Classified as an anxiety disorder, obsessive-compulsive disorder (OCD) is an intense preoccupation with a single fear, thought or worry. More than just washing one’s hands repeatedly or double checking that the stove is turned off, OCD is characterized by a particular set of rituals and routines that provide the patient with comfort without long-lasting relief.
Recurring thoughts are beyond the control of the patient; they are the obsessions that drive the compulsive actions. For example, a patient may obsessively worry about germs and, as a result, compulsively clean doorknobs, wash their hands until they crack and bleed, or be unable to relax until they have cleaned the bathroom several times over.
According to Medline Plus, many OCD patients begin to show symptoms of the disorder during their childhood but most often during their teen years. Most are diagnosed by the age of 19. In some families, the disorder is common, but there is no known cause or verified genetic link. There also is no data supporting specific environmental causes of obsessive-compulsive disorder.
OCD can be debilitating, crippling patients and rendering them unable to function in their day-to-day lives. With treatment, however, OCD patients can mitigate their symptoms with medication and psychotherapy, learning how to manage their fears and concerns without indulging in compulsive behaviors.
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Prevalence of Obsessive-Compulsive Disorder in the United States
According to the National Institutes of Health (NIH), OCD is not one of the more common mental health diagnoses in the United States, but a fair number of Americans living with the disorder have severe symptoms and require treatment. Some NIH statistics include:
- About one percent of American adults over the age of 18 are diagnosed with OCD, or 2.2 million people.
- It’s been found that 50.6 percent of those living with an OCD diagnosis are classified as “severe” cases.
- The average age of onset is 19.
- It is estimated that 2 percent of Americans between the ages of 18 and 29, 2.3 percent of those aged 30 to 44, 1.3 percent of those between the ages of 45 and 59, and .7 percent of those over the age of 60 are diagnosed with OCD.
- OCD diagnoses are equally distributed among men and women.
- Approximately 33 percent of those who are diagnosed with OCD began to exhibit symptoms during childhood.
Screening and Evaluation
The Anxiety Disorder Association of America reports that the screening for obsessive-compulsive disorder usually starts when the patient notices their symptoms of extreme worry or fear in addition to their compulsive behaviors and asks their primary care physician for assistance. Unfortunately, because the diagnosis is so rare, it is often misdiagnosed as another illness or issue first – especially if the patient is struggling with multiple disorders, like OCD in addition to depression or drug and alcohol addiction.
Many patients feel overwhelmed with their fears and worries. As they are unable to control the compulsive behaviors that control them, patients may become depressed and isolate themselves. Still others attempt to medicate the repeated anxious thoughts and depression with drugs and alcohol. For this reason, healthcare professionals may initially believe that depression or addiction is the primary disorder. Patients who experience obsessions that drive compulsive behaviors should share this information with their doctor, being as specific as possible, to aid in a proper diagnosis.
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Hoarding characterizes one severe type of OCD and is defined by the obsessive collecting of objects, believing them to have value even when an objective person may find these same objects worthless or even trash. Patients who hoard are unable to get rid of any of their possessions even when they cause a health hazard, destroy their relationships with family members, or cause them to be evicted from their homes.
Unlike other types of OCD, hoarders often don’t believe their behaviors to be a problem, which makes treatment extremely difficult.
According to the Mayo Clinic, hoarding may be an issue of genetics or it could be environmental, in part caused by being raised by a hoarder, since the issue is often seen in those with a family history of the disorder. The risk factors are similar for hoarding and other types of OCD.
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A study published in Psychological Medicine found that a number of risk factors in adult patients with OCD could be traced back to experiences in their childhood. Some of these included:
- Social isolation
- Physical abuse during childhood that was not reported until later
- Difficult temperament during childhood
- Specific difficulties during the perinatal period as well as difficulties with certain developmental milestones during early childhood were linked to specific OCD symptoms (e.g., ordering of things, shameful thoughts, fear of harm with compulsive checking, etc.).
It is important to note that the above childhood issues did not translate into an automatic OCD diagnosis in adulthood but many adult patients with OCD experienced these issues at a high rate.
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Rituals and Routines
According to the National Institute of Mental Health (NIMH), the rituals and routines are what define OCD – actions that patients feel compelled to perform in order to relieve a certain worry or fear (e.g., fearing a break-in and being unable to sleep because the patient feels compelled to rise repeatedly throughout the night in order to check that the doors and windows are locked).
These rituals, however, provide the patient with no relief. As soon as he or she has completed the task, the worries continue and the compulsion to repeat the task returns. These compulsions can control their entire lives – they simply have no power to “let it go” and move forward.
Depending upon the specific worry that plagues the patient, the ritual or routine may vary. Some common OCD rituals include:
- Washing hands or cleaning
- Checking that something has been done
- Touching items
- Counting things
- Organizing objects to be symmetrical or arranged in a specific pattern
While many patients with obsessive-compulsive disorder realize that their compulsive behaviors are not productive, many do not realize that they are not normal. In some cases, the urge to complete rituals comes and goes, or eases and increases over time. Many will try to manage their symptoms without medical assistance for years by avoiding the situations that cause them worry or self-medicating with drugs and alcohol if they find the symptoms to be intrusive. However, long-lasting and effective treatment usually requires a medical intervention at a mental health treatment center.
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Use of Psychotherapy in OCD Treatment
In most cases, obsessive-compulsive disorder is treated with both medication and psychotherapy. One particular type of psychotherapy called Cognitive Behavioral Therapy (CBT) has been proven to be one of the most effective in the treatment of OCD, according to a study sponsored by the Centers for Disease Control and Prevention (CDC). By learning how to think differently, react more effectively to situations that cause anxiety, and behave without giving in to compulsive behaviors, patients can make huge strides in their ability to function in basic tasks and interactions.
One particularly effective method used in CBT is a type of therapy called “exposure and response prevention.” Here, patients are repeatedly exposed to their fear, or situations in which they believe that they will experience the worst, in a controlled setting so they can learn through action that they can and will be safe and that their fears are unfounded. With repetition, the patient can see that their fear diminishes over time. This type of therapy has been extremely beneficial in helping patients to stop their compulsive behaviors.
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Use of Medication
According to the National Institute of Mental Health (NIMH), antidepressants, anti-anxiety drugs, and beta-blockers are the most commonly prescribed medications in the treatment of OCD. These may be prescribed as a stand-alone treatment or used in addition to psychotherapy.
Though anti-anxiety medications, or benzodiazepines, work right away, most types are generally not indicated for long-term treatment. Klonopin, Ativan and Xanax may be prescribed, depending upon the symptoms experienced by the patient.
Beta-blockers may be prescribed to help patients mitigate some of the physical symptoms associated with OCD. Shaking and sweating associated with deep fear, or panic attacks associated with OCD, can be mitigated by drugs like Inderal.
Antidepressants are slightly more common in OCD treatment because they can be taken for long periods. SSRIs like Prozac, Zoloft, Lexapro, Paxil and Celexa are the most common choices and can take as long as three months to take effect as the dosage and combination of medications are adjusted. MAOIs can be effective as well. For both types of antidepressants, there can be side effects, including headache, disrupted sleep patterns and nausea, but these are usually minimal when doctors start with small doses and increase slowly. They can also be dangerous in the treatment of young adults and teens, so they are to be used with caution.
Close monitoring of patients is an important part of OCD treatment, no matter what type of medication is used.
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According to the International OCD Foundation, there are a number of disorders that are similar to OCD. These include:
- Tic disorders or Tourette’s syndrome. These disorders are characterized by repeating physical and vocal behaviors (e.g., clearing one’s throat) but only those with OCD perform these behaviors because of obsessive thoughts.
- Asperger’s disorder/autism spectrum disorder (ASD). Patients with both may have an obsessive interest in something and an interest in routine but only those with OCD have obsessive fears and try to stop their obsessive thinking.
- Trichotillomania (compulsive hair pulling). Those who compulsively pull their hair do it out of discomfort like those with OCD but they feel better when they indulge in the behavior and those with OCD do not.
- Impulse control disorders. Both types of patients will repeat behaviors despite negative consequences but only those with OCD do so to assuage negative feelings; others indulge in compulsive behavior to increase positive feelings.
- Body dysmorphic bisorder (BDD). Repetitive checking characterizes both disorders but those with BDD obsess only on body-specific details.
- Psychotic disorders. Schizophrenics, like those with OCD will have obsessive thoughts, but patients with OCD usually recognize that they are obsessing and schizophrenics are delusional, believing their obsessive thinking to be correct.
- Obsessive-compulsive personality disorder (OCPD). Characterized by hoarding and perfectionism, the biggest differences between these two is that those with OCD recognize that they have an issue and those with OCPD have no problem with what others view as symptoms.
Helping Someone You Care About
If someone you care about is living with obsessive-compulsive disorder, you can help them to heal whether or not they are ready to enter a mental health treatment program. According to Anxiety Disorders Association of America, support can be a key component in the successful treatment of those with OCD – it is not, however, enough to “cure” your loved one. Whether it is your spouse, child, best friend, parent or extended family living with OCD, you can help them by:
- Educating yourself about OCD and OCD treatment. The more you know about the process of recovery, the better prepared you will be to help your loved one.
- Being patient. Treatment can be a lengthy process as the medications and psychotherapy are given a chance to work.
- Knowing when to exert pressure. Being patient is important but occasionally it can be helpful if you push your loved one to be uncomfortable and work through their obsessions and compulsions rather than indulging in them.
- Taking care of yourself. If you are not physically and emotionally well, you won’t be very effective in providing support to your ailing loved one.
If you would like more information about the mental health treatment options available for those living with obsessive-compulsive disorder, we can give you the information you need and help you locate the right program for you or your loved one. Don’t give up another day of your life to fear and anxiety. Contact us today to get the answers you need to change your life.