What is Obsessive-Compulsive Disorder (OCD)?
Obsessive-compulsive disorder is a mental health condition that causes people to feel a need to perform specific routines or think certain thoughts. A person with OCD generally experiences these obsessions and compulsions throughout the day. Individuals with OCD feel driven to ruminate on intrusive thoughts and carry out rituals even when they understand that there is no need to do so.
The compulsive behaviors that individuals with OCD have can be very time consuming, often taking hours a day to complete. The unwanted thoughts, intrusive thoughts, and obsessive thoughts can also lead to considerable distress. Obsessive-compulsive disorder can interfere considerably with an individual’s ability to function normally in daily life.
While the phrase “obsessive-compulsive” is often used colloquially to refer to a person who is fastidious or perfectionistic, the condition is far more severe than a mere personality defect. In fact, obsessive-compulsive disorder is associated with a variety of other dangerous mental health problems, including anxiety disorder, major depressive disorder, eating disorders, and increased suicidal ideation. There is also a strong link between suffering from OCD and developing a substance use disorder.
Without a strong treatment plan in place, a person with OCD is far more likely than others to abuse drugs and alcohol as a form of self-medication. The consequences of developing a comorbid substance use disorder can be far more catastrophic than suffering from OCD alone. If you, loved ones, or family members are suffering from OCD, it is essential to seek treatment as soon as possible.
Most Common Types of Obsessive-Compulsive Disorder
Psychiatrists do not officially distinguish between subtype of obsessive-compulsive disorder. The manual that the American Psychiatric Association publishes to aid psychiatrists in making diagnoses, the Diagnostic and Statistical Manual of Mental Disorders, classifies symptoms under a single medical condition: obsessive-compulsive disorder (OCD). However, researchers who study with people OCD generally classify sufferers into four different types. While manifests itself very differently among different individuals, individuals who suffer from these different types of OCD tend to experience similar groupings of symptoms. The most common types of obsessive-compulsive disorder are as follows:
Symmetry and Ordering
Individuals with the symmetry and ordering type of OCD suffer from an obsession with alignment, exactness, and organization. They experience obsessions and compulsions that relate to keeping their belongings or living situation arranged in a specific way, often driven by a need for symmetry or mathematical exactness. Many people with this type of OCD also experience intrusive thoughts about something terrible happening if they fail to organize their belongings correctly. This need for symmetry and precision often extends to actions and behavior, such as feeling and compulsion to scratch an itch on the right side of the body after scratching one on the left side.
Cleaning and Contamination
The cleaning and contamination subtype of OCD is probably the image most people have of OCD, given its frequent stereotyped depiction in television and media. Individuals with this form of OCD are driven by a fear of contamination and germs. Many develop an anxiety disorder or phobias surrounding viruses, blood, toxic substances, and other unwanted contaminants. Sufferers can feel a compulsion to clean their living environments long after every last speck has been removed. This can interfere considerably with daily life, for example when a person with OCD leaves work because they are repeatedly checking on the cleanliness of their home. These OCD symptoms and anxieties about cleanliness extend to the contents of a person’s mind: many find themselves worried about having unclean or dirty thoughts. Unfortunately, the intrusive thoughts that are characteristic of OCD can make this a self-fulfilling prophecy.
Forbidden, Harmful, or Taboo Thoughts and Impulses
This form of OCD emphasizes the obsessive symptoms over the compulsive behaviors. While most people with OCD suffer from intrusive thoughts, people with this subtype of OCD experience them almost constantly. The nature of these thoughts is often disturbing, with content that is sexual or violent in nature. This can cause sufferers to experience considerable shame, guilt, and distress. These intrusive thoughts can also lead to self-doubt, driving individuals to question their religious purity, sexual orientation, motives, and morality. They might seek constant reassurances that they’re not bad people. The magical thinking that many people with OCD engage in can lead them to believe that merely having certain thoughts can lead to harmful consequences for themselves or loved ones. For this reason, sufferers often also engage in compulsive behaviors that aim to expunge or eliminate certain unwanted thoughts.
Not to be confused with hoarding disorder, a separate mental health condition wherein a person hoards belongings to the point of unsustainability, OCD of the hoarding variety is distinct in terms of the distress involved. Individuals with this condition often worry that throwing an object away could lead to disastrous consequences for themselves or others. Many also experience overlapping symptoms with the cleaning and contamination form of OCD. It is common for sufferers to feel unable to throw an object away because touching it would lead to contamination. Despite often living in cluttered circumstances, people with this form of OCD often have no desire to keep the objects in their possession but are instead driven by obsessive fears associated with discarding them.
Symptoms of Obsessive-Compulsive Disorder
People with OCD generally experience a range of symptoms that fall under two categories: obsessions and compulsions. The unwanted thoughts and compulsive behaviors that a person with OCD is compelled to engage in can damage careers, interpersonal relationships, and mental health.
Even healthy people have compulsions, but the compulsions associated with OCD are a source of considerable distress. People with this mental illness are unable to control their behaviors and engage in them for hours a day. It is also notable that they receive no pleasure from engaging in these behaviors, aside from a very temporary lessening of anxiety. Common compulsions include:
- Cleaning and hand washing
- Checking behaviors, such as returning home to make sure that the oven is off or the sheets are properly tucked in
- Compulsive counting
- Arranging and ordering belongings in a precise and specific way
- Repetitive behaviors
The obsessions that a person with OCD experience often relate to their compulsions, which can represent a means of expunging certain thoughts. Obsessions are repetitive unwanted thoughts, mental images, and urges that cause distress and interfere with a person’s ability to function normally in everyday life. Common obsessive thoughts include:
- Intrusive thoughts about taboo or forbidden subject matter, often involving sex, violence, or religion
- Fears related to germs and contamination
- A need for belongings and other objects to be perfectly symmetrical
- Negative thoughts about oneself or others
It is also very common for people with OCD to suffer from a tic disorder. Behavioral tics can temporarily relieve some of the pent up anxiety associated with holding back an obsession or compulsion. While adults and children both frequently experience tics alongside their OCD, the condition is more common when OCD begins in childhood. Common motor tics include:
- Head jerking
- Eye blinking or other eye movements
- Facial grimacing
- Shoulder shrugging or jerking
Symptoms of OCD often change and develop over time. An individual may experience a lessening of their symptoms only to have symptoms suddenly worsen. Many go through great efforts to avoid circumstances that exacerbate their symptoms. People with untreated or undiagnosed obsessive-compulsive disorder often engage in self-soothing and self-medicating behaviors. For this reason, alcohol and drug abuse is common among people with OCD. Substance use disorders ultimately increase the severity of OCD symptoms and present complications during treatment.
Causes of Obsessive-Compulsive Disorder
The exact neurological mechanism responsible for obsessive-compulsive disorder is currently unknown. However, neuroimaging techniques have demonstrated that certain parts of the brain are implicated in OCD. Areas of the brain with abnormal activity during OCD symptoms include the orbitofrontal cortex, left dorsolateral prefrontal cortex, right premotor cortex, left superior temporal gyrus, globus pallidus externus, hippocampus and right uncus.
Neurologists have also observed that people with symptoms of OCD have different concentrations of grey matter in different areas of the brain. Nonetheless, the relationship between these abnormal neurological circumstances and the mental illness itself are poorly understood.
While the exact cause of OCD is unknown, research has repeatedly suggested that OCD arises through a combination environmental and genetic factors. There is evidence that OCD is heritable, given that many people who develop OCD have a family history of the condition. Twin studies have also shown that people with identical twins who have OCD are significantly more likely to develop the condition themselves. However, environmental factors play a role as well.
Children are more likely to develop OCD after suffering from trauma, abuse, or other distressing events. Ultimately, however, given how little is known about the causes, OCD is diagnosed based on symptoms alone.
Diagnosing Obsessive-Compulsive Disorder
The symptoms of OCD are generally very recognizable, given how severely unwanted thoughts and repetitive behaviors interfere in daily life. However, medical practitioners begin by eliminating other possible causes for these symptoms. Anxiety disorders, major depression, substance use disorder, Tourette Syndrome, eating disorders, and other mood disorders can sometimes present overlapping symptoms.
For this reason, it is essential to seek the help of a psychiatrist or primary care physician. Medical professionals can provide an accurate diagnosis and help an individual begin their journey of treating OCD.
The American Psychiatric Association uses a textbook called the Diagnostic and Statistical Manual of Mental Disorders, or DSM-5, to diagnose mental illnesses. Obsessive-compulsive disorder is diagnosed based on the presence of specific signs of symptoms. These symptoms are as follows:
- Presence of obsessions, compulsions, or both:
Obsessions are defined by (1) and (2):
1. Recurrent and persistent thoughts, urges, or impulses that are experienced, at some time during the disturbance, as intrusive and unwanted, and that in most individuals cause marked anxiety or distress.
2.The individual attempts to ignore or suppress such thoughts, urges, or images, or to neutralize them with some other thought or action (i.e., by performing a compulsion).
Compulsions are defined by (1) and (2):
1. Repetitive behaviors (e.g., hand washing, ordering, checking) or mental acts (e.g., praying, counting, repeating words silently) that the individual feels driven to perform in response to an obsession or according to rules that must be applied rigidly.
2.The behaviors or mental acts are aimed at preventing or reducing anxiety or 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 obsessions or compulsions are time-consuming (e.g., take more than 1 hour per day) or cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
- The obsessive-compulsive symptoms are not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition.
- The disturbance is not better explained by the symptoms of another mental disorder (e.g., excessive worries, as in generalized anxiety disorder; preoccupation with appearance, as in body dysmorphic disorder; difficulty discarding or parting with possessions, as in hoarding disorder; hair pulling, as in trichotillomania [hair-pulling disorder]; skin picking, as in excoriation [skin-picking] disorder; stereotypies, as in stereotypic movement disorder; ritualized eating behavior, as in eating disorders; preoccupation with substances or gambling, as in substance-related and addictive disorders; preoccupation with having an illness, as in illness anxiety disorder; sexual urges or fantasies, as in paraphilic disorders; impulses, as in disruptive, impulse-control, and conduct disorders; guilty ruminations, as in major depressive disorder; thought insertion or delusional preoccupations, as in schizophrenia spectrum and other psychotic disorders; or repetitive patterns of behavior, as in autism spectrum disorder).
Who is at Risk for Obsessive-Compulsive Disorder?
While the causes of obsessive-compulsive disorder are unclear, researchers understand that certain populations are at a higher risk for developing OCD symptoms. Most people with OCD begin to exhibit obsessive thoughts and behavioral compulsions during adolescence or early adulthood. Risk factors associated with developing OCD include:
- Trauma or abuse during childhood
- Family members with OCD
- The presence of another mental health disorder, such anxiety disorders or a tic disorder like Tourettes Syndrome
- Chronic substance abuse
Obsessive-Compulsive Disorder Statistics
In the United States, the National Institute of Mental Health estimates that 1.2% of adults suffer from OCD on a yearly basis. The prevalence of OCD is even higher across lifespans, with 2.3% of US adults experiencing OCD symptoms at some point in their lives. While more females are diagnosed than males in any given year, this difference can also be interpreted to represent a reluctance on the part of males to seek diagnosis or treatment. People with OCD have high rates of disability. It is estimated that 50.6% of people who suffer from OCD are severely impaired, with 34.8% being moderately impaired.
Not only do the compulsive behaviors and obsessive thoughts associated with OCD make functioning in daily life difficult, however, they also come with a host of other risks. People with OCD are significantly more likely to develop an anxiety disorder, substance use disorder, or other mental health disorders. 52% of people with OCD engage in suicidal ideation, and the risk of suicidal behavior increases when OCD is present alongside another comorbid condition.
Medications Used to Treat Obsessive-Compulsive Disorder
Due to the stigma surrounding OCD, only a fraction of people with OCD seek treatment for OCD. However, OCD is in fact a very treatable mental illness. Treatment for OCD generally involves a combination of psychotherapy and medication. While many talk therapy modalities can be implemented for treating OCD, individuals with OCD respond particularly well to cognitive-behavioral therapy (CBT). People who have moderate to severe cases are often prescribed medication as well. The most frequently used medications are as follows:
- Selective Serotonin Reuptake Inhibitors (SSRIs). SSRIs, which are the most common medication prescribed for major depression as well, are generally the most effective class of medication for people with OCD.
- Certain tricyclic antidepressants, such as Clomipramine. Despite having higher side effects than SSRIs, this medication has also been found just as effective.
- Antipsychotic, such as risperidone and aripiprazole. Antipsychotic have been found to have limited effectiveness over short periods of time. They are generally only prescribed to patients who do not respond to SSRI treatment.
Obsessive-Compulsive Disorder and Addiction Treatment at NuView Treatment Center
NuView Treatment Center is one of the best dual diagnosis treatment centers and we understand that individuals who suffer from obsessive-compulsive disorder (OCD) alongside a substance use disorder often require more care. OCD can lead people to turn to addictive substances, and substance abuse can in turn exacerbate the compulsive behaviors and obsessions associated with OCD.
Treating one condition to the exclusion of the other often leads nowhere, since a relapse with OCD can trigger a relapse with drugs and alcohol, and continued substance abuse can similarly exacerbate the symptoms of OCD. The relationship between these conditions is complex, often making both diagnosis and treatment difficult.
As a holistic dual diagnosis treatment center, at NuView Treatment Center, dual diagnosis patients can receive the integrated care they need. NuView assesses each individual patient to provide them with a treatment plan that addresses their unique needs. We offer a wide range of treatment modalities to ensure that patients improve physically, mentally, and emotionally. Our dual diagnosis rehab program offers psychotherapy, cognitive-behavioral therapy, group therapy, CAM therapy, and medication-assisted therapy. By entering our treatment program for OCD and addiction, individuals can get the long term relief they need.
If you are experiencing obsessions, compulsive behaviors, intrusive or suicidal thoughts, or struggle with alcohol or drug abuse, we are here to help. Recovery is possible.