A little girl, walking home from school, might whisper to herself, “Step on a crack, and you’ll break your mother’s back!” As she walks, she carefully avoids all of the cracks in the sidewalk, skipping, hopping, jumping and generally avoiding the cracks. When she reaches her house, she stops her game and goes inside.
People with obsessive-compulsive disorders might play a version of this game as well, but for these people, the game is far from simple, and it’s almost never fun. Obsessive-compulsive disorder (OCD) is characterized by obsessive thoughts that are mostly negative, and the rituals the person performs in order to banish those thoughts or to keep them from coming true.
According to the National Institute of Mental Health (NIMH) about 2.2 million adults in America have OCD. Many children may also have the disorder. The disease is chronic, meaning that it’s never truly cured, but therapies can provide a significant amount of relief and help the person leave the obsessions and their related compulsions behind for good.
As mentioned, OCD begins with obsessive, intrusive thoughts. According to Mental Health America, common obsessions include:
- A fear of harming someone else
- Worries of contamination or infection
- Becoming convinced that he or she is violating a religious edict or is somehow “evil”
- Unpleasant images of sexual behavior
These obsessions might pop into the person’s brain multiple times per day, and each time they appear, they cause a significant amount of stress or anxiety. Often, the person feels disgusted by the obsession, or the obsession is so terrifying that the person would do anything to make the thought disappear. Sometimes the person experiences the same thought repeatedly, or the person might experience variations on a theme of thoughts.
For some people with OCD, these thoughts are the absolute truth, and there’s nothing that anyone can say to convince them that the thoughts are untrue. There are some people, however, who know the obsessions can’t truly come true and can’t truly cause harm, yet those obsessions don’t go away and they exert a powerful pull upon the actions of the person.
When these thoughts take hold in the person’s mind, he begins to engage in ritualistic movements in order to forget the obsession or distract himself from the thought. Often, the compulsions are performed in an elaborate format, full of many complicated rules, and the person becomes convinced that he or she must perform the ritual perfectly or else begin the ritual again from the beginning.
According to the American Academy of Family Physicians, common rituals include:
- Combing hair
- Counting items
- Touching items in a particular order
- Performing certain movements over and over
- Saving items compulsively
People who have OCD typically focus on only one type of compulsion. A person with a fear of infection might focus solely on washing and scrubbing, for example, while a person concerned about violence might compulsively lock and unlock the front door repeatedly. In addition, these compulsions tend to take up a significant amount of time in the person’s day. People with OCD may spend hours on their compulsions, repeating them and honing their skills until the actions are done properly.
These compulsions don’t bring the person pleasure. In fact, the person may be disgusted by the compulsions, or be embarrassed by the actions they’re taking. They may even try to stop performing the rituals, but when they do so, they may find that the obsessions grow stronger and stronger, and they’re driven to perform the rituals again as a result.
Some people with OCD have a high degree of insight, and they know that their compulsions aren’t healthy and aren’t quite normal. They may still be unable to stop performing the compulsions, however. Other people never know that what they’re doing is somehow unusual.
For most people, the time spent on compulsions becomes more and more burdensome. People may find they’re unable to get up, get dressed and leave the house in the morning. Perhaps they can’t find a time that contains a “good” combination of numbers that would allow them to get up, and they may find themselves stuck at the sink, washing up repeatedly and still finding evidence of germs.
Sometimes, the severity of the disease comes and goes. The person might not feel strong compulsions for many months, and then find that a small life stress tends to trigger a resurgence of symptoms. Some people lean on drugs and alcohol, sedating themselves so they’re unable to develop compulsive thoughts, but as their addiction worsens, so does the OCD.
There are some people who only develop obsessions, and others who only develop compulsions. These people may have difficulty getting an accurate diagnosis, as they don’t seem to fit into a classic profile of a person with OCD. As a result, they may struggle for years without a proper diagnosis.
Causes of OCD
In the past, researchers thought that people with OCD had the disease due to trauma or some sort of negative experience in childhood. Now, researchers suggest that OCD is a genetic disease, handed down from generation to generation in the genetic code. For example, a study in the journal Archives of General Psychiatry compared two groups of people. One set had a first-degree relative with OCD and the other set did not. Over 11 percent of the people with a relative who had OCD also developed OCD at some time in their lives. Less than three percent of the other group developed OCD during their lives. It’s clear that genetics plays a role here.
Modern research uses high-tech imaging machines to look at the brain structure and chemical processing of people with OCD. Studies published in the journal Psychiatry Research suggest that people with OCD use different parts of their brains than do people who don’t have the disease. Other research has suggested that people with OCD have malformations in the amount of, or the use of, specific chemicals in the brain. More research on this is ongoing.
Many mental illnesses include symptoms that are quite similar to OCD, but are not OCD, according to the International OCD Foundation. These are just a few of these related diseases:
- Body dysmorphic disorder
- Asperger’s syndrome
People with these diseases may also engage in compulsive counting or repetitive checking of an item, but often, their behaviors don’t begin with an obsessive thought, and the treatments that work on OCD may not work on these diseases. The reverse may be true as well. This is one reason that finding a qualified doctor is so important. Getting the right diagnosis is one of the best ways to get connected to the right form of treatment.
According to NIMH, people with anxiety disorders like OCD should first see their family doctors for help. A complete physical, including blood work, can help to rule out nutritional imbalances and physical diseases that could cause symptoms similar to OCD. In addition, many insurance companies require all people to see their primary care doctors before they see other doctors or specialists. It’s just a good routine first step.
Once this visit is complete, the person should then see a qualified psychiatrist for a firm diagnosis. Often, OCD is diagnosed after an informal discussion between the provider and the patient, and no fancy brain scans or blood work is needed. Instead, the patient must simply answer questions openly and honestly, and be as descriptive as possible when answering those questions. This can be difficult for some people with OCD. After all, admitting that the person has to open and shut the front door 15 times before leaving the house can be embarrassing for anyone, and the person with OCD might already be filled with shame at performing this act, much less describing it. For this reason, it’s important to find a provider the person can feel comfortable talking to openly and honestly. The person might know, right away, if the provider isn’t quite the right choice. If this happens, the person should feel comfortable finding a new provider. This match is so important, so it pays to be picky.
With a firm diagnosis in hand, the patient and the provider can pull together a treatment plan. Often, this involves medication used in combination with therapy, according to an article published by the National Library of Medicine. The medications can soothe anxiety, while the therapy can help the person see why the rituals must be stopped.
If the person has been abusing drugs or alcohol in order to control the OCD symptoms, that person might benefit from targeted therapies that deal with the addiction and its relation to OCD. These Dual Diagnosis programs, which we offer at Axis, can be instrumental in helping both conditions improve. Please call us to find out more.
As mentioned, OCD is considered a chronic condition, so there are no programs available that can cure the disease forever. But, with therapy, there’s no reason to believe that people with OCD can’t live healthy lives that don’t include damaging rituals. Recovery is possible.