OCD is an anxiety disorder characterized by unreasonable or irrational thoughts and fears (obsessions) that can lead to repetitive behaviors (compulsions); however, both obsessions and compulsions are not always present. In some cases people may not realize that their thoughts or obsessions are irrational, making it more difficult to overcome them. Within OCD there are a number of themes that irrational thoughts or fears may follow; including contamination, religious, fear of harm, fear of causing harm, self-doubt, perfectionism, etc. These thoughts and fears can also be experienced as strong feelings and even visions, where graphic images are visualized. It is usually not possible to simply ignore these obsessions, which is why the compulsions develop, as a way to ease the anxiety and discomfort triggered by them.
Symptoms fall into two categories, obsessions and compulsions. Obsessions often fall into themes and include irrational thoughts and fears. Some examples of obsessive thoughts are:
-Fear of being contaminated
-Doubts that you have completed a task (i.e. turning off the stove)
-Increased stress when things are not organized to a specific set of self-imposed parameters
-Images of harm to one’s self
-Images or fear of harming someone else
-Fear of saying or shouting something inappropriate
-Fear of embarrassment
-Distressing sexual images
-Fear of chemicals or medications that can cause harm
Compulsion symptoms are repetitive behaviors that are completed as a relief of the anxiety that is triggered by the obsessions and often experienced as something they are driven to do. They can also be used to prevent something bad from happening, again driven by the obsessions. Compulsions can also be made up of rules and rituals that help control the anxiety when experiencing obsessive thoughts. Compulsions may also have themes; such as, washing and cleaning, counting, checking, demanding reassurances, following a strict routine, or orderliness. Some examples are:
-Checking doors repeatedly to see if they are locked
-Counting in patterns
-Silently repeating prayers, words, or phrases
-Organizing things into patterns or in a unique way
How is OCD Diagnosed?
A combination of physical exam (to rule out other causes) and psychological evaluation is utilized to diagnose OCD. There is a specific set of diagnostic criteria that is used to diagnose, which is determined by the DSM. The general criteria states that a person:
-Must have either obsessions, compulsions, or both
-May or may not realize that obsessions and compulsions are excessive, irrational, or unreasonable.
-Obsessions and compulsions are significantly time-consuming and interfere with daily routine or social and work functioning.
Obsessions and Compulsions separately must meet certain criteria. Obsessions must be recurrent, persistent, and unwelcome thoughts, impulses, or images that are intrusive and cause distress. A person must try to ignore these thoughts, images, or impulses or to suppress them with compulsive behaviors. Compulsions are repetitive behaviors that you feel driven to perform, they must be in an attempt to neutralize an obsession, and the behaviors or mental acts are meant to prevent or reduce distress, but are excessive and not realistically related to the problem they are intended to correct.
How is OCD Treated?
OCD is most effectively treated through a combination of medication and psychotherapy. Psychiatric medications can assist in controlling the obsessions and compulsions, as well as reduce the feelings of anxiety caused by them. Psychotherapy, most commonly Cognitive Behavioral Therapy (CBT) or Exposure and Response Prevention (ERP) is the most effective treatment for OCD. CBT focuses on correcting thought patterns that lead to distressing emotions and ERP involves gradual exposure to a fear or obsession while teaching healthy and effective ways to cope with the distress. Both forms take significant practice and time, but are effective in reducing symptoms and improving quality of life.