What You May Not Know about OCD

Obsessive-compulsive disorder (OCD) is one of the most misunderstood disorders in the U.S. Even though it affects one out of every 100 adults and one out of every 200 children, most of what is commonly known about OCD is based on stereotypes and misconceptions. In reality, OCD is much more than a desire for things to be neat, clean and organized. It’s a disorder that can relentlessly and severely interfere with a person’s daily activities, relationships and way of life.

What is OCD?

Obsessive-compulsive disorder is a mental health disorder characterized by persistent, unwanted or intrusive thoughts or sensations (obsessions) that drive a person to do something repetitively to decrease distress (compulsions). OCD is most often chronic and long-lasting and can affect people of all ages and backgrounds. According to the National Institute of Mental Health, the average age of onset in adults is 19 years old, and of those diagnosed each year, 50 percent are classified as having a “severe” form of the disorder. In children, OCD will generally first appear between the ages of 10 and 12 and can even set in as early as the age of four.

Those suffering from OCD may have obsessions, compulsions or a combination of the two. The symptoms resulting from both obsessions and compulsions are wide-ranging and can differ from person to person.

The difference between obsessions and compulsions

Obsessions are the repeated thoughts, mental images or urges that trigger unsettling feelings or anxiety. Those with OCD cannot control these urges and can often feel trapped or limited by these thoughts.

Common obsessive symptoms:

• Stress resulting from a need for objects to be symmetrical or perfectly organized and in order
• Irrational fear of germs or contamination and needing things to be perfectly clean
• Recurring doubt that certain tasks have been completed, such as locking doors or turning off an iron
• Unwanted thoughts about aggression and religious or sexual subjects
• Mental images of hurting oneself or another person that cause feelings of discomfort 
• Uncontrollable urges to shout obscenities or act inappropriately 

Compulsions are repetitive behaviors that one may feel driven to perform to decrease anxiety or stress caused by obsessions. These actions may be taken in an effort to prevent something “bad” from happening or as a soothing or control mechanism.

Compulsions are often a short-term, temporary solution to relieving anxiety and do not bring the afflicted person pleasure or long-term comfort. In addition, compulsive behaviors are excessive and sometimes irrational, not having a realistic relationship to the obsession or problem they’re meant to mitigate.

Common compulsive symptoms:

• Excessive cleaning and handwashing that may leave skin raw
• Checking doors or appliances repeatedly to make sure they are locked or turned off
• Compulsive counting or counting in certain patterns
• Following a strict routine and becoming upset when that routine is broken
• Obsessively rearranging objects to maintain symmetry, orderliness or organization
• Repeating a word or phrase either out loud or internally

It’s important to note that not all rituals or habits that one may incorporate into a daily routine are compulsions. For those with OCD, compulsions are involuntary. They will often spend excessive amounts of time each day practicing these compulsive thoughts or behaviors, even if they realize that their actions are unnecessary.

Common myths about those with OCD

Unfortunately, there are many myths and stereotypes that exist about those battling OCD and why they do what they do. We’ve gathered some of the most common myths to provide insight on why they’re false and to help others better understand what those with obsessive-compulsive disorder are going through.

Myth #1: All people who like keeping things neat and organized have OCD.

The Truth: A desire to keep things neat and tidy around one’s house or office is different from having to keep things organized to avoid cripplingly anxiety and stress.

While many find joy in keeping things organized for aesthetic reasons, those with obsessive-compulsive disorder usually don’t enjoy their cleanliness rituals. Their compulsions to keep surfaces spotless or meticulously re-arrange items on a shelf are mechanisms meant to alleviate the stress that a dirty counter or unorganized drawer would bring them as a result of their condition.

In addition, not all who suffer from OCD have compulsions or obsessions related to cleanliness and organization. The disorder manifests itself differently in each individual and symptoms can even change over time.

Myth #2: People with OCD are just “germaphobes.”

The Truth: Having a cleanliness complex can simply be a personality trait; whereas an involuntary need to constantly wash ones hands or repeatedly clean objects is a compulsion.

People who like cleaning because they enjoy the resulting outcome has a choice to follow through with those actions or not. However, people with OCD feel they must constantly rid themselves and their possessions of germs to avoid debilitating stress and discomfort. In this case, it is their uncontrollable urges driving them to eliminate germs and contamination, not just a desire to be clean.

Myth #3: OCD is caused by everyday stress.

The Truth: OCD is a mental health disorder and a life-threatening illness. While the symptoms of OCD can be exacerbated by stress or stressful situations, stress does not cause one to develop the disorder.

Those suffering from OCD cannot simply get rid of their symptoms by trying not to be stressed in certain situations. By telling them to “relax” or “stop obsessing,” you’re essentially telling them to stop something out of their control. Stress and fear are often the result of an obsession, not the cause.

However, there is some evidence that those who have gone through traumatic or stressful life events may be at a higher risk of developing obsessive-compulsive disorder after the events have occurred.

Myth #4: OCD impacts women more than men.

The Truth: Unlike other anxiety disorders, OCD does not affect one gender, age group, race or ethnic background more than another.

While women are two times more likely to develop other anxiety disorders, such as phobias or post-traumatic stress disorder, they are just as likely to suffer from obsessive-compulsive disorder as men and children.

Myth #5: OCD symptoms are always obvious and easy to spot.

The Truth: People with OCD often attempt to suppress or even hide their symptoms to avoid judgement or criticism. Seeking proper treatment can help teach those with OCD coping methods for overcoming their outward-facing compulsions.

There is also a subset of OCD patients who exhibit no visible symptoms of their compulsions, but rely on internal compulsions, such as repeating phrases in their head or constantly trying to reason their obsessive thoughts away, to alleviate anxiety caused by their obsessions. This subtype of OCD is called Pure Obsessional OCD, or Pure-O, and can often go mis- or un-diagnosed due to the lack of outward symptoms.

Myth #6: Your susceptibility for developing OCD is rooted in your childhood.

The Truth: The environment in which you grew up has very little impact on your risk of developing OCD later in life.

While many people believe that having low self-esteem as a result of growing up in a dysfunctional household can cause or increase your chances of having OCD, there is no evidence to suggest that these factors have a direct correlation with developing the disorder. However, there is evidence that obsessive-compulsive disorder may in fact have a genetic tie and can run in a family. In addition, those who experienced abuse or trauma as a child are at a greater risk of developing OCD.

Myth #7: OCD cannot be treated.

The Truth: There are several treatment options available for those suffering from OCD. While these methods may not provide a long-term cure, they can help control symptoms so they do not inhibit people's ability to participate in their daily routines and activities.

Therapy and medication are the two main treatment methods for OCD, with a combination of both methods being the most effective option. 

Therapy

Exposure and response prevention (ERP), a type of talk therapy involving gradually exposing those with OCD to feared objects or obsessions, has proven to be effective in teaching healthy ways to cope with anxiety.

Although not many Oklahoma psychologists are experts in ERP, studies have shown that ERP therapy is effectively treated via video conference or telephone. Dr. Andrea Clark, a Norman, Oklahoma psychologist who does offer ERP therapy, recommends a book called Freedom from Obsessive Compulsive Disorder: A Personalized Recovery Program for Living with Uncertainty. If you want more information about finding the right therapist, check out the International OCD Foundation's website.

Medications

Antidepressants are the most commonly used medication to treat OCD, but a doctor or mental health professional may also recommend other forms of psychiatric medications based on the situation.

The following are antidepressants commonly used and approved to treat OCD.

• Sertraline (Zoloft)
• Paroxetine (Paxil, Pexeva)
• Fluvoxamine
• Fluoxetine (Prozac)
• Clomipramine (Anafranil)

If you believe you’re experiencing obsessions or compulsions relating to obsessive-compulsive disorder, don’t hesitate to seek help and talk to a health care provider about what you’re experiencing. INTEGRIS Mental Health provides a variety of treatment options for coping with not only OCD but other anxiety and depression disorders as well.