Ultimate Guide to Obsessive-Compulsive Disorder (OCD)

by Shea Brogren, MOT, OTR/L October 04, 2019

Ultimate Guide to Obsessive-Compulsive Disorder Blog Post

Obsessive-Compulsive Disorder, commonly referred to as OCD, is an often misunderstood term in today’s society. It isn’t uncommon to hear the term “OCD”  used loosely or as a humorous way to describe behaviors such as cleanliness or perfectionism. However, it is important to know that OCD is a very real disorder and can seriously affect the lives of those diagnosed.

It is estimated that approximately 1 in 40 adults  (aged 18 and over) have a diagnosis of OCD. It is slightly more common in females than in males. For children, the prevalence is around 1 in 100 children. In this article, we will review the signs and symptoms of OCD, consider how OCD manifests throughout the lifespan, and explore the most common treatment options.

Signs and Symptoms of OCD

OCD is a chronic condition that can have an impact on all aspects of life, including work, family, school, and interpersonal relationships. The causes of OCD are not fully understood. Some researchers hypothesize that OCD is genetic or due to abnormalities in brain structure.

Teen with OCD

People who have OCD struggle with two components: obsessions (thoughts) and compulsions (behaviors). In some instances, a person with OCD may have obsessions or compulsions, not both. However, this is relatively rare.

Let's break down the terms obsessions and compulsions further and provide examples of each.

An obsession is a thought, urge, or mental image that is repeated and causes the person anxiety. Some of these thoughts might include: 

  • Fear of germs or contamination 
  • Worried they have said something wrong, made a mistake or broken a rule 
  • Perfectionistic thoughts. For example, the need to keep things in a certain order or keep things equal and symmetrical 
  • Worries about getting hurt or others getting hurt
  • Fear of throwing personal belongings away 

OCD causes the brain to get stuck on these thoughts and this causes the person extreme anxiety. Often, their obsessive thoughts become all-consuming and intrusive. A person with OCD often finds temporary relief from anxiety when they engage in a compulsion, which we will discuss next. 

A compulsion is a behavior that a person with OCD will engage in as a way to help manage their obsessive thoughts. Some examples of compulsions include: 

  • Excessive cleaning of belongings, home, or other personal items. This can include excessive hand washing or washing of other body parts
  • Arranging and ordering personal items in a particular way 
  • Counting objects. For example, counting steps as you walk. 
  • Repeated checking, for example checking to make sure the oven is off, the door is locked, the car is turned off, etc. 

These behaviors or compulsions generally take up a great deal of the person’s time, with some people engaging in their obsessive-compulsive routine repeatedly throughout the day. 

locked doorIt should be noted that every person will occasionally have thoughts that cause anxiety or engage in compulsive-like behaviors (such as double-checking). However, someone with an OCD diagnosis cannot control these thoughts or behaviors, even if they are able to recognize that the thoughts and behaviors are atypical.

To be given an OCD diagnosis, the thoughts and behaviors must take up at least 1 hour of the person’s time per day and they must experience significant personal problems due to their thoughts and behaviors. 

Diagnosing OCD

If OCD is suspected, an official diagnosis can be given by a clinical psychologist or psychiatrist. To diagnose OCD, the person will fill out behavior questionnaires, provide a detailed medical history, and complete behavioral checklists.

If a child is being diagnosed, both the parent/guardian and child will likely fill out these questionnaires.

The psychologist or psychiatrist will also engage the person in an interview to better understand their thoughts and compulsions and how OCD is impacting their everyday life. 

OCD Across the Lifespan

The symptoms associated with OCD (obsessions and compulsions) may fluctuate across the lifespan and may possibly ease over time or may become worse over time. It’s important to note however that OCD is a chronic condition and if symptoms do ease up, there is still a possibility they could return the same as before or worsen. 

In general, most adults with OCD are able to recognize that their obsessive thoughts and actions are out of the ordinary. Many feel as though they have no control over their mind and seek to find ways to cope with their thoughts.

Oftentimes, children with OCD will not realize their behaviors are interfering with everyday life. Their parents, caregivers, or teachers are usually the first to recognize OCD-like symptoms. The earlier OCD can be diagnosed, the better the outcomes are for managing the disorder. 

OCD Treatment 

OCD can be a difficult disorder to manage, as the obsessive thoughts and compulsions can have a great impact on everyday functioning. However, it is important to know that there are still effective treatment options available. The two most promising treatments include the use of medication and cognitive-behavioral therapy. We will discuss these further below. 

Medication 

Selective Serotonin Reuptake Inhibitors (SSRIs) are the most common type of medication used to help manage OCD symptoms. SSRIs are typically used to manage depression, but certain types may also help improve OCD symptoms.

These medications work by impacting the neurotransmitter in the brain called Serotonin. It isn’t completely clear to researchers why SSRIs in particular are helpful to people with OCD. Serotonin is responsible for helping the brain send messages. If there is a low level of Serotonin in the brain, then it is not able to communicate signals to its full potential. This can have an impact on behavior and overall functioning.

There are potential side effects of taking SSRIs, so the benefits and risks should always be discussed with a doctor. Side effects might include headache, drowsiness, dry mouth, insomnia, etc. 

Therapy 

Cognitive-behavioral therapy (CBT) is generally the recommended type of therapy for people with OCD. CBT is focused on challenging thoughts as a way to alter behavior. A more specific form of CBT, called Exposure and Response Prevention (ERP) is commonly used to help people with OCD.

ocd therapy

It is important to find a therapist who is trained in this specific modality to ensure best practice is followed. The exposure part of ERP involves exposing the person to their obsessive thoughts or the thoughts, situations, objects, etc that cause them anxiety.

The response prevention part of the therapy involves making a conscious effort to not engage in the compulsion once the person has been triggered. The therapist will supervise this entire process and assists with finding effective coping strategies to manage the obsessive thoughts. Coping strategies will be different for each person, and this exploration of strategies is an important part of therapy. 

ERP and the brain 

In order to fully understand how Exposure and Response Prevention (ERP) therapy works, it is important to consider how OCD affects the brain.

OCD affects the fight or flight or “alarm” system in the brain. Typically, the brain’s alarm system is activated when a real threat is perceived. For example, if your house catches on fire, the brain’s alarm system would be activated and the body would be alerted to get to safety.

With OCD, the brain’s alarm system is activated to normally unthreatening events. People with OCD perceive their obsessive thoughts as dangerous or harmful, which activates the alarm system in the brain. ERP therapy is a way to help reconfigure the brain by helping the person challenge their thoughts so that their responses to threats are more typical. 

The decision to start therapy or medication is often anxiety-producing for someone with OCD due to the great impact the disorder has on the person’s thoughts and behaviors. Approximately 70% of people with OCD will see improvements from taking medication or engaging in ERP therapy. Again, it is always important to consult with your primary doctor to determine the best course of treatment. 

Concluding Thoughts 

OCD is a disorder that can oftentimes be misunderstood. However, it is important to recognize the great deal of anxiety and internal distress that people with OCD experience.

Both children and adults can be diagnosed with OCD, with an earlier diagnosis leading to more positive outcomes. At this time, effective treatment options involve medication and therapy, or a combination of both. These treatments can help improve the symptoms of OCD.

We hope this article provided a more thorough understanding of OCD, how it can impact the lives of those diagnosed, and provided potential treatment options to consider. 

 

References 

Abramowitz, J.S., Whiteside, S.P., & Deacon, B.J. (2005). The effectiveness of treatment for pediatric obsessive-compulsive disorder: A meta-analysis. Behavior Therapy, 36 (1), 55-63. 

Lack, C.W. (2012). Obsessive-compulsive disorder: Evidence-based treatments and future directions for research.World Journal of Psychiatry, 2 (6), 86-90. 

Shea Brogren, MOT, OTR/L
Shea Brogren, MOT, OTR/L

Shea Brogren, MOT, OTR/L, is an occupational therapist with over three years of experience in pediatrics and child/adolescent mental health and has also worked as an adjunct lecturer at the University of North Dakota. Shea has a special interest in program development and developed and implemented occupational therapy programming at a residential treatment center for children. She now practices in an outpatient setting.

Her primary area of interest involves working with children who have experienced developmental trauma. Shea has advanced training in SMART treatment (Sensorimotor Arousal Regulation Treatment), the Zones of Regulation, using sensory-based interventions to address trauma, infant mental health, attachment, and arousal regulation related to trauma disorders.


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