Obsessive-Compulsive Disorder (OCD)

Nature

The phrase “obsessive-compulsive” has worked its way into the English lexicon and is often used in an offhand manner to describe someone who is meticulous or absorbed in a cause. It is important to distinguish these traits from Obsessive-Compulsive Disorder (OCD).

Although these signs are often present in OCD, a person who shows signs of infatuation or fixation with a subject or object, or displays traits such as perfectionism, does not necessarily have Obsessive-Compulsive Disorder. Obsessive-Compulsive Disorder is most commonly characterized by a person’s obsessive, distressing, intrusive thoughts and related compulsions (tasks or “rituals”) which attempt to neutralize the obsessions.

Experience

Obsessions are experienced as a fear that something has happened, is happening, or may happen.

This fear elicits anxiety, which is defined as an emotional and physiological dysregulation response to a perceived or actual threat. Compulsions are learned behavioral or mental responses that are used to provide temporary relief from the anxiety associated with the fear. While there is some variability in the presence, theme, or dominance of either the obsessions or the compulsions, the following four steps or stages typify the experience of Obsessive-Compulsive Disorder.

While we all may occasionally obsess about something or do something compulsively, the frequency, intensity, intrusiveness of the obsessions and compulsions, and the strength of the conditioned relationship between the two are some of the key factors in determining a diagnosis of Obsessive-Compulsive Disorder.

Common obsessions can include a fear of contamination, of having harmed other people, of losing control, or of succumbing to violent urges. Obsessions can also include having intrusive unwanted sexual thoughts, excessive religious or moral doubts, of thoughts related to having things “just so” or “just right.”

Repetitive behaviors (e.g. hand washing, ordering, checking) or mental acts (e.g. praying, counting, repeating worlds silently) that the person feels driven to perform in response to an obsession, or according to rules that must be applied rigidly. The behaviors or mental acts are aimed at preventing or reducing distress or preventing some dreaded event or situation. However, these behaviors or mental acts are not connected in a realistic way with what they are designed to neutralize or prevent or are clearly excessive. The person attempts to ignore or suppress such thoughts, urges, or images, or to neutralize them with some other thought or action (for instance, by performing a compulsion).

 

Impact

The Impact of OCD

Individuals may spend hours each day performing behavioral or mental rituals to temporarily calm their anxiety. Most individuals with OCD recognize that their fears are irrational, yet still feel unable to resist the obsessions and compulsions.

The key features of OCD include the presence of obsessions and/or compulsions that:

  • Entail at least one hour of a child’s day
  • Interfere with or impair a child’s life at home, at school, with peers and, if they are employed, at work.

A child’s OCD can disrupt family life, interfere with schooling and have a negative effect on relationships with peers. If left untreated, OCD can lead to other mental health conditions, social isolation and difficulty holding regular employment.

The Impact of OCD on the Family

If a child has OCD, common effects on the family include:

  • Disruption of family activities and routines
  • Parent frustration
  • Sibling discontent
  • Arguments

The Impact of OCD on Schooling

At school, a child or teen with OCD can:

  • Be indecisive/distracted (because of their unwelcome thoughts)
  • Waste time (because of their prolonged rituals)
  • Experience medical problems (for example if they refuse to use school bathrooms all day)
  • Be consistently late for school or class or refuse to attend
  • Be unable to use school library books or shared materials for fear of contamination
  • Experience falling grades, school avoidance/refusal

The Impact of OCD on Relationships with Peers

Obsessive-Compulsive Disorder  in a child can be difficult for other children to understand. Because of the insistence on order and rules, OCD can disrupt a range of activities between a child and their peers. In turn, this can lead to bullying or to a child being excluded or isolated in more subtle ways.

Prevalence of OCD

The lifetime prevalence for OCD in the age 18-29 years old demographic is 2%. About 50% of annual cases are classified as severe. The average age of onset for OCD is 19, with 25% of cases occurring by age 14. Males have a slightly higher incidence of OCD than females.

 

Treatment

The gold standard for OCD is Cognitive Behavioral Therapy (CBT), and more specifically Exposure and Response Prevention (ERP).

The goal of treatment is to get symptoms of OCD under control, so they don’t impact daily living. While the success of treatment can’t be guaranteed, many find symptom relief through a combination of psychotherapy and medication.

ERP is a type of CBT that is recommended for treating OCD by helping sufferers confront their obsessions and resist the urge to carry out compulsions.

During ERP, the therapist guides and supports the client by deliberately placing them in situations that increase levels of anxiety and obsessive thoughts, but instead of performing the usual compulsion, the client is encouraged to “sit through” the anxiety, and not engage in the compulsions. As ERP exercises are repeated during session, and practiced outside of therapy, people find that their obsessions cause them less anxiety, resulting in a reduction in the frequency and intensity of the obsessive thoughts. This de-conditioning process, called habituation disbands and dissipates the obsessive, anxious, and compulsive cycle.

The gradual exposure and habituation to triggering events (a feared object, event, or obsession) helps the OCD sufferer learn new ways of coping with the anxiety. The goal is to modify the learned response (hence the name “response prevention”) so more healthy behaviors and thoughts take their place. ERP takes intensive practice through repeated exposures over many months. For many, ERP in combination with medication provide much needed relief for OCD sufferers.

Resources

Anxiety and Depression Association of America, ADAA;
https://adaa.org/understanding-anxiety/obsessive-compulsive-disorder-ocd

International OCD Foundation;
https://iocdf.org/about-ocd/related-disorders/

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