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Obsessive Compulsive and Related Disorders

What are Obsessive-compulsive and Related Disorders?

Obsessive-compulsive disorder (OCD) is a mental health condition that creates a chronic state of anxiety through obsessive thoughts, fears, or worries. Although most people with OCD are aware that the fears are irrational, often the only way to attempt to manage or lessen the anxiety is through compulsions, or repetitive behaviors that the person feels compelled to perform. These behaviors or mental acts aim to reduce the anxiety and distress caused by the obsession.
 
OCD does not discriminate between sexes, races, or ethnicities. It tends to present in teen years and young adulthood, although it can also develop in childhood. Everyone experiences anxious thoughts, fears, or worries from time to time. Some people may even use the word “obsessive” surrounding their desire for a clean and organized living space, but that does not necessarily mean they are struggling with OCD. The most important diagnostic feature of OCD is that it can consume hours of your day and significantly impacts your daily level of functioning at home, work, school, and in relationships. 

Symptoms

Symptoms of OCD can be relentless and extremely distressing. The more anxiety inducing the obsession is, the more rigid the compulsions become. The obsessions and compulsions can consume hours of your day and make it difficult to get to work or school on time or go to bed at a reasonable hour at night.  
A person with OCD has a presence of obsessions, compulsions, or both. The obsessions and compulsions within OCD are incredibly time-consuming, often taking an hour or more a day. People with OCD often get stuck in a loop or cycle of anxiety and the symptoms can be quite debilitating.

 

Obsessions are defined as recurrent and persistent thoughts, images, or urges that are experienced at some point as intrusive and unwanted. In most individuals, the obsessions cause significant anxiety and distress. Typically, a person with OCD will try to ignore or suppress the intrusive thoughts, images, or urges, or they will try to neutralize them by performing a specific ritual or compulsion. Examples of obsessions include, but are not limited to:

  • Intense fixation with germs or dirt
  • Fear of contamination
  • Recurrent doubts (i.e., turning off the stove, locking the door, shutting the garage, etc.)
  • Needing to have things in a very certain order
  • Fixation with order or symmetry
  • Thoughts of violence or of harming others
  • Persistent thoughts or fantasies of inappropriate or violent sexual acts
  • Scrupulosity (fear over thoughts that go against religious beliefs)

Compulsions are defined as repetitive behaviors or mental acts that a person feels compelled to perform in response to the obsession. The compulsions may also be performed because of strict rules that are rigidly followed regarding the obsession.

The compulsions aim to reduce anxiety and distress caused by the obsession; however, the compulsions are usually excessive or not a realistic way to neutralize the obsession. Compulsions can be excessive and disruptive, taking hours of your day. Examples of compulsions include, but are not limited to:

  • Repeated handwashing (can be 100+ times a day)
  • Long periods of time spent counting or touching things
  • Continuous checking and rechecking (making sure the stove is off, door is locked, etc.)
  • Following strict and rigid rules of order, such as putting clothes on in the same order every day, alphabetizing spices, rigidity in the order of a bedtime routine, etc.
  • Demanding or needing constant reassurance

Causes

There is no singular cause of OCD. Research has shown that a combination of genetics, brain abnormalities, and environmental factors contribute to the development of OCD. It appears to run in families, indicating a genetic link and is equally diagnosed between males and females. OCD usually presents in teenage years or young adulthood but can also develop in childhood.

Risk Factors

Several risk factors may contribute to the development of OCD. If you have a family history of OCD, the risk of developing OCD increases. Additionally, traumatic life events may contribute to the development of OCD, although it is important to have a mental health professional rule out any other mental health diagnosis, such as PTSD, which may present with intrusive thoughts and images. There are also other mental health disorders that are related to OCD. They include:

  • Body dysmorphic disorder. A person has an abnormal preoccupation with one or more perceived flaws or defects in their physical appearance that are not observable or seem slight to others. At some time during the disorder, a person has done repetitive behaviors (mirror checking, skin picking, excessive grooming, or reassurance seeking).
  • Hoarding disorder.  This disorder is when someone has persistent difficulty getting rid of possessions, regardless of their actual value. There is a strong belief that the items must be saved, and significant distress associated with discarding them. Difficulties with discarding items result in an excessive accumulation of possessions that clutter and congest living spaces, significantly impacting their intended use.
  • Trichotillomania. Recurrent pulling out of one’s hair, even after consistent attempts to reduce or stop the hair pulling. This disorder causes significant distress in daily functioning in occupational, academic, or social settings.
  • Excoriation (skin-picking) disorder. With this disorder, a person continuously picks their skin, which causes lesions and scabs. There have been repeated attempts to stop the skin picking. It causes significant distress in daily functioning in occupational, academic, or social settings.
  • Substance/medication-induced obsessive-compulsive disorder. Within this disorder, symptoms of OCD and related disorders dominate the clinical picture. There is evidence of obsessions, compulsions, hair pulling, skin picking, and body-focused repetitive behaviors. The symptoms develop soon after intoxication or withdrawal, or after exposure to a certain medication. The involved medication or substance must be capable of eliciting the symptoms of OCD and related disorders.
  • Tics and other repetitive body movements. In OCD and related disorders, tics and repetitive body movements may be present. The tics and body movements must not be better explained by an actual tic disorder (Tourette’s disorder, persistent motor or vocal tic disorder, or provisional tic disorder), or be medication induced.

Complications

Several complications result from OCD and related disorders. Complications include:

  • Excessive amounts of time spent on compulsions or ritualistic behaviors (recurrent handwashing, checking, counting, touching, etc.) 
  • Contact dermatitis from excessive handwashing
  • Skin lesions, scabs, or infections from recurrent skin picking
  • Troubled, conflicted, or disrupted relationships
  • Difficulties at home, work, school, or social settings
  • Chronic anxiety and depression
  • Poor quality of life
  • Self-harm or suicidal thinking

Diagnosis

To make a diagnosis for OCD, it is recommended to meet with both your healthcare provider and mental health provider to rule out any medical conditions or other mental health conditions that may be contributing to or causing your symptoms.

Your healthcare provider will take a thorough medical history, conduct a physical exam, and may order labs to rule out any medical issues that may be contributing to your symptoms. A mental health professional will conduct a psychological evaluation, including question asking, information gathering, and assessments to determine if a diagnosis of OCD or related disorders is appropriate. 

Treatment

OCD and related disorders have various treatments that can help reduce or manage symptoms. There is no known cure for OCD, but a combination of psychotherapy and medication have been shown to significantly improve symptoms and quality of life. Although symptoms may need to be managed throughout life, many people with OCD are able to live happy healthy lives. The most effective treatments include:

Psychotherapy

  • Cognitive behavioral therapy. This type of therapy seeks to identify distorted thoughts, beliefs, and patterns of behavior, and replace them with more positive and adaptive ways of thinking and being.
  • Exposure response prevention therapy (ERPT). This therapy helps patients develop resources for emotional regulation, primarily helping to manage anxiety. Once a patient has developed enough resources for stabilization, the therapist will have the patient perform the obsession, either in vivo or imaginal, while preventing the patient from doing their compulsion.

Medication

  • Antidepressants. Various medications have proven effective for OCD. The most common type of antidepressant that is prescribed is SSRI’s (selective serotonin reuptake inhibitors). Tricyclic antidepressants have also shown to be effective.

Other Treatment Options

  • Electroconvulsive therapy. This therapy attaches electrodes to the head, which sends electric shocks through the brain, causing small seizures, allowing the brain to release helpful chemicals.
  • Transcranial magnetic stimulation (TMS). A magnetic device is placed on the head and is used to deliver electrical impulses to the brain. The impulses cause the brain to release chemicals that have shown to improve mood.