About Obsessive-Compulsive Disorder

According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), Obsessive-Compulsive Disorder is:

characterized by the presence of obsessions and/or compulsions.  Obessions are recurrent and persistent thoughts, urges, or images that are experienced as intrusive and unwanted, whereas compulsions are repetitive behaviors or mental acts that an individual feels driven to perform in response to an obsession or according to rules that must be applied rigidly.

The compulsive behaviors may include but not be limited to repetitive hand washing or bathing, excessive cleaning, having to have things arranged in a specific manner, checking repeatedly to see if doors are locked or appliances are unplugged, going up and down stairs for no other purpose but to satisfy the compulsion or obsession.  It may contain repetitive counting (e.g., of ceiling tiles), stating a specific name or word over and over again, or locking and unlocking of doors, and excessive focus on symmetry such as having the same items lined up on a each side of a desk in the same  manner.   The individual may feel compelled to do something to prevent harm to self or others.  The repetitive behaviors may occur hundreds of times and comsume hours in the day.   Obsessions may include but not be limited to being focused on germ contamination, taboo thoughts, makiing a mistake, of a certain word, unfounded fearfulness that the person has a specific disease, fearful thoughts of having harmed someone (such as accidentally hitting a pedestrian while driving a vehicle) knowing it had not actually occurred.  To try and control obsessions, the person with OCD may engage in a compulsion(s).   The person with OCD may have the insight that his/her behaviors don’t make sense to engage in and obsessive thoughts are not true.  However, the person is at a loss in being able to control them.

In the general population, people may have rituals or thoughts that are repetitive but not be obsessive or compulsive.  For example, a person who checks the stove to make sure it was turned off before going to bed may do it once or twice.  The person with OCD may be compelled to check a hundred of times before the person is able to go to bed.  According to the National Institute of Mental Health, an individual with Obsessive-Compulsive Disorder generally:

According to the DSM-5, for a diagnosis of OCD, the obsession or sompulsion takes up more than an hour a day or cause great distress or impairment in functioning such as socially or at work.  An individual with this disorder may have good insight such as recognizing  that the fearfulness is excessive.  However, there can also be poor insight (such as believing that the person they think they harmed is probably not true).  There may also be no insight.

The actual cause of OCD is not known at this time.  However, there are factors that are thought to put people at risk for developing OCD.  They include genetics (people with first degree relatives (e.g., parent, sibling) who have OCD), certain abnormalities in the brain, and  abuse (sexual or physical) or other trauma experienced in childhood.  OCD or OCD symptoms may develop in some children following a streptococcal infection.

Treatment

According to the National Institute of Mental Health (NIMH), treatment for OCD usually consists of psychotherapy or medication or both and that most people with this disorder respond to treatment.  According to the DSM-5, "if OCD is untreated, the course is usually chronic, often with waxing and waning symptoms  Some individuals have an episodic course, and a minority have a deteriorateing course.  Please note that according to the DSM-5, if left untreated, "remission rates in adults are low.” 

Medications may assist in reducing symptoms. Some effective medications for adults and children include clomipramine, fluoxetine, fluvoxamine and sertraline.  According to the National Institute of Health:  “Research shows that certain types of psychotherapy, including cognitive behavioral therapy and other related therapies (e.g., habit reversal training) can be as effective as medication for many individuals.”  In Cognitive Behavioral Therapy (CBT), there is a focus on thoughts and perceptions.  This therapy recognizes that one’s feelings and behavior are largely influenced by one’s thought(s).  It consists of identifying, testing and correcting erroneous thinking to change the view of self and the world in an effort to decrease psychological disturbance, improve functioning, and decrease unwanted, problematic and self-destructive behaviors.  There is a focus on acquiring skills.  These learned skills may be applied during and following counseling and throughout life to apply to other issues or problems such as relationship difficulties, stress, anxiety, depression, anger.  According to National Institute on Drug Abuse, CBT assists in “enhancing patients’ self-control by helping them develop effective coping strategies. ...  Research indicates that the skills individuals learn through cognitive-behavioral approaches remain after the completion of treatment.   A type of CBT is called Exposure and Prevention Therapy (ERP) which has been demonstrated to be effective in the treatment of OCD.  With this type of therapy, the person is exposed to the obsession and then resists the ritual compulsive act.