OCD (Obsessive-Compulsive Disorder)
The Obsessive-Compulsive Disorder, better known as OCD is a mental state related to anxiety, and characterized by recurrent obsessions and compulsions that make sufferers feel obligated to perform rituals and activities that may seem completely irrational to people around them and sometimes, also to themselves.
But, if they understand that there’s no point in doing something, why would they do it anyway? Despite being conscious that what they’re doing doesn’t make any sense, the OCD sufferers can’t make their obsessive thoughts go away, and they feel uncomfortable, anxious, preoccupied, nervous and deeply depressed if they do not follow a ritual or carry out an activity.
Obsessions are defined as unwanted thoughts, images, impulses, feelings, ideas or sensations that come repeatedly to the OCD sufferer’s mind. They are persistent, sometimes even inappropriate, and can cause severe damage and/or anxiety to the person. Compulsions are intrusive behaviors or mental acts that the OCD’s sufferer feels obligated to do in order to reduce their anxiety. They can be done mentally (the sufferers count and control their thoughts) or physically; when they engage in the ritual, they feel an enormous relief. OCD sufferers might develop tics and establish rules that must be followed; that is because they strongly believe something bad would happen to them. Compulsions are generated by obsessions. OCD has been considered one of the top ten causes of disability in the world by the World Health Organization. There are around two to three million people just in the United States that suffer from OCD. Normally, when OCD sufferers begin to understand that the obsessions are caused by their own minds, and that they aren’t able to resist to this behavior, they feel ashamed of their inability to control themselves, and try to conceal the disorder from relatives and friends, and often deny to themselves that they have a disorder/problem. Besides that, sufferers might also deny their condition; because they are unaware that their attitudes are related to a disease and that there are possibilities of treatment. Hiding their disorder from people who surround them and realizing that they have a problem which is out of their control can be really painful and disturbing. 70% of adult OCD sufferers have gone through at least one episode of major depression in their lives due to (or related to) OCD.
Obsessions are defined as unwanted thoughts, images, impulses, feelings, ideas or sensations that come repeatedly to the OCD sufferer’s mind. They are persistent, sometimes even inappropriate, and can cause severe damage and/or anxiety to the person.
Compulsions are intrusive behaviors or mental acts that the OCD’s sufferer feels obligated to do in order to reduce their anxiety. They can be done mentally (the sufferers count and control their thoughts) or physically; when they engage in the ritual, they feel an enormous relief. OCD sufferers might develop tics and establish rules that must be followed; that is because they strongly believe something bad would happen to them. Compulsions are generated by obsessions.
OCD has been considered one of the top ten causes of disability in the world by the World Health Organization. There are around two to three million people just in the United States that suffer from OCD.
Normally, when OCD sufferers begin to understand that the obsessions are caused by their own minds, and that they aren’t able to resist to this behavior, they feel ashamed of their inability to control themselves, and try to conceal the disorder from relatives and friends, and often deny to themselves that they have a disorder/problem. Besides that, sufferers might also deny their condition; because they are unaware that their attitudes are related to a disease and that there are possibilities of treatment.
Hiding their disorder from people who surround them and realizing that they have a problem which is out of their control can be really painful and disturbing. 70% of adult OCD sufferers have gone through at least one episode of major depression in their lives due to (or related to) OCD.
OCD is not itself characterized by being fatal, but its development can cause mental complications which lead to more intense obsessions and compulsions, that might end up in death.
For example, since the disorder makes the sufferers isolate themselves (they can spend up to ten hours per day, in the most severe cases, exerting the compulsions) and feel ashamed of who they are, it causes low self-esteem, often resulting in depression and eventually, in suicide.
There are also some sufferers that have such a severe concern about contamination that they don’t go to the hospital, so when they get a more serious disease, they don’t get the ideal treatment.
To be diagnosed with obsessive-compulsive disorder you will need to participate in a self-test, answering questions individually. If you are in suspect of suffering from the disorder, the doctor will look for symptoms that include obsessions and compulsions. Once these kind of symptoms are confirmed, he will probably ask for some exams that may include physical (they will examine your heart rate, blood pressure and temperature), laboratory tests (they will count your blood and look for signs of alcoholic and use of drugs) and psychological evaluation (you will have a talk with your doctor or your therapist about your feelings and compulsions, how do you deal with the disorder and if you remember any episode of your life that has been affected by the disorder).
Treatment is often more effective with a combination of medications and psychotherapy.
Link for an individual test for OCD: http://www.ocdtypes.com/oci-r-test.php
The precise cause of OCD (etymology) is still unknown, so we don’t know whether we can or cannot prevent it (and if we can prevent it, how we can do it); however, scientists and researchers have been capable of expanding the field of information about the disorder, which is registered in literature since the 19th century. Science still seeks the cause of the emergence of OCD symptoms in the organism of the sufferers, that are 2-3% of the worldwide population.
But there certainly is evidence showing that there are several factors from biological and psychological order that contribute to the emergence of OCD. The most probable coefficients from biological nature are:
- Because of that, it is possible to associate OCD to a neurochemical disturb related to the nerve pathways that use serotonin (a natural substance generated by the brain). Serotonin acts at the distribution of nerve impulses. The medications used to treat OCD stop the reuptake of serotonin to the nerve cells, which favors the transmission of nerve impulses between cells.
2. With exams called topographies, it has been observed in OCD sufferers a bigger hyperactivity (a bigger operation) in the frontal lobe of the brain (represented in blue in the first image), in the periorbital region, in deeper cerebral areas (ganglia) and close to circular orbits. This activity can be easily normalized with the appropriate treatments.
OCD sufferers have often showed symptoms after injuries or infections in the brain, which makes specialists consider the possibility of OCD being related to that.
The most probable features that cause OCD from psychological nature are:
Not always the emergence of OCD is linked to big events on people’s lives, but, in some cases, the sufferer begins to show symptoms after psychological stress, and if the symptoms already existed, they could get a lot worse.
1. Classical conditioning: With that we can conclude that by unknown reasons, in sensitive or predisposed people, some items and situations can be related to fear, anxiety and frustration.
2. Generalization: Other objects and situations that are somehow similar to the items and situations that were the first ones to cause discomfort and fright also begin to be dreaded by the sufferers.
3. Neutralization: The person starts to suffer these situations that cause significant discomfort and avoidance more often, and with that they realize that by carrying out determined actions it’s possible to reduce or even neutralize fear and anxiety, even if for a short period of time.
4. Fortification and maintenance of the rituals: When sufferers realize that the rituals reduce the bad feelings experienced by them, giving them the impression that they’re doing the right thing. The feeling of accomplishment and temporary calmness perpetuate OCD.
5. Fortification of the wrong beliefs: When sufferers obtain relief by executing compulsions, they reinforce the thought that their fears are real, therefore they can’t stop the compulsions.
These are the reasons why OCD treatment includes both psychological and the pharmacological treatment.
Even though there is a lot more information about the disorder, Science still isn’t able to explain in patient response organism to OCD, and defining that remains on the condition of a mystery.
OCD is a chronicle disease, which means that there is no cure to it. Until recently, there were few ways to treat OCD, and these treatments weren’t very effective. Due to new research in the area, scientists have been able to find ways to treat the disorder, and, thanks to it, 70% of OCD sufferers have been able to reduce their OCD symptoms and have a better quality of life.
The sooner you start the treatment, the better. It’s essential that the sufferers get treated, because if they don’t, their symptoms (obsessions and compulsions) may get considerably worse.
According to the psychiatrist Jeffrey Schwartz, there are four steps for controlling the symptoms of OCD:
The patient has to recognize that the intrusive urges and thoughts that he has are caused by the Obsessive-Compulsive Disorder.
The patient has got to understand that the energy and intrusiveness of his/her thoughts and urges are probably caused by OCD.
The sufferer has to try to control his intrusive thoughts by focusing their attention on other things, and doing other behaviors in order to dominate the compulsions.
The OCD sufferer can’t take the OCD thoughts at face value; they have to understand that they are generated by their own minds and are insignificant.
OCD treatment is individualized and might diversify a lot depending on the severity and type of case. 60 to 70% of OCD sufferers can obtain considerable relief with the correct treatments. Nowadays, there are two ways to treat it: Pharmacological treatment and behavioral therapy. For the treatment to be more efficient and effective, it is recommended that the patients combine both methods.
- Pharmacological treatment
- The pharmacological treatment is one of the most powerful treatments for OCD. Medication can help in 30 to 60% of the cases.
- Through antidepressants that elevate the levels of serotonin in the brain (Selective Serotonin Reuptake Inhibitors - SSRIs), the sufferers start having their symptoms reduced after about three months. However, there are some inconveniences with this treatment. The main problems are that, unlike panic and depression treatments, the treatment for OCD is slow and gradual, and it takes a long time for the patients and family to see the results. Between 40 and 60% of the OCD sufferers that undergo this treatment get their symptoms reduced, but the patients don’t get completely better; some of them even continue to present severe symptoms of the disease. Other common issue is that, in 90% of the cases, around four months after the sufferer stops using the appropriate medications, the symptoms come back.
- Tranquilizers shouldn’t be used for a long period of time. They are a possibility of treatment for people who have more severe OCD symptoms, because they reduce the compulsion urges, relaxing the body muscles.
- For extreme cases, psychosurgery is an option of treatment. Using electrodes, some parts of the brain are severed or disabled. More than a third of patients of OCD who have undergone the surgery improved a lot.
- The only proven form of psychotherapy for OCD is the cognitive-behavioral therapy (CBT), the combination of the behavioral and the cognitive therapies. In the cognitive-behavioral therapy sessions, the patients get informed about OCD and get explanations about the disorder that they are suffering and the possible treatments for it. They also make practical exercises with their therapist, and use the exercises at their lives later. In the first sessions, a list of the patient’s obsessions and rituals is organized, and the exposure and response prevention exercises are planned weekly based on the patients’ symptoms and level of the disease, that are determined by the degree of anxiety created by obsessions and the difficulty the person finds in fighting the obsessions. It’s important that the treatment starts with compulsions that are easier to control, and then, when the patient feels ready, the difficult obsessions ate defeated. For the sufferer not to feel tortured, and for the treatment not to be too fast and exaggerated, the exercises are made by the therapist together with the patient. The treatment requires around 1-2 hours per day to work properly. Like the medication treatment, the cognitive-behavioral therapy includes failures: It is very expensive, and there aren’t many therapists specialized in this area.
- The support of the family and the friends of the OCD sufferers have a big influence on the development or reduction of the symptoms. In most of the cases, the sufferers feel depressed and ashamed of themselves, and it’s harder to undergo these treatments alone than with someone.
Self-help is crucial in order to conquer the symptoms of OCD. The OCD sufferers can also help themselves in many ways:
Getting more information about OCD, learning as much as possible about the disorder by talking to therapists, searching on the internet, reading books. The more you know about it, the better it is to treat it.
- Educate yourself
Using the skills learned during the therapy sessions is a challenge, and requires daily practice, and it is very difficult to resist the compulsive urge when you’re on your own.
- Practice the skills you’ve learned in therapy
OCD takes up a lot of time of the sufferers’ lives, usually making them isolate themselves. Staying connected to other people can help them a lot, because they motivate, help and support the sufferer.
- Stay connected to family and friends
In a support group, patients realize that they are not alone, there are other people going through the same problem. They can share their experiences with people who actually understand them, and they can learn from them.
- Join an OCD support group
- Practice relaxation techniques:
Meditation, yoga and other techniques that relief the stress help patients control their anxiety.
Other treatments for OCD:
- Family Therapy
Sometimes OCD can cause problems in the family life. Family therapy is often indicated as a good way to understanding the disorder and reducing family conflicts, and it usually motivates and teaches family members to help teach their relative.
- Group Therapy
Group therapy is very useful, because through the interaction of OCD sufferers, people who go through the same situations and problems, it decreases the patient’s feeling of isolation, and encourages the sufferer to deal with the disorder and keep on getting treated.
- Anxiety Therapies
OCD is related to anxiety; it is considered an anxiety disorder, so therapies used for the treatment of other types of anxiety may help the OCD sufferer.
New treatments for OCD are being developed and studied. For example, neurosurgical techniques that have been obtaining promissory results are the deep brain stimulation and the gamma-knife capsulotomy.
The Obsessive-Compulsive Disorder is characterized by obsessions and compulsions, which vary from person to person.
Obsessions are unwanted ideas, thoughts, images or impulses that come to one’s mind, and they can’t control them. They are recurrent and cause intense pain, anxiety or distress. OCD obsessions can be separated from the common daily obsessions by frequency, intensity and discomfort. There are two types of obsessions: Autogenous and reactive. Autogenous obsessions are intrusive, uncomfortable guilt-provoking thoughts that are caused without a specific reason. Reactive obsessions appear due to external events. People with OCD can present one or both types of obsessions. The obsessions are:
- The concern with dirt and germs; because of that they might refuse, for example, to touch a public door restroom or even money.
- Excessive concerns about household items; some OCD sufferers, for example, would feel extremely annoyed and anxious when handling hair dyes and pesticides.
- Excessive concerns about environmental contaminants; most of the people are aware that living includes risks, but some patients don’t think that living in a world with asbestos and radiation is such an easy thing to do.
- Bothered by bodily waste or secretions; some OCD patients are afraid that they might get contaminated by saliva, blood or semen, leading to worse consequences. They might relate, for instance, a little red spot to blood left by a HIV carrier, so they would clean it just to feel calmer.
- Bothered by sticky or greasy substances; they feel worried about glue, butter or gel.
- Excessive concern with animals or insects; patients feel disgusted with some animals or insects, such as dogs or flies, and they believe that these animals are dirty and may transmit diseases or infection, because they could be contaminated.
- Colors with strong meanings
- Fear of losing objects
- Fear of being misunderstood
- Fear of saying certain things
- Fear that one is very ill
- Lucky/Unlucky numbers
- Need to know all the information about something, to remember it later (even when knowing all the information is useless)- Strong superstitious fears
2. Less common Obsessions
- Excessive concern with a body part (nose, eyes, hands…) that aren’t related to weight
- Fear of losing one’s positive qualities or changing one’s personality
- Intrusive non-violent images
- Intrusive nonsense words, sounds, music
- Irritation caused by specific sounds
Compulsions are unwanted behaviors or acts (mental of physical) that the Obsessive-Compulsive Disorder sufferer feels the need to perform, in order to minimize their anxiety of discomfort and/or getting rid of the possibility of something bad happening to them or to their loved ones. They are a list of rituals that are fulfilled from time to time and can take up a lot of time of the sufferers’ days. The compulsions are:
- Locks – The person checks them repeatedly, even if they know that they’ve been checked before. The person with OCD fears that someone will break in, steal things or hurt somebody, and they will be guilty for it. OCD sufferers might get this kind of compulsion as a result of a traumatic event, like rape or robbery.
- Stoves, appliances and switches – OCD patients often check if gadgets or other objects that could possibly start a fire are off or unplugged. They are afraid of starting a fire, so when turning off an appliance, they don’t feel safe until it is no longer hot. When they aren’t absolutely sure about whether or not the item is unplugged or turned off they obsess over small things that could start a fire.
- Related to harming others – OCD sufferers tend to feel responsible and guilty if something bad happens, even when they weren’t the ones to cause it, so they check repeatedly if they have accidentally caused harm to other people in any way.
- Related to harming self – The person checks to see if he/she is okay, if they haven’t injured themselves without noticing, etc.
- Surrounding catastrophe – The patient checks if a disaster did/will happen.
- Mistakes – The person checks, several times, if they’ve done something wrong. For example, before handing a test in, they spend more than enough time checking the answers.
- Tied to somatic obsessions – OCD sufferers check features related to the body, both inside and outside. For instance, to see if there are any signs of illness.
- Special words, images, numbers, prayers repeated mentally in order to neutralize bad thoughts and anxiety caused by bad thoughts or feelings.
- Mental counting, list making, erasing intrusive and unwanted mental images, reviewing (talks, situations, actions, etc.).
- Re-reading the same sentence in a book or in a text several times.
- Re-writing repeatedly, in order to correct the writing (and that’s excessive).
- Repeating day-to-day activities.
- Saying the same thing to the same people a lot of times.
- The first group washes and cleans to try to prevent themselves or other people from getting contaminated, getting sick or being harmed. It involves the fear of coming down with a disease or spreading to others whatever causes the disease.
- The second group isn’t preoccupied about harm; they simply feel uncomfortable or contaminated around certain substances, feeling dirty, so they have the need to keep things and themselves clean. These people usually have stronger disgust reactions.
4. There are two types of compulsions performed in order to prevent themselves from getting contaminated and spreading germs. People with contamination fears engage in excessive washing rituals.
- Washing Compulsions
* Hand-washing – The person washes each finger carefully and individually, and sometimes, the fingernails. Then, he/she dries it with a towel or napkin, to avoid contaminating it again. These hand-washing rituals are so intense that sometimes, the sufferer’s hands even get wounded and bleed.
* Showering/bathing, tooth-brushing, grooming or doing toilet are excessively done or ritualized.
- Cleaning Compulsions
* Cleaning household or other inanimate objects, that have come into contact with something/someone considered a threaten by the sufferer.
5. Avoiding Contaminants
- Wearing gloves, using tissues to open doors or doing other things to prevent or remove contamination.
- Avoid touching things that get into contact with the floor or other places considered dirty.
- Making more lists than the necessary (written lists or verbalized aloud)
- Looking excessively for reassurance from others
- Self-damaging or self-mutilation behaviors (for instance, biting your fingernails to make them all even)
- Excessively superstitious behaviors
- Strong urges to tell, confess or ask something
2. Less usual:
- Tic-like compulsions, such as tapping, touching, rubbing something in a specific occasion, blinking too much or staring.
- Ritualized eating behaviors, that can’t be broken (like eating some foods in a certain day of the week, in a certain amount or order).
Incidence of Obsessions
by Percentage (worldwide)
Incidence of Compulsions
by Percentage (worldwide)
Genetics or traumas are some of the many factors that can influence in the appearance of the disorder but having problems during the childhood usually doesn’t cause OCD.
Brain scans or even any types of scan are not able to diagnose the disorder (only the PET scan can show the difference between a normal person’s brain and someone with OCD’s brain but it is not usually recommended). OCD is usually diagnosed by a professional neurologist specialized in OCD with interviews and extensive investigation.
To be neat and tidy have become kind of a stereotype of the disorder because many OCD sufferers feel extremely uncomfortable when they notice that the objects are messy or not aligned in a particular way. Some of them also worry obsessively about their appearance, but this is not an exclusive symptom of OCD. Obsessive-Compulsive Disorder is characterized by obsessions and compulsions, which vary from person to person.
If the person really has OCD she has both obsession and compulsions but sometimes the compulsions are not easily observable, such as mental list-making, mental measuring or counting, mental erasing of unwanted mental images, mental reviewing, silent praying etc, giving the illusion that the person has only the obsession.
Although there are rituals in some religions, they will cause the disorder. People who take part in orthodox religious groups have the same risk to have OCD than non-religious people.
Living with person who has OCD may be very difficult sometimes because family and friends who live with the sufferer also feel its affects. However, they must be very respectful and considerate of the sufferer and might need to understand a little bit more about the disorder. Meanwhile, there are some hints to ease the stress of living with this behavior.
Common misconceptions are that OCD is caused by traumas and bad parenting mainly. Therefore, getting involved with the sufferer’s problems is essential, because family support is crucial for their treatment; they need calm and supportive environment.
Learning about the disorder may help you understand more about it and avoid common misconceptions. It would be easier for a friend to help and deal with the sufferer on a daily basis. If you are a member of the family or just live together with him/her, you should follow the treatment and also go to therapy; a therapist could help both of you understand how to help each other without any further stress.
Although it may not be easy to deal with someone who has Obsessive-Compulsive Disorder, family and friend need to balance it, if you are not able to cope with it alone, you may need a therapist, not because you have any type of mental problems, but because you might need to open up.
Some family members get so involved with the sufferer that helping them in their obsessive rituals seems to be the best way to reduce the distress that the person with OCD is experiencing. However, that kind of involvement may interfere negatively in the patient’s recovery. Nevertheless, if you are used to taking part in the obsessive rituals, you can’t just stop. You need to stop it gradually, otherwise the patient may get confused and irritated with it, and his mental situation may get worse.
We hope to help you improve your quality of life as well as the OCD sufferer’s!
Website for children: http://www.ocdkids.org/3.htm