Obsessive-compulsive disorder (OCD) is a mental health condition characterized by distressing and recurring thoughts (obsessions) that frequently lead to compulsive behavior (compulsions). They may need to perform these compulsions many times until they feel comfortable.
OCD manifests itself in various ways and extends far beyond the prevalent idea that it’s limited to hand washing and to check locked doors. Although these are legitimate OCD compulsions, such perceptions fail to recognize the distressing thoughts that precede such behaviors and fail to emphasize the negative effects these constant compulsions can produce. Most people with OCD are aware of the extreme nature of their thoughts and behaviors but find it difficult to disengage. In the United States, OCD affects between 2% to 3% of the population, and more women are affected than men.
Types of Obsessive Compulsive Disorders
Technically speaking, there are no subtypes of OCD. However, there are some conditions that are similar in some aspects but distinct in others. These conditions are referred to as obsessive-compulsive-related disorders (obsessive-compulsive spectrum disorder).
The most common obsessive-compulsive-related disorders include:
Body Dysmorphic Disorder
Body Dysmorphic Disorder – A person with body dysmorphic disorder is fixated on a nonexistent or scarcely visible perceived fault in physical appearance. These perceived physical flaws lead individuals to believe they are undesirable, ugly, repulsive, or deformed. These obsessions can involve any body part but frequently concern the skin, face, or hair. The preoccupation with imagined physical flaws causes the individual to engage in repetitive and ritualistic mental and behavioral actions, such as constantly looking in the mirror, attempting to conceal the offending body part, comparing themselves to others, and, in extreme cases, undergoing cosmetic surgery. Body dysmorphic disorder affects an estimated 2.4% of individuals in the United States, with somewhat greater prevalence among women than men.
Hoarding Disorder
Hoarding Disorder – People with hoarding disorder cannot let go of their belongings, regardless of how worthless or unnecessary they are. As a result, these folks amass large quantities of typically worthless objects, which clutter their homes. Sometimes, the clutter is so great that the individual cannot use their kitchen or sleep on their bed. People with this condition have a tough time letting go of things because they believe they may eventually be of use or have a sentimental relationship with the items. Hoarding disorder affects nearly 2.6% of the U.S. population, with higher rates among people over 60 and those with other psychiatric diagnoses, especially anxiety and depression.
Trichotillomania
Trichotillomania – Also known as trich, trichotillomania is a condition where a person cannot resist the urge to pull out their hair, most commonly from the scalp, eyelids, and eyebrows. Trichotillomania is more common in teenagers and young adults and can cause significant distress and problems with social functioning. Trichotillomania can range in severity from minor to severe. In extreme situations, trichotillomania can cause anguish, shame, or health concerns, such as tooth damage from hair-biting, gastrointestinal pain, or injury from trichobezoars (masses of hair in the digestive system). Trichotillomania affects approximately 1 to 2% of adults in the United States.
Signs and Symptoms
People with OCD may have symptoms of obsessions, compulsions, or both. Obsessions are recurrent, persistent thoughts, images, or urges that cause anxiety, disgust, or unease. Many individuals with OCD know that these are mental constructs that are excessive or irrational. However, logic or reasoning cannot alleviate the agony brought on by these unwanted ideas. Most people with OCD attempt to alleviate the distress caused by their obsessive thoughts or eliminate the perceived threats through compulsions. They may also attempt to ignore, repress, or divert themselves from their obsessions with other activities.
Examples of common obsessive thoughts include:
- Fear of germs or contamination by people or the environment
- Unwanted or forbidden thoughts involving sex, religion, or harm
- Aggressive thoughts toward others or self
- Excessive concerns about illness, religious issues, and morality
- Extreme concern with symmetry, order, or precision
- Extreme anxiety that something is incomplete
- The dread of losing or discarding something precious
In contrast, compulsions are repetitive behaviors that a person feels driven to do in response to an obsession. These behaviors temporarily relieve or reduce a person’s distress related to an obsession; thus, they are more likely to repeat them in the future. Compulsions can be directly related to an obsession (such as washing hands excessively due to fear of contamination) or be completely unrelated. In more severe cases, a constant repetition of rituals may occupy the day, making it difficult to have a normal routine.
Examples of compulsions include:
- Excessive cleaning, showering, brushing teeth, or handwashing
- Organizing and arranging things a certain way
- Repeatedly checking on things (for example, repeatedly checking if the oven is off or if the door is locked)
- Compulsive counting, repeating, excessively preferencing, or avoiding certain numbers
- Constantly looking for affirmation or acceptance
Some people with OCD also have a tic disorder. Motor tics include sudden, brief, repetitive movements, such as facial grimacing, shoulder shrugging, eye blinking or other eye movements, or head or shoulder jerking. In contrast, vocal tics include repetitive throat clearing, sniffing, or grunting sounds.
OCD symptoms may come and go, improve over time or worsen. People with OCD may try to avoid certain people, places, or situations that trigger their obsessions or use alcohol or other substances to calm themselves. However, doing so will only further impair their ability to function and impact other mental or physical health aspects.
Risk Factors
People of all ages, genders, races, and ethnicities are susceptible to developing OCD. Although OCD can strike at any age, there are two common windows of vulnerability: 8-12 years old and late adolescence/early adulthood.
Studies have revealed that patients with OCD may have unusual reactions to serotonin, a neurotransmitter utilized by some nerve cells for communication in some brain regions. Several studies have indicated that low serotonin levels can lead to OCD, but other factors can also raise a person’s risk of acquiring this debilitating condition.
- Age and gender – Males are more likely than females to acquire childhood OCD.
- Genetics – A family history of OCD can increase your risk.
- Presence of other mental health conditions – The presence of anxiety disorder can increase your risk.
- Life events – Stressful life events, especially those that are traumatic and happen early in life, are key risk factors for OCD.
- Pregnancy and postpartum – Hormones may bring on symptoms, or OCD symptoms may worsen during pregnancy.
The likelihood of developing OCD increases when other controllable risk factors, such as drug and alcohol abuse, marital status, and unemployment, are considered.
In some cases, children may develop OCD following a streptococcal infection. This is known as Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS).
Diagnosis and Treatment
Only certified therapists are qualified to diagnose OCD. Therapists will consider three factors during a diagnosis:
- The characteristics of a person’s obsession.
- Participation in recurrent, abnormal behaviors.
- Time spent on obsessions and compulsions and how it interferes with their daily life.
OCD is generally treated with medication, psychotherapy, or a combination. Treatment can help improve a person’s ability to function at school or work, maintain relationships and improve their overall quality of life.
- Psychotherapy – Exposure and Response Prevention (ERP) is a type of cognitive behavioral therapy (CBT) with the strongest evidence supporting its efficacy in treating OCD. ERP is primarily administered in an outpatient setting by a licensed mental health provider.
- Medication – A class of drugs known as selective serotonin reuptake inhibitors (SSRIs), normally used to treat depression, can also be beneficial in treating OCD. Patients who do not respond to one SSRI medication may respond to another. CBT and SSRIs are the most effective treatment for OCD, especially when OCD symptoms are severe.
In addition to psychotherapy and medications, patients can also benefit from:
- Family Therapy – can help enhance understanding of the condition and lessen family disputes because OCD frequently causes problems in family life and social adjustment. It can also inspire family members and teach them how to assist their loved one suffering from OCD.
- Group Therapy – provides support and encouragement to fellow OCD sufferers while decreasing feelings of isolation.
Contact a Turning Point Center if you or a loved one is struggling with OCD symptoms that negatively impact daily life. The mental health services provided by Turning Point Centers are unparalleled. Our compassionate clinicians offer individualized care to those battling mental health conditions through residential treatment, day treatment (PHP), and intensive outpatient programs.
