do you know if you have Obsessive Compulsive Disorder or OCD?
You know that you might have
OCD if you spend much of your time and energy trying to fend off unwelcome, recurrent thoughts (obsessions) or engaging in
repetitive behaviors (compulsions) that you feel driven to perform. You have the sense that these thoughts
and behaviors are irrational or excessive, or have been told so by others, but you have little or no control over them.
Typical obsessions include fear of contamination (for example, refusing to touch doorknobs or use public
restrooms), fear of acting on violent or aggressive impulses (for example, worrying that you may have accidentally run over
someone and not known it), inordinate concerns with having your household or office arranged in a very particular manner (for
example, being upset with family when they move an article or leave a dish in the sink), or fear of having terrible thoughts
of a blasphemous or sexual nature.
Typical compulsions include excessive washing (particularly hand
washing to the point of causing skin damage to your hands), over-cleaning especially with anti-bacterial products, counting
behavior or making sure you do something a certain amount of times, checking locks or the whether the stove is off over and
over and never being sure it has been done properly, or arranging and ordering your possessions in an exact manner (for example,
refolding a towel a dozen times to be sure it is folder correctly).
You engage in compulsions because
you feel that doing so will protect you in some way or lessen your anxiety. Sometimes you do find yourself
comforted for a moment or two. But this is only short term. In the long term, acting
on your obsessions by engaging in compulsive or ritualistic behavior greatly increases your distress.
other kinds of symptoms can occur with OCD?
Several related disorders fall into the category
of OCD. If you are overly preoccupied with a minor or imagined bodily defect or have exaggerated those
defects to the point of feeling that you are so ugly that others are disgusted by your appearance (with repeated denials from
others that this is true), you may be suffering from body dysmorphic disorder. Hypochondriasis, or being
overly concerned with your health or having unfounded fears about illness, is another example of our thoughts gone awry.
Some problems that fall more accurately into the realm of habit disorders
can also have a repetitive, driven nature. For example, nail biting to the point of injury, pulling out
hair, eyebrows, or eyelashes (trichotillomania), or hoarding, also known as the “pack rat” syndrome.
These habit disorders are sometimes classified as OCD disorders but are less likely to respond to the medications and
behavioral therapies used for OCD. They respond better to therapies specifically designed to treat habit
Of course, almost every sufferer of OCD also becomes depressed or despondent at some
point because she cannot control her thoughts or behaviors despite all of her good intentions.
Are you alone?
Absolutely not! OCD is the
fourth more common neuropsychiatric illness in the United States. One in 40 adults and one in 200 children
suffer from OCD at some point in their lives. That means that at any one time, you have 5 million friends
suffering along with you.
How disabling can OCD be?
its very mild form, when obsessions and compulsions fall more into the category of a personality disorder, you are simply
a “neat freak” or do a mite more checking the locks and the stove than the average bear.
In its mild to moderate form, OCD has a chronic course with symptoms getting more distressing at times
and almost disappearing at other times in your life. At this level of severity, most people can continue
to function and usually only their closest friends, family, or colleagues realize that they have certain habits that seem
odd or excessive. Of course, obsessive thoughts are not visible and may be causing more
severe distress, a kind of private hell.
In its most severe form, OCD is progressive, deteriorating,
and quite disabling. In those cases, the sufferer becomes isolated, regular employment and even normal
social interaction become impossible, and they may require hospitalization.
What about other
compulsive habits like drug and alcohol addiction? Are they forms of OCD?
The difference is that with compulsive gambling, alcohol or drug abuse, overeating, all of which are difficult or impossible
to stop, there is a pleasure component. With OCD, the compulsive behaviors are never,
in and of themselves, pleasurable. There is a strong anxiety or distress component when engaging in the
Are you crazy?
behavior may seem “crazy” to you or even to others, but YOU are not “crazy” in the sense of suffering
from a more serious mental illness such as schizophrenia, where sufferers are not in touch with reality. We
think that there is a biochemical imbalance involved in OCD. The brain’s chemical systems that regulate
feedback about our behavior may be involved. There may be a genetic or inherited factor.
I sometimes describe OCD as having the KGB (the old Russian version of the CIA) in your head giving you
“disinformation” at all times.
Don’t be afraid to seek treatment out of fear that
you will be labeled as “crazy”.
types of treatment are available for OCD?
There are two treatments that have been proven
effective against OCD: Cognitive-behavior therapy (CBT) and medication (primarily medications affecting
serotonin). A combination of medication and CBT is often the most effective treatment for OCD.
CBT consists of a technique called exposure and response prevention. It
is effective for many people with OCD. You are deliberately and voluntarily exposed to feared objects or ideas (the exposure
component), either directly or by imagination and then are discouraged or prevented (with your permission) from carrying out
the usual compulsive response (the response prevention component).
For example, if you are a compulsive
hand washer, you may be urged to touch an object believed to be contaminated and then may be denied the opportunity to wash
for several hours. When the treatment works well, the patient gradually experiences less anxiety from the obsessive thoughts
and becomes able to do without the compulsive actions for extended periods.
of behavior therapy for QCD have found it to produce lasting benefits. To achieve the best results, a combination of factors
is necessary. The therapist should be trained in CBT for OCD disorders, the patient must be highly motivated,
and the patient’s family must be cooperative. The patient must also be faithful in fulfilling
A number of medications
that have been shown to be useful in treating OCD. Drugs that have been shown to be effective in such studies
include: fluvoxamine (Luvox), fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil), citalopram(Celexa), escitalopram
(Lexapro), and clomipramine (Anafranil). To boost a drug’s effect, sometimes two or more medications
are used together. (NOTE: This article was first written in 2007. There are now many new medications which
are effective in the treatment of OCD and other anxiety disorders. Please contact your physician or psychiatrist for
the latest information.)
Where can you find our
more information on OCD?
The Obsessive Compulsive Foundation (OCF) is a not-for-profit mental health organization. The OCF’S mission is to increase research into and promote treatment
and understanding of OCD. OCF resources and activities include: an informative web site with subsections
on compulsive hoarding and a webzine for teenagers and young adults; support groups throughout the United States and Canada;
referrals to treatment providers; the sale and distribution of books, pamphlets and other OCD-related materials.
always recommend starting by reading Edna Foa’s book S.T.O.P. Obsessing available at Amazon.