Obsessive-compulsive disorder

Obsessions and compulsions

Let’s begin with a description of what obsessions and compulsions might feel like for someone affected:

My rituals invaded every aspect of my life. There was counting; counting really bothered me a lot. I would wash my hair three times as opposed to once because three was a good luck number and one wasn’t. It took me longer to read because I’d count the lines in a paragraph. When I set my alarm at night, I had to set it to a number that wouldn’t add up to a ’bad’ number. I knew the rituals didn’t make sense, and I was deeply ashamed of them, but I couldn’t seem to overcome them until I had therapy. Getting dressed in the morning was tough, because I had a routine, and if I didn’t follow the routine, I’d get anxious and would have to get dressed again. I always worried that if I didn’t do something my parents were going to die. I’d have these terrible thoughts of harming my parents. That was completely irrational, but the thoughts triggered more anxiety and more senseless behavior. Because of the time I spent on rituals, I was unable to do a lot of things that were important to me.

Obsessive-compulsive disorder (OCD) is characterized by intrusive thoughts that produce anxiety (obsessions), repetitive or ritualistic behaviors that are engaged in to reduce anxiety (compulsions), or a combination of both. The obsessions or compulsions cause marked distress, are time consuming (take more than one hour per day), or significantly interfere with the person’s normal routine, work or school functioning, or usual social activities or relationships. While most people with OCD are distressed by their symptoms, some apparently are not. While many are concerned about germs or leaving their stove on, people with OCD are unable to control their anxiety-producing thoughts and their need to engage in ritualized behaviors. As a result, OCD can have a tremendous negative impact on people’s day-to-day functioning. How to tell if obsessions or compulsions warrant professional attention? For example, if people are obsessed with germs or dirt, they may develop a compulsion to wash their hands over and over again. If they develop an obsession with intruders, they may lock and relock their doors many times before going to bed. Being afraid of social embarrassment may prompt people with OCD to comb their hair compulsively in front of a mirror-sometimes they get “caught” in the mirror and can’t move away from it. Performing such rituals is not pleasurable. At best, it produces temporary relief from the anxiety created by obsessive thoughts.

Other common rituals are a need to repeatedly check things, touch things (especially in a particular sequence), or count things. Some common obsessions include having frequent thoughts of violence and harming loved ones, persistently thinking about performing sexual acts the person dislikes, or having thoughts that are prohibited by their religious beliefs. People with OCD may also be preoccupied with order and symmetry (wanting things to be symmetrical), have difficulty throwing things out (so they accumulate), or hoard unneeded items.

Healthy people also have rituals, such as checking to see if the stove is off a couple of times before leaving the house. The difference is that people with OCD perform their rituals even though doing so interferes with daily life and they find the repetition distressing. Although most adults with OCD recognize that what they are doing is senseless, some adults and most children may not realize that their behavior is out of the ordinary.

What is the outcome for OCD?

OCD affects between 1 and 2 percent of North American adults in their lifetime, strikes men and women in roughly equal numbers and usually first appears in childhood, adolescence, or early adulthood. One-third of adults with OCD develop symptoms as children, and research indicates that OCD might run in families. Despite the irrational behavior, OCD is sometimes associated with above-average intelligence. People with OCD may also have personality traits such as high attention to detail, avoidance of harmful or risky situations, careful planning, exaggerated sense of responsibility and a tendency to take lots of time in making important decisions.

The course of OCD is quite varied. Symptoms may come and go, ease over time, or get worse. If OCD becomes severe, it can keep a person from working or carrying out normal responsibilities at home. People with OCD may try to help themselves by avoiding situations that trigger their obsessions, or they may use alcohol or drugs to calm themselves.

OCD usually responds well to treatment with certain medications and/or exposure-based psychotherapy, in which people face situations that cause fear or anxiety and become less sensitive (desensitized) to them. Treatment of Obsessions and compulsions is described in another article.

To learn more about psychological treatments for OCD, click here.

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Image credits: Dominick