support from a therapist, who they can talk to about these experiences afterward, these things can become more normalized.

How common is OCD?

According to the American Psychiatric Association, around 2 to 3 percent of the U.S. population has OCD. No definitive data that suggests men or women are more likely to experience it, but symptoms usually start in childhood. ^[7]

Many people with obsessive-compulsive disorder have other mental health disorders, like depression, anxiety, or an eating disorder. ^[8]

OCD vs OCPD – What is the difference?

It can be difficult to tell the difference between someone with obsessive-compulsive disorder (OCD) and someone with obsessive-compulsive personality disorder (OCPD).

The distinguishing factors can be:

• When someone’s symptoms develop – it is commonly understood that OCPD can begin at birth and last for someone’s whole life.
• Level of self-awareness - people with OCD often experience more discomfort with their behaviors and thought patterns than people with OCPD, which makes OCPD harder to treat.
• Treatment – OCPD is more complex to treat because people with this diagnosis are less likely to acknowledge it or want to change their behaviors.
• Someone with OCPD might have obsessions that focus more on extreme perfectionism or an over-fixation of what is right and moral than someone with OCD.
• People with OCPD tend to hoard, including money, or not want to let go of items that seem worthless to others.
• Someone with OCPD is likely to want to exert a level of control over people around them, for example, repeatedly seeking a solid commitment from a friend who says they will pick something up from the store and threatening what will happen if they don’t follow through.

There can be a lot of stigma and shame attached to the idea that any personality disorder is inherent in who someone is, as opposed to a mental health disorder they are experiencing. For this reason, it is important to be sensitive to someone who has this diagnosis or is in the process of seeking it.

Notes

General understanding of OCD*

It’s important to note, whether you have been diagnosed with obsessive-compulsive disorder or are supporting someone with this mental health disorder, that it is a highly stigmatized and misunderstood mental health disorder. It is common in popular culture and general conversation to hear references to ‘being a bit OCD,’ for example.

While society’s understanding of some mental health disorders, like depression and anxiety, has developed a lot in recent years, OCD is not well understood, which may mean you face more barriers when explaining your diagnosis. This is why getting the right support is so important.

The effect of the COVID-19 pandemic*

Recent research focused on the impact of the COVID-19 pandemic on OCD. Studies have evaluated those who were already struggling with symptoms and how these were managed during the height of the pandemic, and whether it contributed to an increase in diagnosis rates.

Many studies found the pandemic worsened symptoms for those who were previously experiencing them at a lower intensity, because of the prominence of public health guidance on contamination and rituals like hand washing, as well as the overall level of state control, for example, through lockdowns.

It is still unclear whether more people have developed OCD due to the pandemic. Many may not have recognized they were already experiencing low-level symptoms or had a predisposition to developing them. ^{[9] [10]}