What is OCD?

Overview

OCD is short for Obsessive compulsive disorder. In the U.S, approximately 2.3% of the population suffer chronically from the disorder. In the last year, 50% of those diagnosed suffered from major impairment that seriously affected their daily living (Nimh). OCD is a mental illness where the severity is often unfairly diminished and disregarded as well as inaccurately depicted in media.

Symptoms

OCD is a disorder characterized by obsessive, intrusive thoughts that inevitably lead to compulsions being acted out. This is a vicious cycle for those with OCD, with these repeated thoughts or images invading the mind that they have to suppress or temporarily negate with compulsive behaviors. There are a multitude of ways that OCD can manifest itself in terms of the forms of obsessions and compulsions. It is not just expressed in terms of obsessive cleaning, the way that people stereotype it to be. There are actually a few major kinds of OCD, checking, contamination, symmetry, and rumination. These are the major ones but really a person can develop obsessions and compulsions regarding anything, others include harm, religious, and unwanted sexual obsessions.

Checking – The obsessive thoughts that cause checking compulsions can vary but typically revolve around the fear that something bad will happen if they don’t, either to themselves, loved ones, or regarding whatever they’re checking. Checking compulsions can include checking locks, appliances, valuables, etc. Individuals may also check themselves for illness, pregnancy, HIV, etc.

Contamination – Contamination is more of an obsession than a compulsion. Compulsions that accompany contamination obsessions are usually avoidance, cleaning, excessive hand washing. The obsessions themselves can revolve around toilets, door handles, hospitals, etc. Really anything that the individuals believes will get them dirty, sick, etc.

Symmetry – Symmetry is a compulsion, like checking. The obsession fueling the symmetry or orderliness is typically the thought that harm will come to yourself or loved ones or discomfort that can only be reduced by orderliness. This compulsion can manifest itself as keeping pictures, objects, books perfectly straight or in a specific order, or making sure things face the same way. These compulsions can overlap with checking as well.

Rumination - Ruminations are obsessions without a fixed compulsion. They are long-term thoughts that aren’t resisted, instead they are fully embraced and a person can get lost in them. Individuals will spend long periods of time thinking about intense topics like morality and religion.

Diagnosis

When an individual is diagnosed with OCD, they typically have suffered from the disorder for a while and may have been misdiagnosed in the past. The average time from developing the condition to diagnosis is 11 years (Fenske & Petersen, 2015). Typically, a primary care doctor will refer a patient to a mental health professional (psychiatrist, psychiatric nurse, social worker, or psychologist) for diagnosis. When a mental health professional (MPH) is diagnosing a patient, they will first rule out other illnesses or medications that can be causing symptoms. Most of the symptom overlap will be with other psychological conditions though, because OCD has such a unique symptomology. Despite this, OCD is commonly misdiagnosed as anxiety and depression. Once the MPH has ruled out any other conditions or medications they will move on to a clinical interview where they can gather information and symptoms that they can diagnose using the DSM-5. They will use the criteria above in symptoms, paying attention to a presence of obsessions OR compulsions even though both are typically seen together in OCD. These obsessions/compulsions have to significantly impact daily life, consuming at least one hour daily of a person’s time. When diagnosing it’s important to distinguish OCD from other “obsessive compulsive and related disorders”. This was a distinction made in the 5th edition of the DSM, separating it from other anxiety disorders. These related disorders are as follows:

Obsessive Compulsive and Related Disorders

- Trichotillomania (hair-pulling)

- Body Dysmorphic Disorder

- Hoarding Disorder

- Excoriation Disorder (skin-picking)

**It’s also important to note that OCD is not the same thing as a tic-disorder. Someone with OCD can have a comorbid tic-disorder, but the two conditions are not the same.

Treatment

Treatment for OCD can include medication and therapy or a combination of the two. There are a few other options than what are listed below but these are the typical paths of treatment.

Therapy - Cognitive Behavioral Therapy (CBT) has been empirically shown to help those with OCD. CBT is focused on identifying and changing the negative thoughts and behaviors of individuals to establish a healthier pattern of thinking and feeling. Exposure therapy is a technique often employed in CBT (with the client’s consent). Exposure therapy is when an individual is exposed to an anxiety inducing trigger, or multiple, to help them reduce this anxiety or fear over time. This is done either gradually or through a process called flooding, where the client is immediately introduced into a fearful situation.

Medication – Part of the reason OCD used to be categorized as an anxiety disorder and the reason that many argue that it should remain in that category is that it responds well to SSRIs. Selective Serotonin Reuptake Inhibitors (SSRIs) are also commonly used to treat anxiety disorders. Antidepressants like Prozac, Lexipro, Paxil, etc. are all SSRIs and commonly used to treat OCD.

What can you do?

Individual with OCD

· Don’t worry about people being afraid of you or judging you for getting treatment

· Do not be afraid to seek help, things won't get better if you don't. Therapists are understanding and ethically bound to remain judgement free, empathetic, and confidential. Anything you say to a therapist (aside from threatening to harm oneself or others) is held in complete confidence between you and the therapist.

· Understand that treatments like CBT can be hard and require a lot of effort but are really effective.

· Facing your fears is a large part of treatment, and being in anxious situations is necessary

· Asking for help does not make you weak, you can't get over other diseases without going to the doctor. Why is this different?

· Don't be disappointed if treatment doesn't work immediately, medications and therapy take time to be effective. It also might take time to find the right medication and/or therapist.

· You are not weak for neutralizing obsessive thoughts or using avoidance.

Loved One

· Be aware of changes in behavior and mood, to try to identify if a loved one could be suffering from OCD

· Talk to that person, don't pressure them if they are uncomfortable but make them aware that you love them and are there for them if they need to talk.

· Pay attention to warning signs of suicidal ideation and call the National Suicide Prevention Hotline (1-800-273-8255) if necessary.

· Be accepting and understanding, help them understand that this is not their fault and they don't need to seek treatment alone

· Respectfully ask about the nature of their obsessions and/or compulsions if they are willing and comfortable to share that with you

· Don’t react in a negative way to their obsessions, remember that they are unwanted thoughts, images, ideas that they don’t wish to think of.

· Be aware that they also don’t take pleasure from their rituals or compulsions, typically they are plagued by them.

· Avoid stigmatizing language, like the statements and questions listed below

Things you shouldn't say to those with OCD:

- I am so OCD about____

- You must love to clean

- You should clean my place!

- Wow, I wish I was this organized

- I’ve never noticed

- You’re just a perfectionist, anal, meticulous, etc.

- I wish I had OCD

Removing Stigma

The stereotypes associated with those with OCD are often perpetuated more often because they are considered less harmful than the stereotypes associated with people diagnosed with schizophrenia or bipolar disorder (link my article). This shouldn’t be the case, stigma is stigma regardless, a stereotype that centers around cleanliness can be just as damaging as a stereotype centered around violence and anger. Especially if the stereotype is one that is so often reiterated and never challenged in daily life. This is the case for OCD stigma. All mental illnesses are stigmatized, but OCD is one of the most targeted, because of the lack of “severity” people think the stereotypes hold. The stereotypes about those that are OCD being clean, germophobic, checking the locks and stove all the time, having tics, etc. All of these stem from a very narrow view of what OCD is, when it really encompasses a wide variety of symptoms. The best thing that someone can do to remove the stigma related to OCD is to…

- Stop using OCD in common language to describe things that aren’t OCD.

- Speak up when someone else is using the term OCD inappropriately, or perpetuating stereotypes.

- When talking to someone about using OCD language, try to tell them that

o OCD is a serious mental illness, and those that suffer from it don’t enjoy their compulsions, etc.

o You would never use any physical illness in the same context of conversation

Sources

International ocd foundation | how is ocd treated? (n.d.). Retrieved April 14, 2019, from International OCD Foundation website: https://iocdf.org/about-ocd/ocd-treatment/

Nimh » obsessive-compulsive disorder(Ocd). (n.d.). Retrieved April 13, 2019, from https://www.nimh.nih.gov/health/statistics/obsessive-compulsive-disorder-ocd.shtml

Diagnostic and statistical manual of mental disorders and ocd – ocd-uk. (n.d.). Retrieved April 13, 2019, from https://www.ocduk.org/ocd/clinical-classification-of-ocd/dsm-and-ocd/

Fenske, J. N., & Petersen, K. (2015). Obsessive-compulsive disorder: diagnosis and management. American Family Physician, 92(10), 896–903. https://www.aafp.org/afp/2015/1115/p896.html

Shelby Chapman

Interdisciplinary Artist