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Obsessive Compulsive Disorder (OCD)

By Saint Louis Behavioral Medicine Institute

Obsessive Compulsive Disorder (OCD):

  • Persistent, recurring intrusive thoughts (obsessions)
  • Typical obsessions include worry about contamination, fears of behaving improperly, acting violently, or religious misconduct.
  • Performing a ritual or routine (compulsions) to relieve the anxiety caused by the obsession becomes an interference with daily life.

Some people try to cope with severe anxiety by repeatedly doing something that may calm their fears. Individuals obsessively worried about contamination, for example, may wash their hands repeatedly. People who fear causing harm may check something such as whether the gas is turned off, over and over.

“ I know it sounds silly, but I feel like something terrible is going to happen if I don’t wash my hands.”

Other signs of obsessive-compulsive disorder include excessive collecting or hoarding, compulsive counting, doing things in an unnaturally slow or ritualistic manner, replacing “bad” thoughts with “good” ones, and scrupulosity (religious obsessions and excessive concern about sin or being morally wrong.

People who behave in these ways are usually aware their behavior is unnecessary or extreme, but they feel unable to stop.

The above quote expresses the kind of dilemma faced by many individuals with obsessive compulsive disorder (OCD). Most people have obsessed about one thing or another or have engaged in some kind of compulsive behavior. For those with OCD, however, the obsessions are overwhelming and the compulsions can interfere even with the most basic tasks of daily living.

Vivian was a 29-year-old housewife who had just given birth to her first child. She was looking forward to being a mother, but one week after the baby was born, Vivian started worrying that she might contaminate her child with germs. She was terrified even by the thought of being responsible for the death of her child. As a result, Vivian washed her hands hundreds of times a day and wouldn’t take the baby out of the house for any reason. In addition, she spent hours talking about her fears and her behavior, seeking reassurance that she had not contaminated her child.

What is Obsessive Compulsive Disorder?

OCD is a potentially disabling condition in which an individual experiences unwanted and disturbing thoughts, impulses, or images (obsessions) and/or engages in repetitive mental or behavioral acts (compulsions). Because people with this condition typically experience severe anxiety, OCD is considered an anxiety disorder. In order to understand OCD it is first necessary to know something about the nature of obsessions and compulsions.

What are Obsessions?

Obsessions can be any unpleasant thought, scary image, unacceptable impulse, or object that creates fear or distress. In all cases, obsessions are involuntary and resisted by the person with OCD. Most people with this disorder understand their obsessions are unrealistic or excessive but feel unable to control them. Here are some common obsessions:

o Dirt, germs, contamination
o Doing something that might cause harm to others
o Making a mistake
o Thoughts perceived as evil or sinful
o Hostile or violent thoughts
o Sexual thoughts or impulses
o Thoughts about unacceptable behavior
o Disease or illness
o Things that are asymmetrical or imperfect

What are Compulsions?

Because the anxiety and other feelings triggered by obsessions can be so distressing, people with OCD develop strategies to try to feel better. These strategies called compulsions or rituals are attempts to relieve the distress caused by obsessions. For example, people afraid of dirt may wash their hands over and over again. An individual afraid of causing harm to other people may spend hours rechecking the stove to see if it is still turned off. Usually, compulsions are performed in a stereotyped, repetitive fashion.

Most with OCD realize their compulsions are unnecessary or in some way counterproductive but feel unable to resist them. Because they are influenced by emotions, more than logic, compulsions can be thought of as superstitious behavior. Here are a few of the more common compulsions:

o Washing (e.g., hands, personal objects, house)
o Checking (e.g., locks, pilot lights, electrical outlets)
o Collecting or hoarding items (i.e., can’t throw things away)
o Repeating certain movements over and over again
o Seeking reassurance
o Straightening or lining things up
o Placing items in a certain order or pattern
o Thinking about special numbers, images, thoughts, or designs in one’s mind

Is Obsessive Compulsive Disorder (OCD) Common?

For many years, mental health professionals believed that OCD was extremely rare. However, recent studies of the general population have revealed that OCD affects about 2% of the adult population. Less is known about the prevalence of childhood OCD, but it is likely that the disorder is also more common among children than was once thought. Among the different types of OCD, washing and checking, compulsions occur most frequently.

What Causes Obsessive Compulsive Disorder (OCD)?

Although there are many ideas about what causes OCD, no single theory has been universally accepted. Most experts agree that a combination of factors, both biological and psychological, contribute to the development of OCD. Therefore, the cause of this disorder can best be understood using a “contributing factors” model. This simply means that a number of factors might potentially contribute to the onset of OCD. Some of the factors that have been proposed include:

* Genetic predisposition
* Biochemical irregularities
* Stressful or traumatic life events
* History of childhood anxiety
* Faulty beliefs and unrealistic expectations
* Certain skill deficits
* Family problems

Can Obsessive Compulsive Disorder (OCD) be Treated?

Yes. Most individuals with OCD improve with appropriate treatment. Many exciting advances have been made in recent years. Treatment should begin with a comprehensive evaluation. It is important to take a close look at anything that could be contributing to the problem, be it physical or psychological. Then, a treatment plan should be tailored to the particular needs of the individual. This plan often includes a well-balanced combination of several approaches.

Cognitive Behavior Therapy

The goal of cognitive behavior therapy (CBT) is to help people learn to think, feel, and behave in ways that will reduce the symptoms of OCD. Patients are educated about the nature of obsessions and compulsions and are assisted in identifying, challenging, and modifying their inaccurate beliefs. They are also taught techniques to manage the physical and mental symptoms of anxiety caused by obsessions. Finally, through a series of exercises called “exposure and response prevention,” CBT helps people gradually face and become more comfortable with the things that used to make them fearful.

Medication for OCD

A class of drugs called serotonin reuptake inhibitors (SRIs) has been helpful in reducing OCD symptoms. Changes in serotonin are believed to be associated with OCD. Five SRI medications approved by the FDA for the treatment of OCD in the United States are Anafranil (clomipramine), Luvox (fluvoxamine), Prozac (fluoxetine), Paxil (paroxetine) and Zoloft (sertraline). Other related medications, such as Celexa (citalopram), may also be effective. SRI medications may be used alone or in combination with other drugs, depending on the individual case. For a few individuals, being on medication for a period of time is all that is necessary. For the majority, however, medication may need to be combined with cognitive behavior therapy.

Other Treatments for OCD

Forms of psychotherapy other than CBT can sometimes be helpful adjunctive treatments for OCD. Support groups – meetings with others who have the same problem – can also be useful. Family involvement in the treatment process is often valuable, and sometimes essential.

Where Can I Find Help?

While it would be reassuring to say that the average psychologist, psychiatrist, therapist, social worker, or counselor is skilled in the type of treatment approaches described, this is not the case. There may be only a handful of professionals in your area skilled in cognitive behavioral treatments for OCD. Similarly, although most physicians have prescribed medication for anxiety, fewer will have extensive experience specifically with OCD. Be a good consumer. Contact resources in your community such as a university medical center or an anxiety disorders treatment program and ask about the resources available. If you live in a community in which this type of facility is not available, contact the Obsessive Compulsive Foundation (203) 878-5669, or your local chapter of the Mental Health Association. They may be able to provide you with information as well as the names of practitioners in your area. Finally, do not hesitate to ask questions of the professionals you contact. They should be able to answer your questions and not be offended if you inquire about their credentials and experience.

What If someone I know has Obsessive Compulsive Disorder (OCD)?

People with anxiety disorders frequently feel isolated and alone. This is particularly true for individuals with OCD. They are often ashamed of or confused by the unusual nature of their symptoms and are understandable hesitant to discuss their problem with others. OCD sufferers sometimes actively hide their symptoms from family members. It is difficult for others to understand the overwhelming terror that people with OCD experience on a daily basis. Not surprisingly, individuals who have been able to tell friends, family members, or even healthcare professionals about their problem may have been met with disbelief or unintentional insult.

If you suspect that someone you care about OCD, please try to be understanding. Encourage him or her to be evaluated by a professional. Reassure the person that OCD is a common condition that affects all kinds of people that it is not a sign of weakness, and most importantly, that it is treatable. If the OCD sufferer’s problem is interfering with your life and the person is not willing to seek help, you can contact a professional yourself to learn how best to deal with the situation.


Saint Louis Behavioral Medicine Institute, Universal Health Services an academic affiliate of Saint Louis University Health Sciences Center is an established mental health care resource for St. Louis, MO. Visit their website at www.slbmi.com

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