It’s normal to double-check that you’ve turned off all the lights before leaving the house or to wash your hands a second time to get out some particularly tough grease under your nails. But for people with obsessive-compulsive disorder (OCD), the anxiety that something might be wrong can drive them to check things over and over, or to perform other repeated, ritualistic behaviors. These behaviors are repeated long past the point of doing any good. The difference between most people’s rituals (such as checking to make sure they have their keys before they leave the house) and the rituals of someone with OCD is that in the case of OCD, the rituals make it difficult for the person to function normally and go about their daily life.
Obsessive-compulsive disorder (OCD) is a type of anxiety disorder with two main types of symptoms: intrusive thoughts that cause worry or fear (obsessions) and repetitive behaviors meant to soothe the anxiety (compulsions). Depending on the person, these symptoms can take a variety of forms.
Obsessive symptoms of OCD can include:
- Attention-grabbing, distressing thoughts, or images that keep returning
- Excessive concern with dirt, germs, cleanliness, contamination, or purity
- Persistent fears of intruders or violence
- Fear that impulses will cause the person to harm a loved one
- Unwanted sexual urges or mental images
- Thoughts that conflict with religious beliefs
- Anxiety or agitation when things aren’t just right
- Frequently doubting that things are okay or worrying that things have gone wrong
- Needing to complete tasks once started
Compulsive symptoms of OCD can include:
- Being overly tidy
- Washing hands or cleaning over and over again
- Locking and unlocking, or opening and closing, doors
- Counting and recounting objects
- Hoarding unnecessary items of little value
- Checking to relieve doubt
- Arranging items in stacks, rows, or patterns
- Repeating a prayer or phrase, either aloud or silently
People with OCD spend at least an hour a day attending to these thoughts and rituals.
According to the National Institute of Mental Health (NIMH), although the causes of OCD aren’t yet known, the disorder is known to run in families. OCD usually emerges when someone is a child or teenager and usually diagnosed by the time the person is 19 years old. About 2.2 million American adults have OCD, with men and women equally affected. The rate of co-occurring disorders is also very high among people with OCD – the American Family Physician says that over 90 percent of people with OCD will be diagnosed with at least one other mental illness in their lifetime. About one to three percent of the adult population has OCD, according to Dialogues in Clinical Neuroscience.
It’s important not to confuse OCD with obsessive-compulsive personality disorder (OCPD), which is characterized by a need for order, perfection, and discipline, as well as control over oneself, one’s environment, and others.
Types of Obsessive-Compulsive Disorder
OCD can take many forms, presenting in different patterns among different people. To help guide therapists towards customizing the right treatment for each individual, it can be useful to figure out which type of OCD the client has.
- Early-onset appears before puberty, with severe and frequent compulsions often showing up earlier than obsessive thoughts. A higher percentage of people with early-onset OCD have tics or other co-occurring psychiatric conditions, such as ADHD. Early-onset OCD is less responsive to first-line treatments like selective serotonin reuptake inhibitors, and exposure and response prevention therapy. According to an article published in the American Family Physician, 17 percent of people with early-onset OCD also have a close relative with some form of OCD.
- Hoarding can be a more severe form of OCD, with the person often having less insight into the nature of their condition. It commonly co-occurs with other disorders, particularly with social phobia. The person might have greater amounts of difficulties in daily life and may not be as responsive to psychological treatment.
- “Just right” OCD causes a person to want to have things certain, perfect, under control, or just so. The person feels compelled to repeat actions until they get it just right, and the feelings of anxiety or discomfort subside. Although these feelings can occur in all types of OCD, for people with “just right” OCD, they are the primary symptom set.
- Primary obsessional OCD occurs when a person’s main symptom set is obsessions, with few or no compulsions. American Family Physician reports that 25 percent of people with OCD are compulsion-free. However, they may still have mental compulsions, such as praying, counting, or repeating phrases or words. Their obsessions may focus on sexual, violent, or religious themes.
- Scrupulosity can happen when someone’s OCD takes the form of religious or moral obsessions, making the disorder particularly impactful for people who feel strong faith or religious affiliation. They may be obsessed with the thought that they have committed a sin or the notion that their thoughts are blasphemous or impure. Compulsions might take the form of repetitive prayer, repeatedly seeking reassurance from clergy and going to confession excessively.
- Tic-related OCD occurs when the person experiences the co-occurring disorder known as tics – small, sudden, involuntary muscle jumps or spasms. This can include verbal tics, where the spasm causes the person to produce sounds or speech. Tics can also be more complex, such as jumping, skipping, or cursing. As many as 10 to 40 percent of early-onset OCD cases may also have tics, according to an article in Dialogues in Clinical Neuroscience. Such combinations are most common among males. People with tic-related OCD also have high rates of co-occurring disorders, such as non-OCD hoarding, Tourette syndrome, attention deficit hyperactivity disorder (ADHD), hair-pulling, and oppositional-defiant disorder. Tic-related OCD generally responds well to a combination of antidepressants and behavioral therapy.
- Pediatric autoimmune neuropsychiatric disorders associated with streptococcus (PANDAS) can include OCD and Tourette syndrome. PANDAS occur when a child gets an infection, and the body’s immune response causes inflammation in the brain, affecting its function. The degree of the OCD symptoms can vary based on the progress of the infection. Infection can both cause OCD symptoms where there were none as well as aggravate OCD that may already exist.
- Brain injury-induced OCD occurs following a head injury that affects the brain’s function. It can also develop alongside other conditions that affect the brain, such as Parkinson’s disease, according to another article in Dialogues in Clinical Neuroscience.
- Substance/medication-induced OCD can result as a side effect of taking atypical antipsychotic drugs, such as clozapine or ritanserin, to treat another condition like schizophrenia.
Treatments for Obsessive-Compulsive Disorder
Just like OCD can have different sets of symptoms, it can also require different treatments. Clients might benefit from medication, psychotherapy, or a combination of the two.
- Exposure and response prevention (ERP) is a type of Cognitive Behavioral Therapy. The cognitive aspect of the therapy is useful for altering the thought patterns that feed obsessions. Meanwhile, to modify behaviors, ERP exposes clients to the situations that trigger anxiety, rituals, or other compulsive behaviors. Then, the client has the opportunity to practice refraining from engaging in the ritual. Over time, this can reduce the anxiety that they feel and allow them to go longer and longer amounts of time without acting on their compulsions. People who go into ERP are confronting their deepest anxieties, which demonstrates great strength.
- Pharmacotherapy involves the use of medication to help regulate regions of the brain that might be overactive or underactive. The National Alliance on Mental Illness (NAMI) reports that medications are helpful for about half of people who try them.
- Selective serotonin reuptake inhibitors (SSRIs) are effective for treating the symptoms of OCD, according to NAMI. It may take 10 to 12 weeks for their full effects to kick in. SSRIs do carry a very small risk of inducing suicidal thoughts, especially in people under 25, so they should only be used in close consultation with a doctor. SSRIS are helpful in treating OCD for about 60 to 70 percent of people who try them, says American Family Physician. Common SSRIs include Paxil (paroxetine), Prozac (fluoxetine), citalopram (Celexa), escitalopram (Lexapro), sertraline (Zoloft), and Luvox (fluvoxamine).
- Serotonin norepinephrine reuptake inhibitors (SNRIs) are similar to SSRIs but have more stimulating effects. One common SNRI is Effexor (venlafaxine).
- Tricyclic antidepressants make up an older class of antidepressant that is less commonly used due to its side effects. One tricyclic that is effective for OCD is Anafranil (clomipramine).
- Atypical antipsychotics may be effective for OCD that hasn’t responded to other medications. These include Risperdal (risperidone), Haldol (haloperidol), Seroquel (quetiapine), and Zyprexa (olanzapine).
Obsessive-Compulsive Disorder and Substance Abuse
Many people with OCD feel that their anxiety makes it a struggle to take on the challenges of the world around them. To keep their anxiety in check, they may begin to use drugs or alcohol. What starts out as a few drinks or the occasional hit can become a habit, and then a necessity. At that point, they’ve developed a Dual Diagnosis: co-occurring OCD and substance abuse. According to the Anxiety and Depression Association of America (ADAA), about 20 percent of Americans with an anxiety or mood disorder also have a substance abuse disorder.
Getting treatment for OCD takes great courage, and you’ve already taken the first step. We’ll help you work with our expert therapists to develop a treatment regimen that addresses the specifics of your condition. Our facilities can treat substance use problems alongside obsessive-compulsive disorder. We want to help – call today.