This article discusses the features of obsessive-compulsive disorder (OCD).
There is also a diagnosis of obsessive-compulsive personality disorder, which is not the same disorder as OCD; even though it shares a few similarities with OCD, it has an entirely different presentation. This article will not discuss facets of obsessive-compulsive personality disorder.
It should be noted that the information in this article is designed to be used for educational purposes only. None of the information in this article is intended to be used for assessing, diagnosing, or treating any individual with any type of psychological or emotional issue. Only licensed healthcare professionals can diagnose and treat these disorders.
- Obsessive-Compulsive Disorder (OCD)
Up until 2013, the American Psychiatric Association listed OCD as one of the anxiety disorders – disorders primarily driven by dysfunctional feelings and expressions of anxious behavior. When the DSM-5, the latest edition of the Diagnostic and Statistical Manual for Mental Disorders was released, OCD was removed from the anxiety disorders and placed in its own category. This move was based on research findings indicating that it was a separate disorder from the anxiety disorders.
There are two primary features associated with a diagnosis of OCD. These features are:
- Experiencing repetitive obsessions: Obsessions are intrusive urges, thoughts, or images that result in the person experiencing very anxious states. The person attempts to suppress these urges or images by performing some specific action that reduces the stress and anxiety that they elicit.
- Experiencing repetitive compulsions: Compulsions are the actions that are designed to reduce the stress and anxiety elicited by obsessions. These can either be mental actions, such as repeating thoughts or reciting certain versus, or they can be behavioral acts, such as washing one’s hands, continually checking to see if doors and windows are locked, etc. The person with OCD continues to repeat these compulsions until the anxiety elicited by the obsession is gone. Once the obsession or the anxiety returns, the individual continues to repeat these compulsive acts.
In order for a person to be diagnosed with OCD, the obsessions and compulsions need to take up at least an hour of the person’s time nearly every day and cause significant distress or impairment in the person’s ability to function normally. These obsessions and compulsions often cause significant issues with the person’s ability to work, engage in interpersonal relationships, attend school, perform their everyday duties, such as engage in childcare, etc. Because individuals who use certain drugs or medications or who have certain medical conditions such as head injuries may exhibit similar types of behaviors, an individual diagnosed with OCD cannot have their behavior better explained by the use of medications, some other psychiatric/psychological disorder, or some medical condition.
- Classifying OCD
Because certain types of obsessions and compulsions seem to be prevalent in OCD, there have been a number of different attempts to classify the disorder in two different subtypes based on the presentation. One of the most recognized systems of classification for OCD consists of four distinct subtypes that include:
- Checking type of OCD: These individuals end up spending a great deal of time investigating or checking certain situations to ensure that they have not created an unsafe situation. For instance, individuals will often check to see if they have locked the door when they leave home and then go back numerous times as a result of their obsessions and recheck the doors and windows. In some cases, the checking is so compulsive that the individual never goes anywhere.
- Hoarding type of OCD: These individuals become very concerned with not disposing of certain types of items, or not disposing of anything at all due to the notion that they will someday need them. Hoarding disorder is now described as a separate disorder from OCD by APA.
- Contamination type of OCD: These people have disruptive obsessions regarding cleanliness or becoming infected with germs, and often spend hours repetitively cleaning the surfaces of their countertops, furniture, and walls, or washing their hands, changing clothes, etc.
- Intrusive thought (rumination) type of OCD: These individuals often have obsessions of a mystical or religious nature that drive them to engage in compulsions, such as reading biblical verses, performing repetitive incarnations, etc. In some cases, individuals have repetitive obsessions of a violent nature and engage in compulsive behaviors to avoid these.
Some people with OCD recognize that their obsessions are irrational and their compulsions are disruptive, and will seek treatment. Others are entrenched in their obsessions and compulsions, and may not be receptive to the notion that these actions are dysfunctional at all. The willingness to engage in treatment is often an important factor in treatment success for any type of medical illness, physical condition, or psychological/psychiatric disorder. Thus, it is important to understand how these individuals view their situation when they are engaged in treatment.
Obsessive-compulsive like behaviors can be caused by the use of certain drugs and by certain types of insults to the brain. Aside from these special cases, there is no known cause of OCD. It is generally believed that an interaction between genetic, biological, and environmental issues lead to the development of this disorder. It is known that females are diagnosed with OCD at slightly higher rates than males.
OCD is comorbid with a number of different psychiatric/psychological disorders, including major depressive disorder, bipolar disorder, anxiety disorder, ADHD, and certain personality disorders (comorbid is a clinical term that describes a condition when two or more disorders occur together). Individuals with OCD are also diagnosed with substance use disorders at a higher rate than individuals without OCD. Most often, these individuals are diagnosed with alcohol use disorders compared to other types of substance use disorders, probably because alcohol is readily available, and it is a quick and efficient means of reducing anxiety.
Nonetheless, individuals with OCD are also prone to developing other substance use disorders, such as prescription medication abuse, marijuana abuse, and stimulant abuse.
The development of co-occurring OCD and a substance use disorder appears to be bidirectional; that is, in some individuals, the OCD appears before the substance use disorder, whereas in other individuals the substance use disorder appeared before the OCD.
How OCD Is Treated
There are several medications that are used to treat OCD. It should be noted that these medications are not long-term solutions to the obsessions and compulsions that these individuals experience, but they do appear to be effective at reducing certain types of obsessions and therefore reducing the associated compulsive behavior with these obsessions. If an individual stops taking the medication, there is a good chance that their behavior will return.
Antidepressant medications are most commonly used in the treatment of OCD. Most often, these include selective serotonin reuptake inhibitors, such as Zoloft, Paxil, Celexa, Luvox, and Effexor. One tricyclic antidepressant medication, Anafranil, has also been demonstrated to be useful in the treatment of OCD.
In cases where there is extreme anxiety, benzodiazepines may be used. Benzodiazepines are medications designed to specifically treat anxiety; however, they nearly always result in the development of physical dependence. As a result, they are drugs that are considered to have high potentials for the development of abuse and addiction. Thus, in individuals with co-occurring OCD and substance use disorders, the administration of these medications would need to be strictly supervised.
Even if medications are used, OCD is most commonly treated by using different types of Cognitive Behavioral Therapy (CBT). One specific type of CBT known as exposure and response prevention therapy is particularly effective in the treatment of OCD. In this therapy, individuals are exposed to situations that trigger obsessions and are not allowed to engage in their compulsions. Often, individuals in these therapies are trained in the use of relaxation and anxiety reduction prior to being exposed to triggers for their obsessions, and they can use these techniques to reduce their anxiety. After continuous successful efforts controlling the anxiety triggered by the obsession, these individuals find that they no longer need to engage in their compulsive behaviors.
This type of treatment also helps to develop long-term strategies to address future issues that may trigger obsessions and compulsions.
People who have both OCD and a co-occurring substance use disorder will typically be engaged in integrated treatment using a multidisciplinary approach to addressing both disorders concurrently. All facets of substance use disorder treatment are integrated and performed alongside the treatment for OCD in these cases. Integrated treatment protocols consist of withdrawal management services when needed, counseling and therapy services for substance use disorders, participation in support groups for both substance abuse and OCD, the development of long-term aftercare programs targeted at both disorders, and the addition of any other needed interventions, such as vocational rehab, tutoring services for school, occupational therapy, etc. The approach of integrated treatment is comprehensive, and treatment teams consist of physicians, psychologists, social workers, volunteers, and other healthcare professionals.
The standard protocols for addressing OCD are generally effective. Nonetheless, there are severe cases of OCD that do not respond to treatment. In severe cases where people have treatment-resistant OCD, these individuals may elect to engage in deep brain stimulation or even psychosurgery to address the disorder.