Obsessive-Compulsive Disorder
Some people naturally tend to be more neat, tidy, and orderly than others. These traits can in fact be useful in many situations, both at work and at home. In obsessive-compulsive disorder, however, they are carried to an extreme and disruptive degree. Obsessive-compulsive people can spend many hours cleaning, tidying, checking, or ordering, to the point where these activities interfere with the rest of the business of their lives.
Obsessions are recurring ideas, thoughts, images, or impulses that seem senseless but nonetheless continue to intrude into your mind. Examples include images of violence, thoughts of doing violence to someone else, guilt about some perceived mistake, or fears of leaving on lights or the stove or leaving your door unlocked. You recognize that these thoughts or fears are irrational and try to suppress them, but they continue to intrude into your mind for hours, days, weeks, or longer. Such thoughts or images are not merely excessive worries about real-life problems and are usually unrelated to a real-life problem. Obsessions are usually perceived as irrational and uncontrollable, and you may fear that you will lose control and act upon these recurring thoughts or images.
Compulsions are behaviors or rituals that you perform to dispel the anxiety brought up by obsessions. For example, you may wash your hands numerous times to dispel a fear of being contaminated, check the stove again and again to see if it's turned off, or look continually in your rearview mirror while driving to assuage anxiety about having hit somebody. You realize that these rituals are unreasonable. Yet you feel compelled to perform them to ward off the anxiety associated with your particular obsession. The conflict between your wish to be free of the compulsive ritual and the irresistible desire to perform it is a source of anxiety, shame, and even despair. Eventually you may cease struggling with your compulsions and give over to them entirely.
Obsessions may occur by themselves, without necessarily being accompanied by compulsions. In fact, about 20 percent of the people who suffer from obsessive-compulsive disorder only have obsessions, and these often center around fears of causing harm to a loved one.
The most common compulsions include washing, checking, and counting. If you are a washer, you are constantly concerned about avoiding contamination. You avoid touching doorknobs, shaking hands, or coming into contact with any object you associate with germs, filth, or a toxic substance. You can spend literally hours washing hands or showering to reduce anxiety about being contaminated. Women more often have this compulsion than men. Men outnumber women as checkers, however. Doors have to be repeatedly checked to dispel obsessions about being robbed; stoves are repeatedly checked to dispel obsessions about starting a fire; or roads repeatedly checked to dispel obsessions about having hit someone. In the counting compulsion, you must count up to a certain number or repeat a word a certain number of times to dispel anxiety about harm befalling you or someone else.
Obsessive-compulsive disorder is often accompanied by depression. Preoccupation with obsessions, in fact, tends to wax and wane with depression. This disorder is also typically accompanied by phobic avoidance—such as when a person with an obsession about dirt avoids public restrooms or touching doorknobs.
It is very important to realize that as bizarre as obsessive-compulsive behavior may sound, it has nothing to do with "being crazy." You always recognize the irrationality and senselessness of your thoughts and behavior and you are very frustrated (as well as depressed) about your inability to control them.
Obsessive-compulsive disorder used to be considered a rare behavior disturbance. However, recent studies have shown that about 2 to 3 percent of the general population may suffer, to varying degrees, from obsessive-compulsive disorder. The reason prevalence rates have been underestimated until recently is that most sufferers have been very reluctant to tell anyone about their problem. This disorder appears to affect men and women in equal numbers. Although many cases of obsessive-compulsive disorder begin in adolescence and young adulthood, about half begin in childhood. The age of onset tends to be earlier in males than females. Obsessive -compulsive disorder has an observed family pattern and may run in families more than other anxiety disorders. There are also several obsessive-compulsive "spectrum" disorders somewhat related to OCD but different, including: compulsive hair pulling, body dysmorphic disorder, and hypochondria, among others. There are specific books and treatments directed to each of these OC spectrum disorders.
The causes of obsessive-compulsive disorder are unclear. There is some evidence that a deficiency of a neurotransmitter substance in the brain known as serotonin, or a disturbance in serotonin metabolism, is associated with the disorder. This is borne out by the fact that many sufferers improve when they take medications that increase brain serotonin levels, such as clomipramine (Anafranil) or specific serotonin-enhancing antidepressants such as fluoxetine (Prozac), fluvoxamine (Luvox), sertraline (Zoloft), or citalopram (Celexa). It also appears that persons with OCD have excessive activity in certain parts of the brain such as the prefrontal cortex and the caudate nucleus.
Relaxation Training
As with all of the anxiety disorders, abdominal breathing and deep muscle relaxation skills are practiced on a daily basis to help reduce anxiety symptoms.
Cognitive Therapy
Fearful, superstitious, or guilty thoughts associated with obsessions are identified, challenged, and replaced. For example, the idea, "If I have a thought of doing harm to my child, I might act on it," is replaced with, "The thought of doing harm is just 'random noise' caused by the OCD. It has no significance. Just having the thought doesn't mean I'll do it." With repeated rehearsal, constructive thoughts begin to replace obsessive thoughts.
Exposure & Response Prevention (ERP)
This technique consists of exposure to situations that aggravate obsessions, followed by enforced prevention from performing rituals or compulsions. For example, if you've been washing your hands every time you touch a doorknob, you'd be instructed to touch doorknobs and then either reduce the number of times you wash your hands or refrain from washing at all. Similarly, if you check the door five times whenever you leave your house, you would leave your house while being required to gradually reduce the number of checks to one.
You and your therapist devise a variety of situations, preferably in your home setting. Then you continually practice exposing yourself to these situations and desist from performing the compulsions (response prevention). Usually your therapist or a support person accompanies you at first to monitor your compliance in not performing compulsions.
When your problem involves obsessions only, without compulsions, any neutralizing thoughts or covert rituals you use to reduce anxiety caused by your obsessions need to be stopped. You would also work on accepting your obsessions without trying to make them go away. (For detailed information on exposure and response prevention in treating OCD, see the book Stop Obsessing: How to Overcome Your Obsessions & Compulsions, by Edna Foa and Reid Wilson or The OCD Workbook, by Bruce Hyman and Cherry Pedrick.)
Medication
Medications such as Anafranil and the SSRI medications including Prozac, Luvox, Celexa and Zoloft help about 70 percent of persons with OCD. Long-term use of medication (at somewhat higher doses than are used for panic disorder) is fairly common with OCD, although in some cases the cognitive and exposure/response prevention strategies described above may suffice.
Lifestyle & Personality Changes
Essentially the same lifestyle and personality changes described for panic disorder and generalized anxiety disorder apply to OCD.
