August 1, 2006
Obessive-Compulsive Disorder (OCD)
David Prescott, Ph.D.
What Are Obsessions and Compulsions? Symptoms of Obsessive-Compulsive Disorder have been the target of more than a few jokes, such as in the movie “What About Bob?” While many of us roll our eyes at our own silly rituals or irrational thoughts, obsessive-compulsive disorder can significantly interfere with even the simplest of activities, like preparing a meal or leaving the house for school.
An obsession is a thought or visual image that occurs repeatedly. Most people do not want the thought to occur in the first place, find it distressing, and feel that they cannot control the thought or image. Examples of obsessions include the thought that you may try to injure or hurt someone, the image of you doing something impulsive like jumping out of a window, or the thought that you are contaminated by germs.
Compulsions are behaviors, usually ritualistic acts, that are performed repeatedly even though the person knows that they are not necessary. In the short run, a compulsive behavior reduces anxiety, although over the long run they become more and more disruptive and interfere with getting things done. Examples of compulsions include frequent hand washing, checking (for example checking the stove, checking that doors are locked) or counting. In severe cases, compulsive rituals can take several hours.
When Does Obsessive-Compulsive Disorder Cross the Line? Many of us have small rituals or thought that occupy a brief part of our day. In fact, we may become anxious or irritable if we are prevented from performing some small ritual, like putting things away in a certain order, or keeping paper clips organized in our drawer. People with obsessive-compulsive disorder are distressed by their thoughts or behaviors, and find that they cannot do things like get to work or complete household chores because these activities take up too much time. If you are in doubt, ask a mental health professional or your family doctor.
What Causes Obsessive-Compulsive Disorder? Like many psychological disorders, it appears that genetics, learning, and irrational ways of thinking all contribute to OCD. Obsessive compulsive disorder affects around 2% of people at some time during their lives. Theories about the how genetics may influence OCD focus on overactive brain circuits that signal danger, or on the circuits normally used to “turn off” the danger signal. One theory suggests that the part of the brain that normally tells us it is O.K. to stop worrying does not work properly in people with obsessive-compulsive disorder.
Other theories of OCD suggest that certain people are much more aware of their internal thinking pattern; that is, they simply “tune in” more to the automatic thought processes that occur in all of us every day. Or, people with OCD may learn that compulsive rituals reduce high levels of anxiety in the short run, even thought they cause problems in the long run. However, they are unable to give up the short term relief in spite of the fact that it interferes with their life.
Treatment of Obsessive-Compulsive Disorder: Can’t people just stop it? While it sounds simple at first, giving up compulsive behaviors in OCD takes time and support. Preventing a person from engaging in compulsive behavior, like hand washing is called response prevention, and if done in conjunction with counseling, it often helps. As you may have found if you ever tried to help a friend, in the short run preventing someone from performing a ritual initially causes anxiety and anger. However, in the long run, it can break unwanted patterns.
Medications used to treat obsessive-compulsive disorder are usually a class of medications called serotonin selective reuptake inhibitors, or SSRI’s. Research suggests that a combination of psychotherapy and medications is the best treatment approach for obsessive-compulsive disorder.