Obsessive-compulsive disorder (OCD) is a mental health condition that involves either obsessive thoughts or compulsive behavior. Everyone has habits and recurring mental thoughts, but in the case of the individual with OCD these will be far more intrusive. Over time the condition can cause a great deal of distress because it interferes with the ability to live life normally.
Just because an individual has occasional obsessive thoughts or compulsive behaviors does not mean that they have OCD. It is only when these thoughts and behaviors start to really detract from life and cause distress that such a diagnosis is appropriate. There will also be individuals who go through a short-period of experiencing these symptoms, but the problem resolves without any intervention.
An obsession is any thought that occurs in the mind repeatedly. These thoughts can be like unwanted guests that cause discomfort for the individual. It is made worse by the fact that the person feels like they are powerless to control their own mind. These thoughts may be frightening or disgusting.
There most common types of obsession that people with OCD will experience includes:
* Evil thoughts and the fear of having such thoughts
* Fear of germs
* Fear that they will cause harm to somebody they love
* Recurring images or sounds
* An urge to keep rechecking that a task has been completed properly
* Repulsion at body waste
* Fear that loved ones are dying
* Fear that inanimate objects are alive
* Sexual obsessions including thoughts about committing rape and incest
A compulsion refers to behaviors that the individual feels compelled to perform. By engaging in these behaviors the individual can get a sense of relief and even experience happiness. These behaviors will tend to have a ritualistic element and can be quite complex in nature. The individual is often aware that these rituals are illogical but they feel compelled to perform them anyway.
Common types of compulsion include:
* Hand washing
* Repeating words
* Counting (this could be something like counting footsteps)
* Pulling out hair
* Skin picking
* Ensuring that objects are in a certain pattern
* Checking locks a certain number of times to make sure they are locked
* Touching certain objects before doing a task
The Connection between Obsessions and Compulsions
In some cases people with OCD can have obsessions without an overt compulsion. Often both elements are present with the condition. The individual will have obsessive thoughts that cause discomfort and increasing anxiety. This person then reduces this tension by performing a certain ritual. An example of this would be the individual who is has an obsessive fear of germs. They can engage in a ritualistic type of hand washing behavior to ease the anxiety caused by their thoughts.
Types of Obsession-Compulsion Disorder
It is possible to loosely categorize people with OCD depending on their obsessions and compulsions. The five categories include:
* Counters and arrangers
* Doubters and Sinners
OCD and Impulse Control Disorder
Impulse control disorder is said to come from the same family of conditions as OCD. Impulsivity and compulsivity are usually considered to be on different ends of a spectrum but the two conditions share many similarities. With impulse control disorder the individual can feel unable to ignore urges to engage in negative behavior. Pyromania and kleptomania are all forms of impulse control disorder. Trichotillomania (hair pulling) can be sometimes labeled as OCD or impulse control disorder. Impulse control disorder differs from OCD in that it is an inability not to do something; compulsion is about a strong desire to do something.
OCD and Addiction
Many individuals with OCD also have an addiction problem. This type of dual diagnosis can be particularly destructive because the individual will have so increased anxiety. In the beginning alcohol or drugs can help lessen the effects of OCD, but ultimately this type of self-medication leads only to increased suffering. It is likely that people with obsessive-compulsive disorder fall more easily into physical and psychological dependency because of their symptoms. It can be difficult for these individuals to escape addition unless both their conditions are treated at the same time. If they manage to enter recovery without treatment for OCD they will be at a high risk for relapse. It will also be hard to treat their OCD unless they are away from alcohol and drugs.
The Causes of Obsessive-Compulsive Disorder
There is still disagreement about the exact causes of OCD. It may be due to cognitive or biological factors such as:
* One possible explanation for OCD is that there is a malfunction in the orbital cortex part of the brain. This is the area directly above the eyes. It could be that problems of communication within this part of the brain causes the rising anxiety associated with the condition.
*Another theory is that there may be problems with the receptors in the brain that manage serotonin. This neurotransmitter is important for mood and other biological functions. Those with OCD will usually have low serotonin levels.
* There are some theories that suggest that there may be a genetic element to OCD. This would suggest that it is something that is passed from one generation to the next in families. There is still not enough evidence to support this theory.
*Psychodynamic theories suggest that this condition is due to unresolved conflicts that remain in the unconscious mind. The individual may have had thoughts in the past that they found disturbing but buried them in the subconscious to avoid dealing with them. This could have been something like an immoral sexual fantasy or desire to be violent. These buried thoughts may express themselves in the symptoms of OCD.
* Cognitive-behavioral theory suggests that people with the condition are simply unable to ignore unwanted thoughts. They may have previously noted that some of their thoughts are undesirable and reacted to this by becoming more attentive to what is happening inside their head. The fact that they are now actively looking for undesirable thoughts will make it far more likely that they will find them.
* There is also the suggestion that compulsions such as hand washing may be learnt behavior. Those people who notice that their hands are unclean will usually get some relief when they wash them. The association between getting relief from anxiety and washing hands can drive the compulsion. Each time the individual carries out the action they may be reinforcing it for the future.
Treatment for Obsessive-Compulsive Disorder
OCD can vary in severity. Some individuals will only experience mild symptoms and these may disappear after a relatively short period. Other people may have a more severe form of the condition that never seems to go away; although they may get periods of remission. There are a number of different treatment options available for people dealing with OCD including:
* Cognitive Behavioral Therapy. This usually involves the combination of exposure with response prevention. The individual will deliberately expose themselves to the trigger for OCD. The aim of this is to reduce anxiety by regular exposure. The response prevention aspect of CBT means not performing the ritual that is usually used to deal with the anxiety created by the trigger. CBT works best with mild forms of OCD and is often combined with medication.
* Selective serotonin reuptake inhibitors (SSRIs) are a type of drug that is also used to treat depression. It works with OCD by boosting the levels of serotonin in the brain. This can help because levels of this neurotransmitter will usually be low with people who have OCD. Some parts of the brain may become deactivated due to lack of serotonin and so restoring them may help deal with the symptoms.
* Clomipramine is another antidepressant that can also be used in the treatment of obsessive-compulsive disorder. It has similar effects to SSRIs but tend to be used less because it has more negative side effects.