In “As Good As It Gets” or “The Aviator,” OCD is portrayed as extreme cleanliness or annoying perfectionism or perfectly scary germiphobia, but the reality is much more complex. True OCD is characterized by frightening obsessions, time-consuming compulsions, and high levels of anxiety. OCD isn’t a phase or a minor annoyance; it is an often-debilitating lifelong disorder, one whose causes are neither fully understood nor easily controlled.
OCD affects between 1 and 3 percent of all adults, 80 percent of whom show symptoms before the age of 18. It affects both genders relatively equally, and studies have shown no correlation with race.
Outwardly, OCD can share symptoms with a number of other neurological disorders, including ADHD. People with OCD may seem distracted or unable to focus, and are often sensitive to touch and sound. If their OCD is uncontrolled, they can show symptoms of depression, including difficulty sleeping, lethargy, and deep feelings of shame and guilt.
Symptoms of OCD
At a basic level, OCD comprises two parts:
– Obsessions are recurring unwanted thoughts that feel intrusive and beyond the patient’s control.
– Compulsions are repetitive behaviors or mental acts that an OCD patient may feel compelled to perform in order to “undo” the obsessive thought.
What does this look like in real life? From an outsider’s perspective, it may not look like much. Symptoms of OCD are primarily internal (though some compulsions can be observed by others), so concerned family members or therapists may need to do a little digging to determine if OCD symptoms do, in fact, exist.
In general, OCD symptoms look like this:
– Fear of harming self
– Fear of harming others
– Fear of being “contaminated”
– Fear of infecting others
– Recurrent sexual or violent thoughts
– Fear of saying certain things (“unlucky” words, comments that disrespect a dead person, etc.)
– Intrusive nonsense sounds
– Excessive washing
– Checking locks, stoves, appliances, etc.
– Repeatedly taking your own pulse, blood pressure, or temperature
– Re-reading pages several times before moving on
– Counting silently or out loud while doing a task
– Need to touch objects or other people
– Calling friends or family members to make sure they’re safe
– Ritualized eating behaviors
These are some of the more common examples, but in reality, obsessions and compulsions can be about anything. When someone with OCD finds himself tortured by an obsession, he’ll resort to his compulsion in an attempt to neutralize or push away the thought. Compulsions can be directly related to the obsession — repeatedly washing hands in response to contamination fears, for example — but they may also be totally unconnected. Performing these “rituals” provides, at best, temporary relief from the torment of the obsession. Not doing them can lead to unbearable anxiety.
In most cases, people with OCD know their obsessions and compulsions are wholly irrational. In fact, that knowledge tends to increase the anxiety and shame they feel about their condition. They may hesitate to seek treatment or convince themselves they can overcome the problems with willpower. If left unchecked, OCD may actually get worse over time. It can lead to serious depression and — in many cases — social isolation as the affected person tries desperately to avoid people or situations that trigger symptoms.
If someone is suffering from severe distress due to OCD symptoms or going to great lengths to hide the condition from family and friends, he or she may start to experience secondary symptoms like depression, insomnia, restlessness, and sensitivity to sound, touch, or other external stimuli.
Types of OCD
According to OCD-UK, OCD behaviors generally fall into one of four categories:
For this person, the compulsion involves repeatedly checking physical objects to make sure they’re in the correct place or turned off. In most cases, the obsession is related to preventing physical harm or damage. It usually involves repeatedly checking stove dials, door locks, faucets, or even your personal memory of completing a task.
This is arguably the most well known form of OCD. The obsession is with being dirty, sick, or “contaminated” in some way, and the compulsion is usually related to cleaning — often repeatedly washing the hands. The patient may also avoid places or people he perceives as “dirty” or that may contaminate him. He may be unable to use bathrooms outside the home or eat food that was prepared by another person. It’s also possible for the patient to feel “mentally contaminated” — often by perceived negative behavior from friends or family — and to feel the need to wash the outside of his body to get rid of the negative feelings.
Though some experts consider hoarding as a condition separate from OCD, others view it as a subtype. The obsession, in this case, is the worry that throwing away something will have negative consequences; the compulsion is retaining the object for far too long. Hoarding is one of the most physically destructive subtypes of OCD, often making homes impossible or dangerous to navigate.
– Ruminations and intrusive thoughts
Ruminations are a specific type of obsession where patients ponder unanswerable questions (like, “What’s the meaning of life?”) for hours on end. This subtype of OCD isn’t usually as distressing to patients, but it can create challenges at work or in personal relationships.
Intrusive thoughts, on the other hand, are involuntary, upsetting thoughts that “pop up” in a person’s head periodically. These usually involve fears of harming a loved one, unwanted sexual thoughts, or religious concerns. The sufferer will often label herself as a “bad” or “evil” person — for having these thoughts in the first place — and will often do a ritual (like knocking on wood) to try and neutralize the thought. In extreme cases, the person may be so afraid that she will act on the bad thought that she avoids loved ones or public places.
The typical age of an OCD diagnosis varies. It may be detected as young as six in children that demonstrate consistent patterns of obsessive cleanliness, tantrums if something gets “out of order,” and close attention to rituals. Children diagnosed with a comorbid condition like ADHD, depression, or Tourette’s Syndrome, may experience symptoms of OCD earlier in life. In the majority of cases, however, OCD symptoms begin to manifest in the teen years and early adulthood.
When seeking a diagnosis, first find a specialist in OCD. Since no definitive medical test exists for OCD, it’s not an easy disorder to detect, and diagnosis should not be made lightly. Most mental health professionals will use a rating scale called the Y-BOCS, which stands for Yale-Brown Obsessive Compulsive Scale. The Y-BOCS is a comprehensive questionnaire outlining the nature of a patient’s obsessions or compulsions, how long they have presented, and how intrusive they are to a patient’s life.
Professionals also typically take a detailed medical history as well as a comprehensive mental health history to determine if it’s OCD, a disorder on the OCD spectrum, or even generalized anxiety disorder.
Treatment Options for OCD
OCD is most commonly treated with a specific type of therapy known as Exposure and Response Prevention therapy, or ERP. In this type of the therapy, the patient is deliberately exposed to their obsession — but not allowed to perform the compulsion. For example, a patient with a cleanliness obsession will be instructed to touch something “contaminated” without resorting to hand-washing afterward. Anxiety will rise dramatically — the first few sessions are generally very stressful for the patient — but under the therapist’s guidance, a patient will start to learn how to manage the anxiety in a healthy way.
“The power of an OCD thought comes in the intrusion, and it comes in the avoidance,” says Roberto Olivardia, Ph.D., a clinical psychologist who specializes in the treatment of OCD at McLean Hospital in Boston. “So the more one avoids or pushes away that thought, the more power he or she is giving to that thought.” ERP therapy takes power away from the obsessive thought by forcing the patient to confront it head on.
Medication is sometimes used alongside ERP, but it is almost never a sufficient treatment on its own. Selective serotonin reuptake inhibitors (SSRIs) are the most common medications used, as OCD is thought to be related to levels of serotonin in the brain.
Cognitive behavioral therapy (CBT) is occasionally used — particularly if the person is not wholly convinced that their obsessions are, in fact, irrational — but it usually combined with ERP for maximum effectiveness.