People with OCD, which stands for obsessive-compulsive disorder, suffer from thoughts that are unwanted and uncontrollable, and from repetitive and ritualized behaviors that the patient feels the need to complete. Most people with OCD are aware that their compulsive behaviors and obsessive thoughts are not normal, but they are unable to stop them.
There are approximately one million children and 3.3 million adults in the United States who suffer from OCD. Men and women are equally susceptible to OCD, and can be experienced by people belonging to any socioeconomic background or race. Although it sometimes runs in families, it is not known why some members of the family have OCD and others do not. Symptoms of OCD are usually first noticed and experienced during childhood, the teen years, or as a young adult.
What Are the OCD Symptoms?
People who have obsessive compulsive disorder usually have both obsessive thoughts and compulsive behaviors, but sometimes only suffer from one or the other.
Obsessive thoughts may include:
- Fear of causing harm to others or to yourself
- Fear of becoming contaminated with germs, or contaminating someone else
- Excessively focusing on moral or religious ideas
- Fear of not having or losing things that are needed
- Having thoughts or images that are violent or sexually explicit
- Excessive thoughts of needing symmetry and order
- Excessive superstitious thinking about what is lucky or unlucky
Compulsive behaviors may include:
- Checking on loved ones repeatedly to make sure they are ok
- Excessively and repeatedly checking things like light switches, locks, and appliances
- Reducing anxiety by repeating words, counting, tapping, etc.
- Arranging or ordering items in an exact way
- Cleaning or washing excessively
- Collecting empty food containers, old newspapers or other junk
- Taking part in excessive rituals or praying due to religious fears
OCD Symptoms in Children
OCD normally begins during the teen years or as a young adult, but children can also suffer from OCD symptoms. Other disorders, such as Tourette’s syndrome, ADD, and autism often have similar symptoms, so it is important to seek help from psychological and medical professionals to ensure an accurate diagnosis.
How Is OCD Diagnosed?
Unlike many other medical conditions, a doctor confirms the diagnosis of OCD based on assessing symptoms rather than by ordering a lab test. The diagnosis is also based on how often the patient displays compulsive behaviors.
Certain criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders, or DSM, must be met in order for OCD to be diagnosed. The DSM assists mental health doctors with diagnosing mental health conditions and insurance companies with determining eligibility for medical reimbursement.
Diagnostic Criteria for OCD
To be diagnosed with OCD, the patient:
- Has obsessive thoughts, compulsive behaviors or both
- May or may not be aware that these thoughts and behaviors are unreasonable or excessive
- Suffers from these thoughts and behaviors to the point that they are very time consuming and interfere with work or social functioning and daily routine
The obsessive thoughts:
- Are persistent, unwelcome and recurrent, and may include images or impulses that cause distress and are intrusive
- Cannot be ignored even when using compulsive behavior to try to suppress them
The compulsive behaviors:
- Involve repetition, such as mental acts like counting, or actions, like hand washing, that need to be performed
- Are attempted to be halted with another action or obsessive thought
- Are acted out in order to combat or prevent distress but they are not appropriate to the problem or are excessive
Diagnosing a patient with obsessive compulsive disorder can be challenging because the symptoms are similar to other mental health conditions such as depression, schizophrenia, obsessive-compulsive personality disorder, and anxiety disorders. It is possible for someone to have both obsessive-compulsive personality disorder and OCD at the same time. It is important to follow the process for diagnosis set out by your doctor in order to confirm an accurate diagnosis and receive required treatment.
You can also do the following test to help you determine if you might need to see a mental health professional for diagnosis and treatment of OCD.
How Is OCD Treated?
The best treatment for OCD in most cases is cognitive-behavioral therapy (CBT). It may be used along with medication. Medication without therapy is seldom effective in treating OCD.
Cognitive-Behavioral Therapy (CBT)
There are two components of CBT that are used to treat obsessive compulsive disorder:
- Exposure and response prevention is performed by being exposed to the root cause of the obsession repeatedly while being asked to refrain from the accompanying compulsive behavior. An example of this method for a compulsive hand washer may be to prevent them from washing their hands after touching a door handle in a public washroom. After many tries, the individual will no longer have the urge to hand wash. This allows the patient to develop control over obsessions and compulsions.
- Cognitive therapy brings focus to the irrational thoughts and excessive responsibility felt by the patient. This therapy helps the individual to develop effective and healthy methods of reacting to thoughts that does not involve behaving compulsively.
Effectiveness of CBT
More than 75% of patients with OCD experience improvement in symptoms after completing a course of CBT. Although symptoms may not disappear completely, the obsessive thoughts and compulsive behaviors are often reduced. The other 25% do not find CBT effective or find it too stressful to complete. Some of these patients may find cognitive therapy by itself helpful.
If a patient has completed two courses of CBT but have not experienced symptom relief, an OCD specialist may be consulted.
The obsessive thoughts and compulsive behaviors experienced by those with OCD may be treated using psychiatric medications, with antidepressants being the most common.
The Food and Drug Administration (FDA) has approved the following antidepressants to be used as treatment for OCD:
- Sertraline (Zoloft)
- Fluoxetine (Prozac)
- Clomipramine (Anafranil)
- Fluvoxamine (Luvox CR)
- Paroxetine (Paxil, Pexeva)
Other psychiatric medications and antidepressants may also be prescribed for OCD treatment.
Side Effects & Risks of Medication
Although OCD medications are prescribed in an effort to manage symptoms, there are some risks that need to be considered.
- Side effects: Some side effects from psychiatric medications can include sleep disturbances, reduced interest in sex, sweating, and upset stomach. It is important to discuss side effects and any monitoring that may need to be done while taking medication for OCD.
- Suicide risk: Although antidepressant medications are usually safe, some people, especially those under the age of 25, may experience suicidal thoughts when taking them. It is very important to contact your doctor right away if you experience suicidal thoughts while taking these medications.
- Interactions with other substances: Antidepressants may interact negatively with other substances such as food, alcohol or medications. Be sure to let your doctor know if you take any over the counter drugs, including vitamins and other supplements.