Can’t get that thought out of your head? Losing sleep over a comment you made to a person at work? Feel like you just have to get the house clean so you can feel better? Gotta mix those eggs and grits together? Are these normal concerns and habits? Or are they over the top…a sign of a mental disorder?
Obsessive-Compulsive Disorder (OCD) is a neurobiological disorder that affects approximately 2.5 percent of the population, or one out of every 40 people. People with OCD often say that they feel as though their brain is stuck on a certain thought and they are unable to let go of it. They are bombarded by unwanted thoughts over which they have little control…except by engaging in repetitive, and oftentimes nonsensical, behaviors.
If we were to break down the term “Obsessive-Compulsive”, we would find a good definition of the disorder; an “obsession” is a worry, thought, or mental image that persistently intrudes into an individual’s thinking. The individual may then utilize a “compulsion” (i.e., repetitive behaviors or mental exercises), to relieve the discomforting thoughts and images created by the obsession.
An example of this might be as follows: Upon going to bed at night, a person begins to think about someone breaking into the house. This thought becomes persistent, and may also be accompanied by other, perhaps more disturbing, thoughts. This, of course, is the “obsession.” As the psychological and physical discomfort increases for the person, he/she may get out of bed, turn all the lights on, and go around to all the doors, making sure they are locked. This is the “compulsive” act. If performing this action doesn’t relieve the fear and discomfort, the person may perform the compulsion numerous times.
Common obsessions include:
- Thinking about germs and contamination
- Thinking that one has done harm to another
- Fearing that one will be harmed
- Having a need for neatness and order
- Needing things to be a certain way
- Fearing that one will make a mistake
- Fearing one will lose control of oneself
Common compulsions include:
- Excessive handwashing
- Checking and rechecking locks (or the stove & oven)
- Repeated arranging of objects
- Repeated counting of objects
- Silently repeating words
- Saving or hoarding things
While most of us include pleasant rituals in our lives, such as lighting candles for religious events and celebrations, or reading prior to retiring for bed, the rituals that are a part of OCD are anything but pleasant. The worries of leaving the house unlocked, or of becoming contaminated by germs, can become extremely stressful and interfere with normal functioning.
Most people with OCD first show symptoms before the age of 40, with as many as half first experiencing symptoms during childhood. The symptoms may fluctuate over time, ranging from mild to extremely severe. Men and women appear to be equally affected by the disorder.
Most people with OCD realize that their obsessions and compulsions are excessive and irrational, but feel unable to control them. Because they are aware of them AND they feel embarrassed by them, people also tend to be secretive about their symptoms.
In many cases, individuals suffering from OCD are able to keep their rituals a secret from everyone, including family members. Sure, family members may have some idea that the OCD sufferer is a little strange in some ways (i.e., takes too long in the shower, washes hands frequently, vacuums the house every day, won’t throw anything away, etc.), but they wouldn’t say the loved one has a “problem”.
During the course of a normal visit to ones physician, it would take a very astute doctor to pick up on OCD. The secrecy with which the OCD individual guards his/her problem poses yet another obstacle to diagnoses and treatment.
The most effective treatment for OCD is a combination of medication and cognitive-behavioral therapy. Selective serotonin reuptake inhibitors (SSRIs) are frequently used by physicians to treat OCD. Examples of SSRIs include Prozac, Luvox, Zoloft, and Lexapro.
Cognitive-behavioral therapy involves teaching patients how to change their behavior so that they can change their thoughts and feelings. The cognitive aspect of the therapy helps the patient change thought patterns and reduces the catastrophic thinking and exaggerations typical of people with OCD. Completing as many as 20 sessions of cognitive-behavioral therapy has been reported to reduce OCD symptoms by up to 80 percent.
Treatment with medication alone is helpful, but not as effective as combining it with cognitive-behavioral therapy. Medication can help to reduce the number and duration of intrusive thoughts, but it doesn’t teach an individual the tools for coping with the thoughts when they occur. Thus, relying on medication alone results in a higher relapse rate; the intrusive thoughts return when the medication is discontinued.
So, in answer to the original questions posed at the beginning of this article, most of these thoughts and habits are pretty normal, meaning that most of us indulge in those, or others that are similar. If, however, these types of thoughts and behaviors interfere with your everyday living—taking up more than an hour each day and interfering with work and relationships—it is important to talk with your doctor about it. Don’t make the mistake of keeping it a secret, especially when effective treatments are available.
