Anxiety disorders paralyze millions of people daily, hijacking their thoughts, and blocking them from living their best lives. Fear, nervousness, and worry involuntarily fill their heads regularly, making it hard to think rationally or find any peace. One commonly known anxiety disorder is obsessive-compulsive disorder or OCD for short.
These three letters are an acronym for a disorder that keeps people in their disturbing thoughts and focused on their irrational urges. The loop of obsessive thoughts and compulsive behaviors are hard to control or escape from. People with OCD engage in ritualistic behaviors, such as excessive hand washing, and compulsively act to manage their thoughts. This routine offers some relief, but for many, it will not last long.
Hannah Boone, a writer for The Bold Italic, shares what it’s like to live with obsessive-compulsive disorder, describing it as “a heater that works for the winter but doesn’t turn off when summer rolls around.”
When her brain can’t turn off, her obsessive thoughts take her down the proverbial rabbit hole.
“…. the obsessions go off into things beyond work and self-improvement and into pointless things like adding and subtracting and counting and assigning numbers the roles of ‘good’ and ‘evil.’ I curse the teacher who taught me simple math,” she writes.
According to the American Psychiatric Association (APA), about 1.2 percent of U.S. adults have OCD and that adult women are affected at a slightly higher rate than men. The APA also reports that OCD begins in childhood and that symptoms typically start to appear at age 19.
Read on to learn more about OCD care and how you can develop an OCD treatment plan with your doctor.
What Is OCD?
Obsessive-compulsive disorder (OCD), as defined by the National Institute of Mental Health (NIMH), “is a common, chronic and long-lasting disorder in which a person has uncontrollable, [recurring] thoughts (obsessions) and behaviors (compulsions) that he or she feels the urge to repeat over and over.”
The Mayo Clinic writes that OCD “features a pattern of unreasonable thoughts and fears (obsessions) that lead you to do repetitive behaviors (compulsions). These obsessions and compulsions interfere with daily activities and cause significant distress.”
Trying to ignore or stop obsessions and compulsions only increases one’s distress and anxiety, the Mayo Clinic explains. Because of this, people with OCD will feel compelled to carry out acts of compulsion to ease their stress. Unfortunately, this does not stop irritating or bothersome thoughts or urges; they just return.
What results is ritualistic behavior, and this behavior traps people in what Mayo Clinic describes as the “vicious cycle of OCD.”
What Does OCD Look Like?
Obsessive-compulsive disorder is not always easy to spot despite the extreme thoughts and behaviors that accompany it. Excessive hand-washing and counting are common ways the condition shows itself. However, some people may not realize their obsessions or compulsions have become unreasonable and hard to manage.
Examples of this include a daily routine that takes up a lot of time or actions that affect one’s daily routine, the Mayo Clinic notes. It advises that people with OCD typically have both obsessions and compulsions. However, it is possible for a person to have only obsession symptoms or only compulsion symptoms.
NIMH writes that people with OCD:
- Struggle with controlling their thoughts or behaviors, even when it is recognized that both are excessive
- Spend at least an hour daily on their thoughts or behaviors
- Do not get any pleasure from the behaviors or rituals they engage in or perform, but find some relief from anxiety albeit briefly
- Experience significant challenges daily because of disturbing thoughts and behaviors
To understand OCD, health officials define what obsessions and compulsions are separately and list the signs for each.
The following is a description of each from NIMH’s website, which says:
“Obsessions are repeated thoughts, urges, or mental images that cause anxiety. Common symptoms include:
- Fear of germs or contamination
- Unwanted forbidden or taboo thoughts involving sex, religion, and harm
- Aggressive thoughts towards others or self
- Having things symmetrical or in a perfect order
“Compulsions are repetitive behaviors that a person with OCD feels the urge to do in response to an obsessive thought. Common compulsions include:
- Excessive cleaning and/or hand-washing
- Ordering and arranging things in a particular, precise way
- Repeatedly checking on things, such as repeatedly checking to see if the door is locked or that the oven is off
- Compulsive counting
The APA writes that compulsions serve to reduce fear, discomfort, or dispel anxiety. OCD symptoms can linger and either ease up or worsen over time. Some people will avoid triggering situations while others turn to alcohol and/or drugs to self-medicate and calm themselves.
The condition may be recognizable by the behavior shown. HelpGuide reports that people with OCD typically fall into the following categories:
- Checkers: This group repeatedly checks things, such as seeing if doors are locked, or if the oven is turned off, as they fear harm or danger and try to protect against those.
- Counters and arrangers: Order and symmetry are major priorities among people in this category. They also may hold superstitious beliefs about certain numbers, colors, or arrangements.
- Doubters and sinners: Among people in this group, there is fear that punishment will follow if things are not done perfectly or done in a particular way.
- Hoarders: Some people with OCD hoard items, even those they don’t want, need, or use because they fear something bad will happen to them as a result of them not having it. Depression, post-traumatic stress disorder (PTSD), compulsive shopping, attention-deficit hyperactivity disorder, skin picking, and tic disorders are common among this population, HelpGuide writes.
- Washers: People in this group fear contamination or getting dirty, or getting germs on them. Their compulsions are hand-washing and routine and excessive cleaning.
While these groups give a better idea of who could be struggling with OCD, keep in mind that some people successfully hide their symptoms out of stigma or embarrassment, Medical News Today says.
What Causes OCD?
The cause of obsessive-compulsive disorder remains unknown though researchers have identified several factors that could contribute to its occurrence. NIMH writes that these factors include:
Studies of twins and families have found that people whose parent, sibling, or child has OCD are at an increased risk of developing the disorder themselves. The risk is higher if the first-degree relative developed OCD as a child or teen,” NIMH writes. “Ongoing research continues to explore the connection between genetics and OCD and may help improve OCD diagnosis and treatment.”
Brain Structure And Functioning
Images of the brains of patients with OCD have highlighted differences in the organ’s frontal cortex and subcortical structures. Research continues to establish whether there is a link between abnormalities in certain parts of the brain and OCD symptoms.
Survivors of physical or sexual abuse that occurred during their childhood are also at a higher risk of developing OCD, NIMH writes.
As Medical News Today reports, some rapid-onset cases of OCD that involve children might result after Group A streptococcal infections or other pathogens.
How Is OCD Diagnosed?
While obsessive-compulsive use is one of the more widely known mental health disorders, diagnostic criteria extend beyond excessive hand-washing and counting. BeyondOCD.org highlights what needs to be present for a diagnosis of OCD, as provided by the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, or the DSM-5. The following text appears on the site, which is taken from the manual:
- The presence of obsessions, compulsions or both
- The obsessions or compulsions are time-consuming (e.g., take more than 1 hour per day) or cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
- The obsessive-compulsive symptoms are not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition.
- The disturbance is not better explained by the symptoms of another mental disorder.
If these criteria are met, then a person may be diagnosed with OCD.
Treatment For OCD
Obsessive-compulsive disorder is usually treated with medication and psychotherapy; some patients could be treated with both at the same time. NIMH writes, “Although most patients with OCD respond to treatment, some patients continue to experience symptoms.”
NIMH cautions that a person is evaluated for other mental health disorders if OCD is being considered. Many people who struggle with OCD also have other mental health illnesses, such as anxiety, depression, and body dysmorphic disorder, the federal health agency says. In many cases, the most effective OCD services will involve a mix of medications and psychotherapies. Ultimately, the best OCD rehab is the one that you and your doctor decide is best for you.
Cognitive Behavioral Therapy (CBT)
Cognitive behavioral therapy is widely recommended for people with OCD. It can take place in a one-on-one setting or groups. The Mayo Clinic explains that during this therapy, a person pairs up with a mental health professional, such as a therapist or mental health counselor, in a structured setting to learn how to become more aware of inaccurate or negative thinking so they can improve their response to challenging and stressful situations.
CBT allows people to learn about their mental health condition and how to practice techniques that promote relaxation and resilience.
According to NIMH writes that CBT can be as effective as medication for some people, and it writes that Exposure and Response Prevention (EX/RP) can help reduce compulsive behaviors, even for people who found medication ineffective.
Exposure and Response Prevention
Exposure and response prevention is a form of therapy that’s often used to treat anxiety disorders and phobias, but it may also treat OCD. Exposure therapy involves exposure to thoughts, images, or concepts that you have an aversion to or ones that have caused triggers in the past. It’s a branch of CBT that is specifically designed to help people that have mental health disorders centered on triggers that they might experience in their everyday life.
Exposure and response therapy seeks to help you increase your tolerance for triggers and to create strategies to help you overcome those triggers when you experience them in daily life. For someone with OCD, this may involve methods of quieting obsessive thoughts or dealing with them without engaging in compulsive rituals.
For people that are not ready to face triggers directly, imaginal exposure involves imagining triggers and increasing your tolerance. For example, someone that can’t shake someone’s hands without having to engage in ritual hand-washing may imagine shaking a person’s hand. Your therapist may guide you through exercises of imagining triggering events and how you might be able to handle them in a positive way.
OCD Treatment and Dual Diagnosis
Mental health disorders have a significant overlap with drug and alcohol use and abuse. It’s so common for them to occur at the same time that having a mental health disorder is a risk factor for substance use problems. Substance use disorders can occur alongside common mental health disorders like anxiety and depression, but they can also occur alongside OCD.
People with mental health disorders often seek drugs or alcohol as a way to dull uncomfortable mental or emotional symptoms. People with OCD may approach drugs or alcohol for similar reasons. Drugs or alcohol may serve to temporarily suppress obsessive thoughts or compulsive actions. This is called self-medication, which is the use of an active substance to treat medical or mental health issues without consulting a doctor.
While self-medication may offer temporary relief, it is more likely to cause more harm than good. If a substance use disorder is added to your OCD symptoms, your challenges may be compounded. Plus, having a substance use disorder and OCD at the same time can complicate treatment.
Dual diagnosis involves a mental health and substance use disorder, and dual diagnosis treatment involves medications and therapies that address both at the same time. Mental health and substance use problems can worsen one another. If you try to treat one while ignoring the other, you may have limited success with either disorder. However, many treatment options can be used to treat both issues. For instance, cognitive behavioral therapy is used to treat both disorders.
Several medications treat OCD and other issues OCD may cause. People who take medications as prescribed for OCD have shown improved quality of life, according to the APA.
If medication is prescribed for OCD, it likely will be from a class of medicines called selective serotonin reuptake inhibitors (SSRIs), a type of antidepressant.
As the Mayo Clinic explains, SSRIs ease symptoms of moderate-to-severe depressions. Serotonin is a brain chemical called a neurotransmitter that carries signals between cells in the brain. SSRI medications block the reabsorption, or reuptake of serotonin, making more of the chemical available.
According To PsyCom, The Medications Most Prescribed In OCD Treatment Are:
- Sertraline (Zoloft)
- Fluoxetine (Prozac)
- Clomipramine (Anafranil)
- Fluvoxamine (Luvox, CR)
- Paroxetine (Paxil, Pexeva)
The dosage for SSRI medications may be higher for OCD patients than those who are prescribed to take it for depression. The APA advises that six to 12 weeks could pass before a patient sees noticeable benefits from the medication. Harvard Health Publishing writes that some people treated for OCD may find it beneficial if they continue to take medication indefinitely.
If that needs to change, it writes that the APA advises clinicians and patients give the treatment some time before changing it. If 10 to 12 weeks have passed, and no benefits are seen, then it may be time for a change.
Anxiolytics may also be used to treat OCD, especially if it comes with severe anxiety or sleep problems. Anxiolytics are depressants that have anti-anxiety effects on the brain. Most prescription anxiolytics fall under the category of benzodiazepines, a group of depressants that cause sedation, hypnosis, and anti-anxiety. However, other non-benzodiazepine sleep aids are mild and have a lower risk of chemical dependence.
Living With OCD
OCD is a treatable condition for many people, but it’s also a chronic one, which means people who have it must commit to a lifestyle that promotes health and wellness and become aware of triggers and warning signs.
HelpGuide offers tips and strategies for how people with OCD can help themselves when they recognize that OCD symptoms have emerged. Those include learning how to resist OCD rituals by facing your fears and planning for compulsive urges.
Writing down obsessive thoughts or worries can help the brain to avoid getting stuck on anxiety-causing thoughts. Scheduling a specific period or place to engage in OCD “worry periods” that last 10 minutes or so is one way to manage stressful thinking. Always seek support from family, friends, and organizations. OCD groups such as the OCD International Foundation and ones that can be found locally can help people feel less alone as they manage life along with a mental health disorder.