OCD
What is Obsessive Compulsive Disorder (OCD)
Obsessive Compulsive Disorder (OCD) is the name given to a condition in which people experience repetitive and upsetting thoughts and/or behaviours. OCD has two main features: Obsessives and Compulsions.
Obsessions
The person does not want to have these ideas, finds them disturbing and intrusive, and usually recognizes that they don’t really make sense. People with OCD may worry excessively about dirt and germs and be obsessed with the idea that they are contaminated or may contaminate others. Alternatively they may have obsessive fears of having inadvertently harmed someone else (perhaps while pulling the car out of the driveway), even though they usually know this is not realistic. Obsessions are accompanied by uncomfortable feelings, such as fear, disgust, doubt, or a sensation that things have to be done in a way that is “just so.”
Compulsions
Compulsions are acts the person performs over and over again, often according to certain “rules.” People with an obsession about contamination may wash constantly to the point that their hands become raw and inflamed. A person may repeatedly check that she has turned off the stove or iron because of an obsessive fear of burning the house down. She may have to count certain objects over and over because of an obsession about losing them. Unlike compulsive drinking or gambling, OCD compulsions do not give the person pleasure. Rather, the rituals are performed to obtain relief from the discomfort caused by the obsessions.
Other features of Obsessive-Compulsive Disorder
Most individuals with OCD recognize at some point that their obsessions are coming from within their own minds and are not just excessive worries about real problems, and that the compulsions they perform are excessive or unreasonable. When someone with OCD does not recognize that their beliefs and actions are unreasonable, this is called OCD with poor insight. OCD symptoms tend to wax and wane over time. Some may be little more than background noise; others may produce extremely severe distress.
Research suggests that OCD involves problems in communication between the front part of the brain (the orbital cortex) and deeper structures (the basal ganglia). These brain structures use the chemical messenger serotonin. It is believed that insufficient levels of serotonin are prominently involved in OCD. Drugs that increase the brain concentration of serotonin often help improve OCD symptoms. Pictures of the brain at work also show that the brain circuits involved in OCD return toward normal in those who improve after taking a serotonin medication or receiving cognitive-behavioural psychotherapy. Although it seems clear that reduced levels of serotonin play a role in OCD, there is no laboratory test for OCD. Rather, the diagnosis is made based on an assessment of the person’s symptoms. When OCD starts suddenly in childhood in association with strep throat, an autoimmune mechanism may be involved, and treatment with an antibiotic may prove helpful.
One third to one half of adults with OCD report that it started during childhood. Unfortunately, OCD often goes unrecognized. On average, people with OCD see three to four doctors and spend over 9 years seeking treatment before they receive a correct diagnosis. Studies have also found that it takes an average of 17 years from the time OCD begins for people to obtain appropriate treatment. OCD tends to be under-diagnosed and under-treated for a number of reasons. People with OCD may be secretive about their symptoms or lack insight about their illness. Many healthcare providers are not familiar with the symptoms or are not trained in providing the appropriate treatments. Some people may not have access to treatment resources. This is unfortunate since earlier diagnosis and proper treatment, including finding the right medications, can help people avoid the suffering associated with OCD and lessen the risk of developing other problems, such as depression or marital and work problems.
No specific genes for OCD have yet been identified, but research suggests that genes do play a role in the development of the disorder in some cases. Childhood-onset OCD tends to run in families (sometimes in association with tic disorders). When a parent has OCD, there is a slightly increased risk that a child will develop OCD, although the risk is still low. When OCD runs in families, it is the general nature of OCD that seems to be inherited, not specific symptoms. Thus a child may have checking rituals, while his mother washes compulsively. In addition a more detailed description of an OCD experience can be found here: What is O.C.D.? by Steven Phillipson, Ph.D.
The first port of call for children/adolescents with OCD is to contact their local GP first (or have their parent contact the GP). The GP will then make a referral to a child/adolescent mental health service where the person will get the treatment required. You can visit the ‘Finding Psychiatrist/Therapist’ part of this website for more information on where to get help. A good book to look at is Talking Back to OCD: The Program That Helps Kids and Teens Say “No Way” — and Parents Say “Way to Go” by John S. March. This self-help workbook book has 2 sections – one for parents on how to help their kids and then one for children/adolescents on how to help themselves. The website www.juvenilementalhealthmatters.com has the slides from our talk on March 19th 2008 (An Introduction to Obsessive Compulsive Disorder with children and adolescents) by Dr. Gary O’Reilly – it is under the heading ‘PDF copies of the overheads from our talks and conferences’.
Obsessions can come in the form of involuntary thoughts, images or impulses. Common obsessions include, but are not limited to: fears about dirt, germs and contamination; fear of acting out violent or aggressive thoughts or impulses; unreasonable fears of harming others, especially loved ones; abhorrent blasphemous or sexual thoughts; inordinate concern with order, arrangement or symmetry; inability to discard useless or worn out possessions; and fears that things are not safe, especially household appliances. The main features of obsessions are that they are automatic, frequent, upsetting or distressing, and difficult to control or get rid of.
Just as with obsessions, there are many types of compulsions.
It is common for people to carry out a compulsion in order to reduce the anxiety they feel from an obsession.
Common compulsions include excessive washing and cleaning, checking, repetitive actions such as touching, counting, arranging and ordering; hoarding, ritualistic behaviours that lessen the chances of provoking an obsession (e.g. putting sharp objects out of sight); and acts which reduce obsessional fears (e.g. wearing only certain colours). Compulsions can be observable actions, for example washing, but they can also be mental rituals such as repeating words or phrases, counting or saying a prayer. Again, not all types of compulsions are listed here. The main features of compulsions are they are repetitive and stereotyped actions that the person feels forced to perform. People can have compulsions without having obsessional thoughts but, very often, these two occur together. Carrying out a compulsion reduces the person’s anxiety and makes the urge to perform the compulsion again stronger each time.
People with OCD typically try to make their obsessions go away by performing compulsions.
Compulsions are acts the person performs over and over again, often according to certain “rules.” People with an obsession about contamination may wash constantly to the point that their hands become raw and inflamed. A person may repeatedly check that she has turned off the stove or iron because of an obsessive fear of burning the house down. She may have to count certain objects over and over because of an obsession about losing them. Unlike compulsive drinking or gambling, OCD compulsions do not give the person pleasure. Rather, the rituals are performed to obtain relief from the discomfort caused by the obsessions.