Obsessive Compulsive Disorder, also known as OCD, is characterized by a pattern of unreasonable thoughts and fears (obsessions) that lead you to do repetitive behaviors (compulsions). Many individuals try to ignore or stop their obsessions, but that only increases the distress and anxiety experienced by these individuals. These obsessions and compulsions interfere with daily activities and cause significant distress. Many individuals with OCD know or suspect their obsessions are not true; others may think they could be true (which is known as poor insight). About 1.2 percent of Americans have OCD and the typical age of onset is around 19 years old and about 2% of cases start by age 14. The onset age for individuals after the age 35 is unusual, but does occur. Males have an earlier onset of OCD than females and are more likely to have comorbid tic disorders.
Obsessive Compulsive Disorder Defined
Obsessive compulsive disorder is an anxiety disorder in which people have recurring, unwanted thoughts, ideas or sensations (obsessions) that make them feel driven to do something repetitively (compulsions). For people with OCD, thoughts are persistent, and unwanted routines and behaviors are rigid, and not doing them causes great distress. Many individuals with OCD have dysfunctional beliefs that may include: an inflated sense of responsibility and the tendency to perfectionism, overestimate threat, intolerance of uncertainty, over importance of thoughts, and the need to control thoughts. Some individuals with obsessive compulsive disorder may use alcohol or drugs to calm themselves. OCD is treatable, but if left untreated, the course can be chronic. Poor insight has been linked to worse long-term outcomes.
Different Types of Obsessive Compulsive Disorders
While there are not different types of obsessive compulsive disorders, there are 3 levels of insight in the Diagnostic and Statistical Manual of Mental Disorders.
- With good or fair insight: the individual recognizes that obsessive compulsive disorder beliefs are definitely or probably not true or that they may or my not be true.
- With poor insight: the individual thinks obsessive compulsive disorder beliefs are probably true.
- With absent insight/ delusional beliefs: the individual is completely convinced that the obsessive compulsive disorder beliefs are true.
Obsessive Compulsive Disorder Causes
The cause of obsessive compulsive disorder can depend on environment, genetics, and or brain structure and functioning. Research shows that in many cases individuals who have experienced abuse (physical or sexual) in childhood or other trauma are at an increased risk for developing OCD. Genetically, the risk is higher if the first-degree relative developed OCD as a child or teen. Twin and family studies have shown that individuals with first-degree relatives (such as a parent, sibling, or child) who have OCD are at a higher risk for developing OCD themselves. Research has found a connection between abnormalities in certain parts of the brain and OCD symptoms. These parts include frontal cortex and subcortical structures of the brain.
Obsessive Compulsive Disorder Symptoms
To be diagnosed with general obsessive compulsive disorder, according to the Diagnostic and Statistical Manual of Mental Disorders, the following criteria must be met:
A. Presence of obsessions and compulsions, or both:
Obsessions are defined by (1) and (2):
- Recurrent and persistent thoughts, urges, or images that are experienced, at some time during the disturbance, as intrusive and unwanted, and that in most individuals cause marked anxiety or distress.
- The individual attempts to ignore or suppress such thoughts, urges, or images, or to neutralize them with some other thought or action (i.e., by performing a compulsion)
Compulsions are defined by (1) and (2):
- Repetitive behaviors (e.g., hand washing, ordering, checking) or mental acts (e.g., praying, counting, repeating words silently) that the individual feels driven to perform in response to an obsession or according to rules that must be applied rigidly.
- The behaviors or mental acts are aimed at preventing or reducing anxiety or distress, or preventing some dreaded event or situation; however, these behaviors or mental acts are not connected in a realistic way with what they are designed to neutralize or prevent, or are clearly excessive.
* Young children may to be able to articulate the aims of these behaviors or mental acts. *
B. The obsessions or compulsions are time-consuming (e.g., take more than 1 per day) or cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
C. The obsessive- compulsive symptoms are not attributable to the physiological effects of a substance (e.g., a drug abuse or a medication) or another medical condition.
D. The disturbance is not better explained by the symptoms of another mental disorder e.g; excessive worries, as in generalized anxiety disorder, preoccupation with appearance, like body dysmorphic disorder; difficulty with discarding or parting with possessions, as in hoarding disorder; hair pulling, as in trichotillomania (hair picking disorder); skin picking, as in excoriation (skin picking disorder); stereotypes, such as stereotypic movement disorder; ritualized eating behaviors, like eating disorders;preoccupation with gambling or substances, like substance-abuse-related disorders or gambling disorders, repetitive patterns of behavior, as in autism spectrum disorder; thought insertion or delusion, as in schizophrenia; sexual urges or fantasies; as in paraphilic disorders; impulses, as in disruptive, impulse- control, and conduct disorders; and guilty rumination, as in major depressive disorders.
How to Approach a Loved One
There is not a perfect way to approach a loved one that you assume or know has obsessive compulsive disorder. People with obsessive compulsive disorder may be embarrassed and try to hide symptoms or rituals, and mental rituals can be very difficult to recognize. While preventing a loved one from developing an obsessive compulsive disorder is not possible, providing support and being aware of what they’re learning in treatment can be helpful. For more information on how to approach a loved one with a obsessive compulsive disorder visit: https://www.psychguides.com/guides/how-to-find-help-treating-obsessive-compulsive-disorder/
Types of Obsessive Compulsive Disorder Treatment
Treating obsessive compulsive disorder usually includes the combination of medication and therapy. It is important to distinguish the best course of treatment individually.
The most common forms of medication used to reduce OCD symptoms are serotonin reuptake inhibitors (SRIs) and selective serotonin reuptake inhibitors (SSRIs). Some medications that are effective in both adults and children with OCD include fluoxetine, fluvoxamine, and sertraline.
Research has also shown that antipsychotic medication (like risperidone) can also be effective if the other listed medications do not work. When using medication, it is important to talk with a doctor or a pharmacist to make sure the risks and benefits are understood. Do not stop taking a medication without talking to a doctor first.
Psychotherapy is also an effective treatment for adults and children with obsessive compulsive disorder. Research shows that certain types of psychotherapy, like cognitive behavior therapy (CBT) can be as effective as medication for many individuals. Specifically, Exposure and Response Prevention (EX/RP). This form of treatment, which is used in reducing compulsive behaviors in OCD, is usually the add-on treatment of choice when SRIs or SSRIs medication does not effectively treat OCD symptoms.
Differences Between Common Disorders
There are other disorders that may resemble general obsessive compulsive disorder, so it is important to differentiate the difference between common disorders that may get confused with this disorder.
- Anxiety disorder-Recurrent thoughts, receptive request for reassurance, and avoidant behaviors also occur in anxiety disorders. The difference is these recurrent thoughts (as seen in generalized anxiety disorder) are usually about real life concerns, which is different than recurrent thoughts in individuals with OCD that are usually odd, irrational, or seemingly magical in nature.
- Major depressive disorder-Obsessive compulsive disorder can be distinguished from the rumination of major depressive disorder, in which thoughts are usually congruent to an individual’s mood and not typically intrusive or distressing. These ruminations are not linked to compulsions like in OCD.
- Other obsessive compulsive related disorders- In body dysmorphic disorder, the obsession and compulsions are limited to concerns about physical appearance. Another example is trichotillomania (hair pulling disorder). The compulsive behavior is limited to hair pulling in the absence of obsessions.
- Eating disorders- OCD can be distinguished from anorexia nervosa in that in OCD the obsessions and compulsions are not limited to concerns about food and weight.
- Tics (in tic disorder) and stereotyped movements- Tics and stereotyped movements are typically less complex than compulsions and are not aimed at neutralizing obsessions. It is difficult to distinguish between complex tics and compulsions. Some individuals have symptoms of both OCD and a tic disorder.
- Psychotic disorders- While individuals with obsessive compulsive disorder have poor insight or even delusional OCD beliefs, these individuals have obsessions and compulsions and do not have other features of schizophrenia or schizoaffective disorder.
- Other compulsive like behaviors- Certain behaviors can be described as compulsive, like gambling and substance abuse. However, these behaviors are different from the compulsions seen in individuals with OCD in that the person usually derives pleasure from the activity and may wish to resist it because of its damaging consequences.
- Obsessive compulsive personality disorder- While obsessive compulsive personality disorder and OCD have similar names, the presentation of these disorders are very different. Obsessive compulsive personality disorder is not characterized by intrusive thoughts, images, or urges or by repetitive behaviors that are performed in response to these intrusions. Instead obsessive compulsive personality disorder is a pattern of excessive perfectionism and rigid control. Both disorders can be diagnosed.
American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders.
(5th ed.) Arlington, VA: American Psychiatric Association.
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