Obsessive-compulsive and related disorder

Obsessive-compulsive disorder is a neurobiological disorder that is characterized by unreasonable thoughts and fears (obsessions) that lead to repetitive behaviors (compulsions). It is possible to only have obsessions or to only exhibit compulsions and still be eligible to be diagnosed with an OCD disorder. The disorder usually centers around themes, but without treatment it is very difficult to overcome obsessive thoughts and urges, which in turn lead to a vicious cycle of engaging in more ritualistic behaviors. Typically, OCD disorders are classifiable into four main groups: checking, contamination/mental contamination, hoarding and ruminations/intrusive thoughts.

Causes

One single responsible factor related to the onset of an OCD disorder has yet to be found, but possible candidates include:

 

Changes in the brain’s chemistry or functions

 

Genetics may also be responsible, though specific genes are yet to be identified

 

Possible environmental factors: infections, stressful life events

 

Symptoms and signs

General patterns to be observed before an OCD diagnosis can be made:

The obsessions and compulsions consume excessive amounts of time (at least one hour)

They cause significant levels of stress and are deemed difficult in managing

They interfere with daily activities either at home, school or work, with social activities and relationships

 

Checking signs and symptoms:

Obsessive need to check (compulsion) for fear of preventing certain undesirable outcomes (such as damage of any kind, fire, leaks):

Memory – checking to make sure an intrusive thought is just that, and not real

Illnesses and symptoms (fear of developing illnesses and constantly checking to make sure symptoms have not developed, also known as hypochondria)

Re-reading parts of texts, letters for fear of either not having remembered the information or for having made mistakes

Fear of saying or doing something hurtful to loved ones

Fear of harm happening to a loved one (constant checking to see the person in question is not harmed)

Fear of causing accidents by gas, electric stoves, water taps, appliances, house lights etc.

Fear of causing car accidents

Fear of developing schizophrenia due to being diagnosed with an OCD disorder

 

Contamination signs and symptoms:

The need to wash and clean constitutes the compulsion, while the intrusive thought is deemed as being ‘contaminated’/’dirty’ may cause an illness, and eventually death (either to oneself or to a loved one)

Fear of using public toilets

Fear of coming into contact with chemical substances

Fear of contracting germs from other people through hand-shaking/ touching door knobs/ using public telephones/ being inside a general hospital’s waiting room etc.

Fear of being in large crowds

Fear of eating in restaurants or cafes

Obsessive avoiding of red objects and stains (for fear of HIV/AIDS being contracted through blood stains)

Excessive teeth brushing/ washing of hands

Obsessive cleaning for fear of germs spreading to loved ones

Obsessive shaking of clothes for fear of developing illnesses due to dead skin cells

 

Mental contamination signs and symptoms:

Physical or mental abuse can cause an abnormal sense of internal uncleanliness that can only be felt to be less intense when engaging in repetitive washing or showering, despite the fact that the source of uncleanliness is not triggered by contact with a physical, ‘dirty’ object

 

Hoarding signs and symptoms:

The inability to discard worn out or useless possessions, leading to massive build-ups of objects

Buying, saving or collecting any kind of objects

Problems with a proper organization of objects

 

Ruminations signs and symptoms:

According to the OCD-UK charity, ruminations mainly refer to a “train of prolonged thinking about a question or theme that is unproductive”, but not necessarily deemed as objectionable (as is the case of intrusive thoughts)

Examples of ruminations are the constant dwelling on issues such as the origins of the universe, life, death, religious, philosophical topics

Ruminations usually take the form of searching for and weighing various possible scenarios and theories, without coming to any satisfactory solution

 

Intrusive thoughts signs and symptoms:

Obsessive and repulsive thoughts that are considered highly objectionable, extremely disturbing, even horrific in nature

Common subcategories include thoughts on the themes of:

Relationships – constant fear of being involved in an unsuitable relationship, questioning the partner’s or one’s own sexuality

Sexuality – fear of causing unintentional harm, fear of being attracted to members of one’s family, fear of being attracted to members of the same sex, fear of being a pedophile, fear of having inappropriate thoughts related to God, saints, or other religious figures

 

Magical thinking:

The fear that even thinking about something bad will actually cause its occurrence in real life

Attempts to dispel intrusive thoughts by engaging in time-consuming, bizarre rituals (such as stepping only in certain places, counting up to a certain number, touching objects for a specific number of times etc.)

Having certain thoughts is considered as bad as actually having performed the action itself

Religion:

Belief that sins will never be forgiven

Belief that religious buildings will surely elicit ‘bad thoughts’

Screaming profanities in religious places

Certain prayers must be corrected and said repeatedly

The belief that one is always doing something sinful

Having intrusive thoughts during prayers will ruin the ‘beneficial effect’ of praying

The person in question’s sense of having lost touch with God and faith

The need for touching or kissing religious objects repeatedly

Violence:

Fear of harming loved ones or children

Fear of killing innocent people

Fear of using sharp objects

Fear of jumping in front of a moving vehicle

Fear of poisoning loved ones

Fear of acting on unwanted and uncontrollable impulses (either provoking sexual harm or killing)

Symmetry and orderliness:

Objects must be placed in their rightful place at all times

Pictures have to be perfectly aligned

Canned foods have to face the same way

Clothes have to hang perfectly and face the same way

Surroundings have to be spotless

Books have to be perfectly lined up in a row

Avoidance:

A person will go to great lengths to avoid the objects, people or places they believe trigger their OCD disorder, in an attempt to avoid the stressful and time-consuming engaging in their specific rituals

Advice

Various forms of therapy may ameliorate symptoms, but not necessarily cure the disorder

Psychotherapy:

Exposure and response prevention is the most effective therapy in cases of OCD disorders

It involves a gradual exposing to the feared object or allowing for a gradual access to the feared thought, in order to find healthy ways of coping with the anxiety and feelings of shame and guilt

This type of therapy can be performed individually, in groups or with family members

Medications:

Antidepressants have been approved for treatment of OCD, but administration of drugs may vary according to the type of disorder exhibited

Deep brain stimulation therapy is sometimes used as an alternative measure when psychotherapy and medications have proven to be unsatisfactory

MISCONCEPTIONS
  • OCD is commonly confused with the desire to maintain one’s cleanliness, preference for keeping the environment clean and organized, for planning one’s schedule in detail

    All repetitive or ritualistic behaviors are indicative of having OCD – many people engage in repetitive tendencies from time to time

    Being meticulous is a sign of having OCD

    The main symptom of OCD is hand washing

    OCD sufferers are solely concerned with cleanliness and hygiene

    Sufferers from OCD do not understand that their behavior is irrational

Statistics

According to the World Health Organization, OCD has been ranked as one of the top 20 causes of illness related disabilities for individuals between the ages of 15 and 44

OCD affects men and women equally

OCD typically begins during early childhood years or during adolescence

Most people are diagnosed by about age 19

Estimates report a rate of 1 in 100 children having been given an OCD diagnosis

According to recent tests approximately 3.3 million Americans experience OCD symptoms in a given year

One third of adults will develop OCD symptoms during childhood

OCD costs in the U.S. in 1990 were estimated to have been $8.4 billion, 7% of the estimated $147.8 billion cost of all mental illness, and 18.0% of the costs of all anxiety disorders, estimated to be $46.6 billion*

The indirect costs of OCD, reflecting lost productivity of individuals suffering from or dying from the disorder, were estimated at $6.2 billion*

Did you know?

A ‘trigger’ for OCD related thoughts or behaviors can range from places, to people, to objects

Interrupting ritualistic compulsive behaviors usually implies having to start them all over again

The thoughts are not voluntarily produced, nor do they represent fantasies that the sufferer wishes to act upon – in fact, part of OCD symptomatology is the association of the disorder with high levels of stress caused by the patient’s recognizing of the nature and difficulty in managing the disorder

Many patients experience intense feelings of shame and remorse due to their illness

Famous personalities diagnosed with OCD: Leonardo DiCaprio, Jessica Alba, Cameron Diaz, David Beckham, Billy Bob Thornton, Donald Trump, Marc Summers, Howie Mandel

Famous personalities suspected of having had OCD: Albert Einstein, Charles Darwin, Howard Hughes, Nikola Tesla, Martin Luther