Obsessive Compulsive Disorder
Published in Health and Home Digest - October 2003
By Jennifer Ferrell-Hanington, Psy.D., Licensed Psychologist
What does it mean when someone says, “I’m obsessed with collecting dolls.”, or “I am a compulsive shopper.” These terms are used loosely in our daily vocabulary, but the clinical meaning of these words may be quite different when we use them in the context of Obsessive Compulsive Disorder (OCD).
What are the symptoms of OCD?
OCD is characterized by excessive worries (obsessions) and repetitive behaviors (compulsions). Obsessions are recurrent, intrusive, and distressful thoughts. These thoughts can pop into the mind suddenly and usually produce doubt and fear.
Common obsessions include, but are not excluded to:
- Worry about germs, contamination, and dirt
- Fear of inadvertently harming another person, or fear of something bad happening
- Unrealistic concern about order, arrangement, or symmetry
- Worry about discarding useless possessions
Compulsions are behaviors that are repetitive and are often performed in order to relieve the anxiety associated with the obsessive thoughts. They are performed to relieve doubt, or are meant to prevent bad things from happening. Not only are compulsions observable behaviors, but they also may include specific mental activity.
Common compulsions include, but are not excluded to:
- Excessive hand washing or cleaning
- Repeated checking, e.g. whether the stove is turned off or whether the doors are locked
- Counting objects over and over again
- Arranging and ordering objects
- Hoarding and saving useless objects
Not all worries and repetitive behaviors represent an illness. In fact, they may be helpful in most cases. For example, hand washing and proper cleaning is important regarding our health, and keeping doors locked is necessary for safety and protecting property. In addition, proper organization and planning can assist us avoiding errors and in succeeding our goals. Therefore, if we view these symptoms on a continuum, professional help is recommended only when these symptoms become excessive, are unrealistic, create significant distress, or interfere with daily functioning, school, jobs, or relationships.
Behaviors such as gambling, abusing alcohol/drugs, and excessive shopping are often referred to as “compulsive”. However, these activities are different than the ones associated with OCD. Gambling, using drugs, or shopping provide a certain level of pleasure. However, OCD compulsions are not inherently pleasurable. Instead, the compulsions may be experienced as repulsive or senseless, and are only performed to relieve the fear and doubt stemming from the obsessions.
How common is OCD?
OCD was once thought to be a rare condition. However, in the United States, 1 in 50 adults currently suffers from OCD, and five million people at any time are experiencing obsessive compulsive symptoms. Most individuals usually begin exhibiting OCD in adolescence or early adulthood. With appropriate treatment, symptoms can often be managed successfully.
What treatment is available?
Cognitive behavioral psychotherapy is often recommended for those with OCD.
The behavioral focus of this treatment helps people learn how to change their thoughts and feelings by first changing their behavior. This treatment teaches people how to decrease their anxiety by repeated exposures to the feared situations, while refraining from the compulsive behaviors. Cognitive therapy helps people alter their style of thinking in order to assess situations more realistically.
Medications have been developed that can alleviate symptoms of OCD. The medications that are most effective for treating OCD are in a group called Selective Serotonin Reuptake Inhibitors (SSRI). The use of medication may be based on the severity of the symptoms.
Psychotherapy has been found to produce a 50%-80% reduction in symptoms and symptom relief is often long lasting. Fewer than 20% of those treated with medication alone obtain complete symptom relief. A combination of psychotherapy and medication is usually the most effective treatment. Each person may have different needs and display a unique set of symptoms that requires a personalized treatment plan. Before any decisions can be made about appropriate treatment, a thorough evaluation by a mental health professional is recommended. If you would like more information about OCD and its treatment, please visit the Obsessive Compulsive Foundation website at www.ocfoundation.org.