OCD - signs, symptoms and treatment
Everything you need to know
Despite the fact that obsessive-compulsive disorder is on the increase, it's still largely misunderstood
Obsessive-compulsive disorder (OCD) is not a rare condition suffered by eccentric types who have little else to worry about. It’s an extremely common and incredibly debilitating anxiety disorder suffered by everyday people. More than half a million Australians in fact. OCD is now being diagnosed almost as often as asthma, and there are thought to be thousands more living with it undiagnosed.
“Victims of OCD engage in bizarre and self-destructive behaviours to avert some imagined catastrophe,” says Dr. Jeffrey Schwartz, psychiatrist and author of Brain Lock – Free Yourself From Obsessive-Compulsive Behaviour.
“But of course, there is no realistic connection between the behaviours and the catastrophes they so fear. For example, they may shower 40 times a day to ‘ensure’ that there will not be a death in the family. Or they may go to great lengths to avoid certain numbers so as to ‘prevent’ a fatal airplane crash. Unlike compulsive shoppers or compulsive gamblers, people with OCD derive no pleasure from performing their rituals. They find them extremely painful.” The impact this has on their lives can be severe.
“It is a devastating disease that often creates chaos in the lives of its victims – and those who love them,” says Schwartz. “The preoccupation with repetitive behaviours, such as washing, cleaning, counting or checking, causes trouble on the job, leads to marital strife and difficulty with social interaction.”
What causes OCD?
Frustratingly, it’s not known what exactly causes OCD. At one time during the early twentieth century, OCD was thought to be the result of poor parenting, specifically (and bizarrely) the result of inadequate toilet training. Thankfully, we now know this is not the case.
“To date, no specific gene or genes for obsessive-compulsive disorder have been identified and I don’t believe there ever will be,” says Dr. Robin Pauc, a specialist in neurology and author of Could It Be You?
“It has been suggested that the neurotransmitter serotonin might be the underlying cause. This is backed up by the way that serotonin re-uptake inhibitors – drugs that prevent serotonin from being removed from where it acts – work so well in treating OCD. The neurotransmitter dopamine could also be involved.”
There may also be one or more environmental triggers at play, such as a stressful life event or ongoing anxiety. As compulsions are learned behaviours, they may develop into a habit if they are associated in some way with providing relief from the cause of the anxiety.
Who gets it?
Anybody can get OCD, it doesn’t seem to matter what nationality you are, your gender or what level of social or economic class you’re in.
“Symptoms can appear at any point within the life cycle but most commonly begin during childhood, adolescence or young adulthood,” says Dr. Bruce Hyman, cognitive behaviour therapist and author of Coping with OCD.
“Many people with OCD experience their first symptoms during childhood, as repetitive touching, tapping or counting behaviours; obsessions with dirt and germs; or persistent and repetitive demands for reassurance from their parents. Onset of OCD in childhood generally predicts a lifelong predisposition to the problem.”
Childhood-onset OCD can run in the family but this may or may not be biological. The mother who washes her hands compulsively in times of stress may influence the manner in which the child responds to their own stressful situations later in life.
“Factors in our environment, specifically having overly worrisome parents or experiencing early childhood stressors such as parental death, illness and divorce, may contribute to a vulnerability to OCD symptoms,” says Hyman.
What are the signs and symptoms?
It’s possible to be obsessively compulsive about virtually anything, however, there are some typical OCD symptoms. Common obsessions include fear of harm from illness or accidents, obsessive thoughts and images about sex or violence, hoarding, needing to remember details, excessive concern with symmetry and fear of contamination from germs or poisons.
“Obsessions usually begin with persistent doubt, which is why OCD is sometimes referred to as ‘the doubting disease’,” says Hyman. “This doubt leads to intolerable levels of uncertainty, which generates anxiety. To relieve the anxiety, you may start engaging in compulsive behaviour – excessive washing, checking, reassurance seeking and so forth.
“These behaviours might relieve your anxiety for a little while, but the relief won’t last long,” says Hyman. “The anxiety-provoking obsession returns, often stronger and more frequently than before. So you may try to adopt even more elaborate rituals to relieve the anxious feelings of uncertainty.”
“In its milder forms, the cycle of obsession and compulsion can be annoying and inconvenient. At its most extreme, it can be severely disruptive to all aspects of your life.”
How is it treated or managed?
Orthodox treatment of OCD usually involves psychological treatments and in some cases, medications as well.
Cognitive behavioural therapy appears to have the greatest success. A major part of this therapy concerns gradually exposing the person to situations that cause obsessive triggers while at the same time the psychologist works with the patient to reduce the compulsions. Cognitive therapy also has an educational component.
“Cognitive therapy engages the person with OCD in directly challenging the dysfunctional beliefs and ideas that fuel OCD,” says Hyman.
Medication in the form of SSRIs have also been used successfully with some sufferers of OCD.
“These drugs act to enhance the level of the brain chemical serotonin, a neurotransmitter that helps regulate mood and emotions,” says Hyman.
“Medication can significantly reduce OCD symptoms, but for most people with the disorder, it’s only a partial solution.”
Anxiety management techniques help sufferers to manage their symptoms and thereby increase their ability to function normally from day to day. Examples of such techniques include relaxation methods, like meditation and yoga, deep breathing techniques and hyperventilation control.
Other self-help techniques which can be used to some effect include distracting yourself and refocusing your attention, writing down your thoughts and worries and creating a ‘worry period’ – a period of time devoted to obsessing, so that when urges appear you can put them off to a designated time of day.
How can family members help?
It can be extremely difficult living with a family member who has OCD. There is often guilt and blame from parents who think they may somehow be responsible. There is the responsibility of undertaking daily activities that the person with OCD cannot do and there is the general distress and disruption to the household.
The most helpful thing a family member can do is be understanding – let the person know that you understand that the condition is not their fault. This will help alleviate the victim’s feelings of guilt, which can exacerbate symptoms. Talk about how they feel but don’t irritably keep reminding them that their behaviour is irrational – they know that already.
Encourage them to seek professional help and contact support groups where you can go with them and meet other families with similar experiences. This helps build up a useful social network and helps you to feel less isolated.
Finally, be sure to acknowledge their improvement, however minor it may be.