Do I have OCD? The nitty gritty details with no fluff.
Many of us have probably heard the phrase "I'm so OCD," but it's crucial to understand that OCD goes beyond wanting order or cleanliness. OCD is a deep and complex issue that warrants more understanding and empathy. It’s important that we work together to reduce stigma around seeking a diagnosis so that those suffering can feel more comfortable seeking the help they need.
OCD, or Obsessive-Compulsive Disorder, is a condition that involves the presence of obsessions and compulsions, which cause considerable distress. Some describe their OCD symptoms as only occurring in their minds. Sometimes people informally refer to this phenomenon as "Pure O", though this is somewhat a misguided way of referring to someone whose OCD involves mental compulsions rather than no compulsions at all.
All people with OCD display compulsive urges of some sort, even if they are not outwardly visible. Examples of mental compulsions include ruminating, contingency planning, praying, counting, and self-reassuring.
Specific OCD subthemes are distinct for each person with OCD. These subthemes can include contamination, symmetry, harm (hit-and-run, suicide, violence), sexual or religious taboos (pedophilia, sinning, demonic possession), relationships, sensorimotor experiences (blinking, swallowing, breathing), existence (meaning of life, nature of reality), and many more.
OCD is relatively common with over 4 million people experiencing the disorder that we know of.
While OCD is a highly treatable disorder, it usually takes the average person 7-10 years to be properly diagnosed. In part, this is due to undertrained professionals misinterpreting OCD symptoms for anxiety or psychosis. It's also due to the stigma associated with some manifesting sub-themes, such as suicide and sexual harm.
Obsessions
Obsessions are recurrent and persistent thoughts, urges, or images that are experienced as intrusive and unwanted. Intrusive thoughts often present disturbing content that goes directly against the person's values. In truth, the person is the exact opposite of the fears that OCD shows them, which is why these thoughts can be even more disturbing. Obsessions can show up as:
Urges
Possibilities
Images
Doubts
Sensations
Compulsions
Compulsions are repetitive behaviors or mental acts that an individual feels driven to perform in response to an obsession or according to rules that must be applied rigidly. Compulsions are usually referred to as "rituals" in OCD treatment and aim to mitigate or neutralize the anxiety that comes with OCD symptoms. Some people are only disturbed minorly by compulsive behaviors, while others might perform rituals for up to 8 hours per day. Many people realize that their compulsions are not reasonable, but they still feel an intense urge to do them anyway. Types of compulsions include:
Checking
Counting
Handwashing
Rereading & rewriting
Reassurance Seeking
Avoidance
Ruminating
Praying
Googling
How do people develop OCD?
Temperament
Research suggests that people with OCD have a tendency to internalize stress, lean toward greater negative emotionality, and experience behavioral inhibition during childhood. People with OCD also tend to be highly sensitive, creative, and conscientious, leading to greater feelings of moral responsibility and an increased focus on negative possible outcomes.
Genetics
Genetic inheritance of OCD is at least in part related to having family members with the disorder. Research has found that individuals with a first-degree relative who has OCD are two times more likely to develop the disorder, while those who developed OCD during childhood are 10 times more likely to have a relative with the disorder. Dysfunction in the orbitofrontal cortex, striatum, anterior cingulate cortex, and thalamus has been indicated to play a role in symptom manifestation. People with OCD also have a larger-than-average amygdala.
Environment
Different environmental factors might also increase an individual's risk of developing OCD. These include perinatal events, premature birth, abuse during childhood, and other stressful or traumatic events. Some individuals may develop a sudden onset of Obsessive-compulsive symptoms after experiencing an infection such as step throat. This has been referred to as pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANS or PANDAS). More information can be found on the International OCD Foundation website.
How is OCD treated?
Cognitive Behavioral Therapy: In a nutshell, CBT is an umbrella for treatment models that focus on the structured targeting of disordered thoughts, feelings, and behaviors. CBT therapists espouse the idea that therapeutic healing ensues when those with OCD learn to challenge negative thinking errors and begin to act in accordance with a positive and healthy outlook. This can be a risky approach if done incorrectly. While CBT can supplement therapies that directly target OCD by aiding against low motivation for treatment, it’s very important not to use CBT techniques to argue against obsessive thoughts. This inadvertently works against OCD treatment by offering reassurance, which can easily become compulsive.
Exposure and Response Prevention (ERP)
The International OCD Foundation has labeled ERP the "gold standard" treatment for OCD. In ERP, the person with OCD approaches distressing situations, gradually, in a manner of increasing intensity. Then, they prevent themselves from engaging in any type of compulsion. This might look like someone touching a dirty towel that they consider to be contaminated without washing their hands until their anxiety levels reduce by about half. ERP is a behavioral therapy treatment and does not care much about labeling the meaning of thoughts. Individuals create a fear ladder or hierarchy with lower levels at the bottom and more serious triggers at the top. Then gradually, with the help of a therapist they begin to put themselves in situations involving their triggers.
Inference-Based Cognitive Behavioral Therapy (I-CBT)
I-CBT is a meta-cognitive model for treating OCD. Rather than exposing people to their fears, it asks them to identify the obsessional sequence, paying special attention to obsessional doubts. Obsessional doubts, says I-CBT, are the basis for all other OCD symptoms, and if we rid ourselves of the doubts, we rid ourselves of OCD. I-CBT targets that initial doubt that causes people with OCD to ask, "What if..?" It believes that faulty reasoning is at the heart of obsessional doubt and it aims to empower the client to trust in their senses and avoid going into the "OCD Bubble".
Acceptance and Commitment Therapy (ACT)
ACT is a form of CBT that aims to empower individuals to defuse from their OCD thoughts, or to place less importance on them and gain psychological flexibility. It encourages people to live a full, values-based life without letting OCD get in the way.
Medication
Medication alone is not considered the first line of treatment for OCD, however, it can be an effective tool for lowering OCD symptom baselines. It is best used in conjunction with specialized OCD-focused therapies. Popular medication choices for OCD include clomipramine, fluvoxamine, sertraline, and paroxetine.
How Can I Know if I Have OCD?
If you suspect that you or a loved one may be experiencing symptoms of OCD, it is crucial to seek a professional evaluation for a conclusive diagnosis. However, recognizing potential warning signs and understanding common symptoms of OCD can be helpful in initiating conversations and seeking appropriate support.
Awareness of Intrusive Thoughts and Doubts
People with OCD often experience intrusive thoughts, images, or doubts that continually invade their minds (specific thoughts feel very “sticky”), causing significant distress. These thoughts might often feel irrational, bizarre, or disturbing. If you find yourself constantly plagued by unwelcome thoughts that feel sticky despite your best efforts to find relief or a solution, it may be an indicator of OCD.Recurring Ritualistic Behavior
Do your attempts to alleviate pain and suffering related to disturbing thoughts or fears follow a specific pattern or rule? Do loved ones ever say that your rules are excessive? Asking for repeated reassurance, compulsive Googling and worrying, repeatedly checking things (e.g., doors, appliances), arranging objects symmetrically, or adhering to strict rituals are some examples of compulsive behaviors. If you find yourself engaging in such repetitive activities that feel difficult to control or resist, it may be a sign of OCD.Impact on Daily Life and Functioning
OCD symptoms often disrupt an individual's daily life, affecting their ability to function at work, school, or social activities. Recurrent thoughts or rituals can consume a significant amount of time, leading to distress and interference with personal relationships, work productivity, or overall quality of life. If you notice that your obsession-compulsion cycle is significantly impinging on your daily activities and causing distress, it is advisable to seek professional help.Emotional Distress and Anxiety
The thoughts and rituals associated with OCD generate intense anxiety, fear, or distress. Individuals with OCD may experience panic attacks or overwhelming anxiety when unable to perform their rituals or when their intrusive thoughts become more intense. If you find that your anxiety levels are consistently high due to persistent obsessions or compulsions, it is advisable to consult a mental health professional.Family History and Chronicity
OCD can have a genetic component, meaning it can run in families. If you have close family members, such as parents or siblings, with diagnosed OCD, you might have an increased likelihood of developing the disorder. Additionally, pervasive and chronic symptoms that persist for extended periods are indicative of OCD. If you identify a family history of OCD or recognize that your symptoms have persisted for a significant amount of time, it is crucial to reach out for professional assessment and support.
Identifying potential symptoms of OCD is an essential step towards seeking appropriate professional help. However, it is essential to remember that only a qualified mental health professional can diagnose OCD accurately. If you suspect you or someone you know may be experiencing OCD symptoms, reach out to licensed mental health professionals who can provide a comprehensive evaluation, diagnosis, and beneficial treatment options. Remember, early recognition and timely intervention pave the way to effective management and a proactive approach to mental well-being.
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Do you think you or a loved one might have OCD? Reach out to inquire about a formal assessment, or check out our resources page to learn more.
This blog post is for informational purposes only and should not be considered a substitute for professional medical advice, diagnosis, or treatment.