Thomas is a thirty year old who is deadly fearful of germs. Throughout the day, he constantly thinks about things he may do wrong in his job. He doubts himself in almost every situation. He feels that he must always do things “just right.” He has a fear of certain numbers, which makes his friends call him “superstitious.”
Thomas is experiencing Obsessions, which are recurrent thoughts, urges or images that are felt to be intrusive and unwanted.
Richard is a high school junior who has strict rules at every meal about how his food is presented and eaten. He constantly comes back to his house to check and see if he locked the front door and shut off the stove. He finds himself counting all the letters in an advertisement.
Thomas and Richard are suffering. They have Obsessive-Compulsive Disorder, a form of an Anxiety disorder.
OCD, as it is called, is characterized by obsessions AND/OR compulsions.
Obsessions are persistent thoughts, images or impulses that are usually experienced as intrusive and inappropriate by the individual. (Some may feel that the mental belief is not true, others may think that it could be true, while some are sure that the belief is true.)
Compulsions are repetitive behaviors or acts that the individual believes will prevent or reduce the anxiety felt with the mental obsession. Compulsive behaviors may involve thoughts or actions such as hand washing, going back to check something, ordering objects or controlling their presentation.
We all obsess about something at some times, and we all can exhibit superstitious behaviors to reduce anxiety or bring us “good luck.”
A true mental health diagnosis of an Obsessive-Compulsive Disorder requires that such thoughts and/or compulsions occur for more than an hour a day. The persistent thoughts may not start and stop with the event that seemed to cause them. These individuals are always “playing” some script in their heads. It is, unfortunately, a script that they cannot turn off.
OCD is the fourth most common psychiatric disorder.
OCD involves obsessions and compulsions that cause one’s very existence to be rigid and time-consuming, while causing significant distress, emotional and mental suffering, as well as impairment on the job, at home and in one’s social relationships.
Obsessive-Compulsive Disorder starts earlier with males than with females. There are two age periods where males tend to start exhibiting OCD. One age group is at age ten and a second group around age twenty-one. Females start in late adolescence and early adulthood, around ages seventeen to twenty-nine.
The early diagnosis of a true Obsessive-Compulsive Disorder is very important. A 1990 study found that 80% of adults with OCD had an onset in childhood or adolescence. A recent August, 2014 article in the New England Journal of Medicine noted that only about 33 percent of individuals with OCD receive medication, and less than 10 percent receive cognitive behavior therapy, which is considered evidence-based therapy.
This means that many individuals with OCD have suffered from childhood — and continue to suffer. This is especially sad for children because their symptoms involve more obsessions about harm, as well as intense fears of death, than adults. If untreated for years in childhood, OCD can be more difficult to treat in adulthood, even if it is correctly diagnosed.
In addition, OCD in children is very often found with other existing mental health problems, such as Oppositional Defiant Disorder, Tics, Tourette’s syndrome, ADHD, sadness or anxiety.
This column is one in a series of OCD. In next week’s column, I will address symptom types of obsessions and compulsions, and how often they are seen in OCD. I will also address specific ways to diagnose OCD in childhood and adulthood, and finally, effective forms of treatment.
Philip Kronk, M.S., Ph.D. is a clinical psychologist and neuropsychologist. Dr. Kronk has a doctorate in Clinical Psychology from the University of Tennessee and a postdoctoral degree in Clinical Psychopharmacology from Fairleigh Dickinson University. He has worked with children, adolescents, adults and families for more than forty years, has taught at UT and Pellissippi State College and has published different professional articles. He can be reached at firstname.lastname@example.org if you would like to suggest topics for future columns.