Obsessive compulsive disorder: what is it and how do you treat it?

Medically reviewed: 3, February 2024

What is Obsessive compulsive disorder (OCD)?

Obsessive compulsive disorder (OCD) is a psychological condition, characterized by high anxiety, which can significantly interfere with normal life.

OCD usually involves having both obsessions i.e. recurring, obtrusive, unwanted thoughts that are experienced and result in unreasonable fears, and compulsions i.e. act or rituals carried out in response to fears caused by the obsessions. A person may however have only obsessive thoughts without their expression as compulsive behavior.

An individual usually feels less anxious once they have carried out the compulsion.

Failure to complete the compulsion often results in severe anxiety or panic – but continuing to try to live with the rituals often also leads to anxiety or depression.

Examples of compulsions are:

1. Excessive hand washing is a term used to describe the act of washing one’s hands excessively, going beyond the required level for maintaining personal hygiene. This behavior involves repeatedly washing and scrubbing the hands even when it is not necessary, resulting in an excessive amount of time and effort spent on hand hygiene, and can be considered as a compulsive behavior.
2. Similarly, cleaning to an excessive extent, surpassing the usual standards of cleanliness, can also be categorized as a compulsive behavior.
3. Another example is counting, where an individual feels compelled to count objects or repeat numbers excessively, even when it serves no practical purpose. Similarly, checking refers to the compulsive need to repeatedly verify or inspect things, often driven by irrational fears or doubts.
4. Touching, as a compulsive behavior, involves an individual feeling compelled to touch certain objects or surfaces repeatedly, often due to perceived contamination or to alleviate anxiety.
5. Arranging, on the other hand, refers to the need to arrange items or objects in a particular order or pattern, often driven by an intense desire for symmetry or perfection.
6. Hoarding is characterized by an uncontrollable urge to accumulate a large number of items and a strong resistance to getting rid of them, which ultimately leads to the accumulation of cluttered and disorganized living environments.
7. Measuring, as a compulsive behavior, is characterized by the need to measure or quantify objects or spaces repeatedly, often driven by a need for precision or control.
8. Excessive neatness, which refers to an intense desire for everything to be in its proper place, can also be considered as a compulsive behavior.
9. Lastly, repeating tasks or actions beyond what is necessary or logical, commonly known as compulsive repetition, is another manifestation of obsessive-compulsive tendencies.

Obsessions can manifest in various forms, such as an overwhelming preoccupation with germs, contamination, or dirt.

Severe types of obsessive compulsive disorder (OCD)

But there are other symptoms of OCD that is on a darker side, and which cause real problems to the patients. For example is the constant fear of having caused harm to others, which can consume one’s thoughts.

Intrusive sexual thoughts or urges may also be a form of obsession that individuals struggle with.

Additionally, obsessions can revolve around the themes of death and illness, causing individuals to constantly worry and obsess over these topics. Individuals suffering from Obsessive-Compulsive Disorder (OCD) possess a deep understanding that their compulsions and obsessions are devoid of rationality or exceed what is considered normal.

They recognize the irrationality and excessiveness of their behaviors and thoughts, acknowledging that they deviate significantly from the conventional standards of reasoning.

The perception of reality remains intact and unaltered, yet merely possessing this understanding does not provide individuals with the ability to cease their persistent obsessions and compulsions.

Numerous studies have suggested that a significant proportion of OCD cases in adults actually originated in childhood, with at least one-third of affected individuals experiencing the onset of OCD during their younger years.

There is a higher incidence in people with Tourette’s Syndrome with approximately 35-50% of patients having OCD.

Symptoms of obsessive compulsive disorder (OCD)

Obsessive compulsive disorder is a mental health condition that’s all about getting intrusive thoughts and doing repetitive stuff that really messes with your head. It’s important to reach out for professional help because there are treatments that actually work, like therapy and medication. Therapy helps you tackle and control those irrational thoughts, and meds can make a difference by messing with your brain chemicals.

However, medication alone is usually not enough and is often used alongside therapy. Overall, addressing intrusive thoughts and developing healthier coping strategies can greatly improve the quality of life for individuals with OCD.

These thoughts can be persistent and intrusive, leading to a sense of helplessness and frustration. Furthermore, obsessive compulsive disorder is a chronic condition that tends to persist over time if left untreated. The severity of symptoms can fluctuate, with periods of remission and exacerbation.

It is not uncommon for individuals with OCD to experience high levels of distress and impairment, leading to reduced quality of life.

It is crucial to acknowledge that individuals suffering from obsessive compulsive disorder frequently possess an understanding that their thoughts and behaviors are illogical or excessive. Nonetheless, they encounter great difficulty in resisting the compulsion to partake in these repetitive actions or rituals, as doing so momentarily alleviates the anxiety and distress stemming from the intrusive thoughts.

This perpetual cycle of unwelcome obsessions and subsequent compulsions can gradually take over every facet of a person’s existence, profoundly impacting their relationships, professional endeavors, and overall state of being.

The symptoms and behaviors associated with obsessive compulsive disorder encompass a broad spectrum. From intrusive and distressing thoughts to repetitive and time-consuming rituals, OCD can significantly impact an individual’s daily life and well-being.

It’s really important to know and recognize the signs of obsessive compulsive disorder so that people can get the right help and support they need. People with OCD often have repetitive behaviors or rituals to try and ease their anxiety, like always washing their hands or having certain routines for counting. These compulsions can really take over their time and make their everyday life difficult, causing stress and making it hard to function properly. Besides that, there are very common symptoms of OCD:

• Experiencing an overwhelming anxiety towards dirt and germs, leading individuals to engage in excessive cleaning rituals and frequently request others to repeat their actions. This fear-driven compulsion stems from a deep-seated aversion towards contamination and a desperate need for cleanliness and hygiene.
• Constant checking things, such as doors, locks etc.
• Constant counting, while performing routine tasks.
• Feelings of having to do things a certain number of times or doing things in a certain order.
• Obsessively arranging things in an methodical, orderly fashion.
• Intrusive unwanted thoughts, often of a disturbing nature.
• Intrusive unwanted words or phrases have a tendency to repetitively occupy the thoughts and mental space of an individual, causing distress and discomfort.
• Hoarding of objects, usually of no apparent value.
• Trichotillomania (compulsive hair-pulling) may be associated with obsessive- compulsive disorder.
• Depression, social phobia.
• People with OCD are more likely to also have panic disorder.

What are causes of obsessive compulsive disorder?

The exact cause of OCD is still a mystery, as scientists haven’t figured out the exact things that lead to the development of this disorder. Many people think that imbalances in serotonin, an important chemical in the brain, might have a big part in causing obsessive compulsive disorder.

By utilizing medication to boost serotonin levels, it is possible to alleviate the symptoms associated with this condition.

While stress itself is not considered the direct cause of OCD, it has been observed that certain individuals may experience the onset of this condition following a particularly stressful event. It is worth noting that the occurrence of obsessive compulsive disorder tends to be more prevalent among individuals with a family history of the disorder. Several studies indicate that multiple genes play a role in this phenomenon. The personality type of an individual can also play a significant role, as those who have perfectionistic tendencies are often more susceptible to developing Obsessive-Compulsive Disorder (OCD).

How to diagnose obsessive compulsive disorder?

OCD is often not diagnosed or treated enough.

If a GP diagnoses someone with obsessive compulsive disorder, they’ll suggest that person go see a psychiatrist or psychologist who’s experienced in treating OCD.

The DSM-IV categorizes obsessive compulsive disorder as an anxiety disorder due to the repetitive and distressing nature of the obsessions and compulsions, which can consume a significant amount of time and have a profound negative impact on an individual’s daily functioning and overall well-being.

The diagnosis of this condition is determined by considering the following factors: firstly, the presence of symptoms that cause a considerable amount of distress to the individual; secondly, the symptoms occurring for more than one hour each day; thirdly, the symptoms greatly impeding the person’s ability to perform their work, maintain relationships, or engage in their daily activities; and finally, the person’s awareness and acknowledgement that their obsessions and compulsions are irrational and excessive.

In certain circumstances, obsessive-compulsive disorder (OCD) can become more complex, leading to prolonged periods of depression, particularly when distressing thoughts are present. There are two primary methods commonly used for treating OCD: medication therapy and cognitive behavioral therapy. Many individuals with OCD have found that a combination of these approaches is the most effective way to effectively manage their symptoms and enhance their overall quality of life.

Treatment of OCD (obsessive compulsive disorder)

By utilizing both medication therapy and cognitive behavioral therapy, individuals can address the underlying causes of their OCD and develop coping mechanisms to minimize the impact of their obsessions and compulsions on their daily lives. This comprehensive approach acknowledges the intricate nature of OCD and aims to provide individuals with the necessary tools and support to regain control over their thoughts and behaviors.

Medication therapy involves the use of specific medications, such as selective serotonin reuptake inhibitors (SSRIs), to regulate brain chemicals and reduce the severity of OCD symptoms.

Conversely, cognitive behavioral therapy focuses on identifying and challenging irrational thoughts and beliefs that contribute to OCD behaviors, as well as implementing practical techniques to resist and manage compulsive urges.

By working closely with a qualified therapist or healthcare professional, individuals can customize their treatment plan to suit their specific needs and gradually make progress towards their recovery goals. It is important to recognize that the effectiveness of treatment may vary from person to person, and finding the optimal combination of therapies may require some trial and error.

Nonetheless, with dedication, patience, and ongoing support, individuals with OCD can significantly improve their quality of life and regain control over their thoughts and behaviors. Additionally, it is worth noting that self-help strategies, such as participating in support groups, practicing stress management techniques, and making lifestyle modifications, can complement professional treatment and contribute to the overall success of managing OCD.

By incorporating these strategies into their daily routine, individuals can strengthen their resilience and maintain their progress in the long run. In conclusion, the treatment of obsessive-compulsive disorder involves a comprehensive and personalized approach that combines medication therapy and cognitive behavioral therapy.

With the appropriate support and resources, individuals with OCD can take significant strides towards managing their symptoms, enhancing their overall well-being, and leading a fulfilling life.

Drug therapy for OCD

Antidepressant medication is frequently prescribed, regardless of the presence or absence of depression. In the past, the go-to treatment for this condition was Clomipramine, a type of tricyclic antidepressant (TCA), and it was highly effective in providing relief. In summary, while TCAs have been historically used for the treatment of depression, they are accompanied by a higher incidence of side effects compared to SSRIs.

The newer class of antidepressants, SSRIs, offer a more tolerable side effect profile, reduced potential for drug interactions, and improved safety in specific populations. These factors make SSRIs a preferred choice for many individuals seeking pharmacological intervention for their depressive symptoms.

Therefore initially in most cases now, SSR’s are prescribed because of the improved safety, tolerability, and equivalent effectiveness.

However, it is important to note that, with the exception of fluoxetine (Prozac), SSRIs should not be recommended for individuals under the age of 18 due to the heightened risks involved. While medication can effectively alleviate the symptoms of OCD, it is worth mentioning that discontinuing the medication often leads to a relapse of symptoms.

The typical timeframe for medication to take effect is around 4 weeks, although it may take up to 10 weeks for the full benefits to be realized. Once the medication proves to be effective, it is customary to continue taking it for a minimum of one year.

Interestingly, the dosages required for treating obsessive-compulsive disorder (OCD) can occasionally be higher than those prescribed for depression. It is worth noting that the use of medication can result in a significant improvement of symptoms, with potential enhancements of up to 60%.

Cognitive Behavioural Therapy (CBT)

CBT operates on the belief that our thoughts and interpretations of events greatly influence our emotions and behaviors. It emphasizes the idea that our reactions are not solely determined by external circumstances, but also by our internal perceptions and beliefs.

Through the therapeutic process, individuals are encouraged to gain insight into their thought patterns and identify any distorted or unhelpful thinking that may be contributing to their emotional struggles. One of the key components of CBT is helping individuals recognize and challenge their negative or irrational thoughts. This is done through various techniques such as cognitive restructuring, where individuals learn to reframe their thoughts in a more realistic and positive manner.

By replacing negative self-talk with more accurate and balanced thinking, individuals can gradually change their emotional responses and behaviors. The collaborative nature of CBT is another distinguishing feature. Therapists work together with individuals to set goals, monitor progress, and provide guidance and support throughout the therapeutic journey.