How do you know if you have Obsessive Compulsive Disorder or OCD?

You know that you might have OCD if you spend much of your time and energy trying to fend off unwelcome, recurrent thoughts (obsessions) or engaging in repetitive behaviors (compulsions) that you feel driven to perform.  You have the sense that these thoughts and behaviors are irrational or excessive, or have been told so by others, but you have little or no control over them.

Typical obsessions include fear of contamination (for example, refusing to touch doorknobs or use public restrooms), fear of acting on violent or aggressive impulses (for example, worrying that you may have accidentally run over someone and not known it), inordinate concerns with having your household or office arranged in a very particular manner (for example, being upset with family when they move an article or leave a dish in the sink), or fear of having terrible thoughts of a blasphemous or sexual nature.

Typical compulsions include excessive washing (particularly hand washing to the point of causing skin damage to your hands), over-cleaning especially with anti-bacterial products, counting behavior or making sure you do something a certain amount of times, checking locks or the whether the stove is off over and over and never being sure it has been done properly, or arranging and ordering your possessions in an exact manner (for example, refolding a towel a dozen times to be sure it is folder correctly).

You engage in compulsions because you feel that doing so will protect you in some way or lessen your anxiety.  Sometimes you do find yourself comforted for a moment or two.  But this is only short term.  In the long term, acting on your obsessions by engaging in compulsive or ritualistic behavior greatly increases your distress.

What other kinds of symptoms can occur with OCD?

Several related disorders fall into the category of OCD.  If you are overly preoccupied with a minor or imagined bodily defect or have exaggerated those defects to the point of feeling that you are so ugly that others are disgusted by your appearance (with repeated denials from others that this is true), you may be suffering from body dysmorphic disorder.  Hypochondriasis, or being overly concerned with your health or having unfounded fears about illness, is another example of our thoughts gone awry. 

Some problems that fall more accurately into the realm of habit disorders can also have a repetitive, driven nature.  For example, nail biting to the point of injury, pulling out hair, eyebrows, or eyelashes (trichotillomania), or hoarding, also known as the “pack rat” syndrome.  These habit disorders are sometimes classified as OCD disorders but are less likely to respond to the medications and behavioral therapies used for OCD.  They respond better to therapies specifically designed to treat habit disorders.

Of course, almost every sufferer of OCD also becomes depressed or despondent at some point because she cannot control her thoughts or behaviors despite all of her good intentions.   

Are you alone?

Absolutely not!  OCD is the fourth more common neuropsychiatric illness in the United States.  One in 40 adults and one in 200 children suffer from OCD at some point in their lives.  That means that at any one time, you have 5 million friends suffering along with you.

How disabling can OCD be?

In its very mild form, when obsessions and compulsions fall more into the category of a personality disorder, you are simply a “neat freak” or do a mite more checking the locks and the stove than the average bear. 

In its mild to moderate form, OCD has a chronic course with symptoms getting more distressing at times and almost disappearing at other times in your life.  At this level of severity, most people can continue to function and usually only their closest friends, family, or colleagues realize that they have certain habits that seem odd or excessive.  Of course, obsessive thoughts are not visible and may be causing more severe distress, a kind of private hell.

In its most severe form, OCD is progressive, deteriorating, and quite disabling.  In those cases, the sufferer becomes isolated, regular employment and even normal social interaction become impossible, and they may require hospitalization.

What about other compulsive habits like drug and alcohol addiction?  Are they forms of OCD?

No.  The difference is that with compulsive gambling, alcohol or drug abuse, overeating, all of which are difficult or impossible to stop, there is a pleasure component.  With OCD, the compulsive behaviors are never, in and of themselves, pleasurable.  There is a strong anxiety or distress component when engaging in the OCD rituals.

Are you crazy?

No.  You behavior may seem “crazy” to you or even to others, but YOU are not “crazy” in the sense of suffering from a more serious mental illness such as schizophrenia, where sufferers are not in touch with reality.  We think that there is a biochemical imbalance involved in OCD.  The brain’s chemical systems that regulate feedback about our behavior may be involved.  There may be a genetic or inherited factor. 

I sometimes describe OCD as having the KGB (the old Russian version of the CIA) in your head giving you “disinformation” at all times.

Don’t be afraid to seek treatment out of fear that you will be labeled as “crazy”.   

What types of treatment are available for OCD?

There are two treatments that have been proven effective against OCD:  Cognitive-behavior therapy (CBT) and medication (primarily medications affecting serotonin).  A combination of medication and CBT is often the most effective treatment for OCD.

CBT consists of a technique called exposure and response prevention.  It is effective for many people with OCD. You are deliberately and voluntarily exposed to feared objects or ideas (the exposure component), either directly or by imagination and then are discouraged or prevented (with your permission) from carrying out the usual compulsive response (the response prevention component).

For example, if you are a compulsive hand washer, you may be urged to touch an object believed to be contaminated and then may be denied the opportunity to wash for several hours. When the treatment works well, the patient gradually experiences less anxiety from the obsessive thoughts and becomes able to do without the compulsive actions for extended periods. 

Studies of behavior therapy for QCD have found it to produce lasting benefits. To achieve the best results, a combination of factors is necessary.  The therapist should be trained in CBT for OCD disorders, the patient must be highly motivated, and the patient’s family must be cooperative.   The patient must also be faithful in fulfilling “homework assignments.”   

A number of medications that have been shown to be useful in treating OCD.  Drugs that have been shown to be effective in such studies include: fluvoxamine (Luvox), fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil), citalopram(Celexa), escitalopram (Lexapro), and clomipramine (Anafranil).  To boost a drug’s effect, sometimes two or more medications are used together.  (NOTE:  This article was first written in 2007.  There are now many new medications which are effective in the treatment of OCD and other anxiety disorders.  Please contact your physician or psychiatrist for the latest information.)

Where can you find our more information on OCD?

The Obsessive Compulsive Foundation (OCF) is a not-for-profit mental health organization. The OCF’S mission is to increase research into and promote treatment and understanding of OCD.  OCF resources and activities include: an informative web site with subsections on compulsive hoarding and a webzine for teenagers and young adults; support groups throughout the United States and Canada; referrals to treatment providers; the sale and distribution of books, pamphlets and other OCD-related materials.

I always recommend starting by reading Edna Foa’s book S.T.O.P. Obsessing available at Amazon.