While it’s normal to occasionally go back to make sure you unplugged the iron or turned off the stove, people who have obsessive-compulsive disorder (OCD) struggle with obsessive thoughts and compulsive behaviors that often become so involved and lengthy that they interfere with daily life. You may spend hours cleaning your house for fear of contamination or avoid interactions with people that may involve shaking hands or touching objects others have touched. You may spend a great deal of time praying or performing specific rituals to ensure a loved one’s safety or to stave off a natural disaster, no matter how unrelated the events may be. Your brain may spend hours every day, a single thought stuck in your mind and repeated over and over. You may realize that most of your day involves performing compulsive acts to counteract the intrusive, obsessions that play on repeat in your mind. Your life may now revolve around these obsessions and compulsions; breaking free seems like an impossibility.
Signs and Symptoms of Obsessive-Compulsive Disorder
Obsessive-compulsive disorder (OCD) is a moderately common, often undiagnosed, chronic mental health disorder associated with significant distress and impaired functioning. OCD is characterized by overpowering, unwanted thoughts and recurring, ritualized behaviors an individual feels a compulsion to perform. Many people do understand that these obsessive thoughts and compulsive behaviors are not rational, but find stopping a major challenge.
Obsessions are defined as recurrent, persistent thoughts, urges, or images that, at some point during the disturbance, are intrusive and inappropriate and lead to intense feelings of distress and anxiety. A person who has OCD makes attempts to ignore or suppress these thoughts, impulses, and images or neutralize them with another thought or action.
Compulsions are repetitive behaviors (such as hand-washing, checking, or ordering) or mental acts (such as counting, praying, repeating words silently) performed in response to an obsession or according to rigidly applied rules. Compulsions are an attempt to reduce distress or prevent a dreaded situation or event from occurring. However, these compulsions are not connected in a manner that could realistically nullify or prevent what they are meant to address or are unmistakably extreme.
Obsessions and their related compulsive rituals usually fall into one or more common categories, which include:
- Fear of contamination leads to excessive hand-washing, cleaning compulsions
- Need for symmetry, precise arranging leads to compulsions of ordering, arranging, and straightening until it is “just right”
- Unwanted sexual or aggressive thoughts or images lead to compulsive praying, checking, “undoing” actions, asking for reassurance
- Doubts about safety lead to compulsive checking behaviors, such as door locking, checking the stove, or checking electrical outlets
- Concerns about throwing away something valuable leads to compulsive hoarding
People who have OCD often have obsessions and compulsions in several categories, and generally the first obsession is a fear of contamination. Despite being a relatively simple disorder to treat, many individuals with this disorder – due either to the stigma or lack of recognition – live many years before proper diagnosis and treatment.
While once considered a relatively rare disorder, obsessive-compulsive disorder was found by the Epidemiological Catchment Area study to have a lifetime prevalence of 2.5%. The yearly prevalence for OCD in those over the age of 18 is about 1% of the U.S. population; about half of those cases, or 0.5% of the adult population, are classified as severe.
Causes and Risk Factors for Obsessive-Compulsive Disorder
It’s not entirely certain what combination of factors leads to OCD. Most theories regarding the etiology of OCD include:
Genetic: Twin studies have supported strong heritability for obsessive-compulsive disorder, however the specific genes involved in OCD are not yet identified.
Physical: Abnormalities in serotonin neurotransmission in the brain are meaningfully associated with obsessive-compulsive disorder. Additionally, functional imaging studies (MRIs and PET scans) have demonstrated that overactivity in blood flow and metabolic activity in the orbitofrontal cortex, limbic structures, caudate, and thalamus is related to OCD.
Environmental: It’s been suggested that some children and young adults develop OCD after acute exposure to group A streptococcal infections. It’s been suggested that infections trigger a CNS autoimmune response resulting in neuropsychiatric symptoms.
- Brain trauma
- Stimulant abuse
- Carbon monoxide poisoning
- Stress worsens existing OCD symptoms
Signs and Symptoms of Obsessive-Compulsive Disorders
Obsessive-compulsive disorder symptoms generally include both obsessions and compulsions, however it is possible to have only one set of symptoms (only obsessions or only compulsions). Approximately 1/3 of people who have OCD also have tic disorders, which include sudden, brief, intermittent movements or sounds. OCD symptoms often begin slowly and gradually become worse over time, especially during periods of stress. As OCD is a chronic condition, symptoms may become so severe and time-consuming that it becomes disabling. Symptoms of OCD are broken into two categories, obsessions and compulsions.
- Fear of being contaminated by shaking hands or touching objects others have touched
- Doubts that the door is locked or the stove is turned off
- Intense stress when objects aren’t orderly or facing a certain direction
- Thoughts of shouting obscene words or acting in an inappropriate manner
- Images of hurting oneself or others
- Fears about hurting other people
- Avoidance of situations that may trigger obsessions
- Distress about unpleasant sexual images being replayed in one’s head
- Excessive attention to something considered lucky or unlucky
- Washing hands until skin is raw
- Repeatedly checking on loved ones to ensure they’re safe
- Checking doors repeatedly to ensure they are locked
- Tapping, counting behaviors
- Counting in certain patterns
- Checking the stove over and over to ensure that it’s off
- Silently repeating a word, phrase, or prayer
- Praying excessively
- Engaging in rituals triggered by religious fear
- Arranging boxed food to make sure it’s all facing the same way
If you feel that you are in crisis, or are having thoughts about hurting yourself or others, please call 9-1-1 or go to the nearest emergency room immediately.
Effects of Obsessive-Compulsive Disorder
While OCD is a treatable mental disorder, many people do not receive the proper diagnosis or seek treatment for the disease. Long-term effects of untreated OCD are related to co-occurring disorders, genetic influences, stress, and symptom severity and may include the following:
- Inability to attend work, school, or social activities
- Poor interpersonal relationships
- Social isolation
- Difficulties holding down a job
- Unstable finances
- Poor overall quality of life
- Contact dermatitis from skin washing
- Substance abuse
- Suicidal thoughts and behaviors
Obsessive-compulsive disorder often occurs with other mental health disorders. The most common co-occurring, co-morbid disorders include:
- Anxiety disorders
- Depressive disorders
- Bipolar disorder
- Obsessive-compulsive personality disorder
- Tic disorder
- Body dysmorphic disorder
- Oppositional defiant disorder