Angie is an 12-year-old girl who stays up until 1am working on her school homework. It has to be perfect, no marks, no errors and perfect penmanship. She avoids stepping on certain dark spots on the wood floor because if she does it feels like something bad is going to happen to her family. She misses out on sleepovers because it takes her hours to perform her morning and bedtime rituals. One example is that she has to flip her shirt a certain way and always has to start by putting her right leg in first. If it doesn’t feel just right she has to continue the steps until her OCD is satisfied.
Rob is a 48-year-old man who has thoughts that he is going to lose control when he is driving and swerve into oncoming traffic. This has never happened to him, but he is so fearful of it happening that he cannot stop thinking about it. He imagines the horror of the accident and the reactions of his friends and family. Due to the anxiety experienced by this fear, Rob has decided that he is going to stop driving.
Obsessive Compulsive Disorder is a condition that affects millions of adults, adolescents, and children. Many of us have quirks, find ourselves avoiding stepping on cracks, or checking our stove a few times to make sure it is off. It is also common to hear things like, “I am obsessed with chocolate,” or “you are so compulsive.” These phrases or behaviors can be used to describe obsessive compulsive tendencies, but do not describe the agony that is experienced with obsessive compulsive disorder. OCD includes obsessions, compulsions and distress or impairment caused by the behavior. This disorder can take a number of different forms, many of which most people would not identify as OCD.
Obsessions: Unwanted thoughts, impulses, or images that repeatedly enter one’s mind. They are usually experienced as unpleasant and can sometimes be similar to worries. These thoughts are involuntary, meaning that they come to mind despite trying to think of something else. Obsessions can also change over time, some lose their importance and some become more significant. Common obsessions include fears of contamination, fears of harm coming to loved ones, fears of losing control and doing something violent or sexually inappropriate, fears of making God angry, fears of never getting rid of an uncomfortable feeling, and fears of hitting someone when driving.
Compulsions: Actions that are performed deliberately and repeatedly in order to decrease anxiety that is experienced due to the obsessions. These are sometimes called rituals. Many individuals are secretive about their compulsions and hide them from others. There are also mental rituals such as counting, praying, or repeating a phrase; this is especially hard for others to notice. Some examples of common compulsions include hand washing, cleaning, tapping, checking, praying, doing things a certain number of times, repeating your steps, and lining items up so they are symmetrical. People also often have avoidance compulsions and avoid situations or people that make them uncomfortable. This may include not touching door handles, or going to places that cause anxiety.
The onset of the disorder is often sneaky and gradual. People will notice little rituals that do not take too long, but seem to give them temporary relief from the anxiety caused by the obsessions. OCD is a very greedy disorder in that the compulsions that used to work now need to be performed longer or in a “just right way.” The things that used to work as quick fixes now can take several hours. The few places or objects that were avoided grow into numerous situations. There is a form of OCD that has a sudden onset, although this seems to occur mostly in children and may be related to strep antibodies. Whether it comes on gradually or has a rapid onset, people find that their OCD is overpowering and causes them much distress. They often notice changes in their mood, physical state, and behavior that can include: headaches, upset stomach, fatigue, anger, temper tantrums (adults too), confusion, frustration, fear, embarrassment, irritability, and tension. This disorder can be private or can involve rules that not only control the individual, but also the family. Family members will first refuse to comply with OCD rules (shower before you sit down in the house), but will often give in once they see their loved one so uncomfortable. Soon family members are now stuck in the OCD web and the family feels like prisoners to the OCD.
This is a disorder that has been misunderstood by therapists and researchers for many years. It was once viewed as a disorder that was very difficult to treat, but is now one of the most treatable disorders. In fact many therapists and researchers have found their success rate in treatment to be over 80%. There are a number of different forms of psychotherapy. The type that has been empirically proven to be most effective in treating OCD includes behavior therapy with and without the use of medication.
Behavior Therapy: This type of therapy involves ACTION! It includes a technique called exposure and response/ritual prevention. Exposure includes exposing yourself to the thoughts or situations that trigger OCD anxiety (touch the doorknob). Response prevention is not doing anything to escape from the anxiety (do not wash your hands). Through repeating these exercises, the intensity of the fear decreases and it becomes easier to break OCD rules. This process can be done in a very gradual way. In therapy, a therapist would work with the individual to develop a hierarchy, which is a list of easiest to most difficult ways to stand up to OCD. Individuals start with the easier items and work their way up the list. As they practice they get better at breaking OCD rules and the things that once felt impossible, now feel manageable and eventually easy. This is a delicate process and typically people benefit from the guidance of a therapist.
Medication: Most of the medications used to treat OCD work on a chemical in your brain called serotonin. Medication works differently for each person and a medication that may work for you may not work for someone else with OCD and vise-versa. If you currently or later decide to try medication, be sure to work closely with your doctor to monitor any side effects that you could experience.
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