Obsessive Compulsive Disorder

Condition

What is OCD?

Obsessive-Compulsive Disorder (OCD) is a type of anxiety disorder that involves obsessions and compulsions. Obsessions are persistent and uncontrollable thoughts, urges or images that are invasive, unwelcome and alarming. They cause anxiety or discomfort that significantly interferes with normal life. The obsessions become so powerful that individuals with OCD feel compelled to act repeatedly in response to their obsessive thoughts. Often, people with OCD realize their obsessions are irrational, but they believe their compulsive behavior will help relieve their discomfort. Sadly, any relief provided by the compulsion is short-lived, and people can find themselves locked in a downward cycle of obsessive-compulsive behavior from which they can’t escape.

OCD is a fairly common behavioral health condition. In the U.S., about 1 in 40 adults and 1 in 100 children have OCD.

Causes of OCD

Research shows that OCD is based on brain chemistry, but so far no definitive cause or causes of OCD have been found. OCD is likely caused by a combination of genetic, chemical, cognitive, behavioral and environmental factors that work together to trigger the disorder.

Genetics are responsible for approximately 45-65% of the risk for developing OCD. 1 in 4 people with OCD has an immediate family member with the disorder. 

Cognitive factors impacting OCD include faulty or dysfunctional beliefs. Examples include perfectionism, intolerance for uncertainty, a sense of inflated responsibility and more. These misinterpretations or intrusive thoughts often lead to the formation of obsessions and compulsions.

The behavioral theory suggests that people with OCD associate certain objects or situations with fear, avoiding those things by performing "rituals."

The environment we live in can have an influence on whether OCD symptoms will develop. Studies indicate that people with OCD have experienced stressful and traumatic life events prior to the onset of the illness.

OCD Symptoms & Signs

OCD is characterized by two types of symptoms:  obsessive thoughts & compulsive behaviors. OCD can show itself in many ways, but behaviors are usually based on repetition. Repetition may manifest itself in your thoughts to create obsessions. These repetitive actions are called compulsions or rituals. Often, compulsions are obvious—something we can observe. However, they may also occur mentally, such as internal counting or repetition. Mental rituals can be as incapacitating as those we can see for an individual with OCD.

Common OCD Obsessions & Behaviors

Common obsessions are based on perfectionism, concern for safety, fear of contamination, or losing control. Obsessions are intrusive and unwanted, but they’re persistent and difficult to ignore. And, obsessions often lead to repeated actions to relieve the stress.

Compulsive behaviors are actions that a person takes to try to alleviate the distress of obsessive thoughts, to stop the thoughts or to prevent something bad from happening. Examples include repeatedly locking the door or checking if the stove is turned off or washing your hands and cleaning excessively to address an obsession with contamination. Obsession around perfectionism can lead to compulsions of maintaining symmetry and order. OCD behaviors are commonly centered around a repetition of a certain number, like the compulsion to wash your hands three times before they feel clean.

OCD Side Effects

A variety of side effects have been associated with OCD, including:

  • Mood disruptions – ­fear, guilt or panic attacks
  • Behavioral issues – agitation, hoarding, impulsivity or social isolation
  • Psychological conditions – anxiety or depression
  • Others – food aversion or nightmares

OCD Diagnostic Options

Your mental health is just as important as your physical health, and we’re here to help you take care of both. Our Mercy care team can help you identify symptoms and treatment for OCD. Some ways to determine an OCD diagnosis include:

Having a physical exam by a primary care provider helps rule out other problems that could be causing your symptoms. Your doctor may also run lab tests. Following this exam, your doctor may provide a referral to a behavioral health specialist if necessary.

A behavioral health professional can assess your symptoms and their impact on your daily life. After completing the psychological evaluation, a diagnosis is made by comparing your symptoms to the Diagnostic and Statistical Manual of Mental Disorders, (DSM-V).

OCD Treatment Options

Though OCD can feel isolating and overwhelming, we’re here to provide support and care. We’ll work with you to determine the most effective treatment for your OCD. Treatments typically include medication, therapy and self-care.

Several classes of medication are common in the treatment of OCD, including selective serotonin reuptake inhibitors (SSRIs), anxiolytics and antidepressants. Your doctor may prescribe one or more of these depending upon your symptoms and overall health. 

A variety of psychotherapy approaches are helpful to people with OCD, including:

  • Cognitive-behavioral therapy (CBT) – Talk therapy helps people modify negative thoughts, behaviors and emotions that often accompany psychological distress.
  • Exposure-response prevention (ERP) therapy – Gradual exposure to the source of anxiety in a safe setting helps reduce psychological distress. With each step, a therapist helps the patient not to panic and works to decrease anxiety, until the item/situation no longer frightens them.
  • Behavioral therapy – As a treatment for OCD, behavioral therapy may include symptom substitution (ie., picking the fuzz off of a stuffed animal rather than your eyebrows) or rewards for avoiding repetitive behaviors.
  • Group therapy – Therapists also work with groups of OCD patients to help them manage their conditions. 

Sometimes, OCD can resist medications. If you have a case of treatment-resistant OCD, your physician may suggest TMS or transcranial magnetic stimulation. TMS is a non-invasive, FDA-approved treatment for OCD that involves stimulating the brain through repeated magnetic pulses. TMS doesn’t require surgery or sedation, as the electromagnetic coil is placed against your head to give magnetic pulses. The effects of TMS wear off over time, so repeated sessions are recommended.

Another possible solution for treatment-resistant OCD is deep brain stimulation (DBS). In recent years, DBS has been used for treatment-resistant mental disorders including depression, anxiety and OCD. DBS has been used since the mid-1980s to treat movement disorders such as severe tremors or Parkinson's disease.

Integrative medicine or complementary health approaches such as acupuncture, meditation and mindfulness can be an important part of a comprehensive treatment plan for OCD. Many people with OCD also find that these practices help them avoid or control their triggers and manage their symptoms.     

At Mercy, care for patients with OCD is provided in a variety of settings. Patients who are acutely ill and need 24-hour supervised care for their safety may require inpatient care. A full range of evaluation and treatment services are available for comprehensive, individualized inpatient mental health care across Mercy. 

People with OCD may fall back on unhealthy coping strategies that complicate their condition. Some turn to alcohol or drugs out of desperation. The most important step for managing OCD is knowing your triggers. Triggers are thoughts or situations that bring on OCD symptoms. By understanding your triggers, you can begin to control compulsive urges.

 

Other coping skills include reducing stress with exercise and social contact. Build a support system, and reach out for help when you need it. Living with OCD can be lonely and isolating if you try to manage it alone. 

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