Obsessive Compulsive Disorder
Overview
Obsessive-compulsive disorder (OCD) is characterized by repetitive, unwanted, intrusive thoughts (obsessions) and irrational, excessive urges to do certain actions (compulsions). Although people with OCD may know that their thoughts and behavior don't make sense, they are often unable to stop them.
Symptoms associated with OCD are severe and persistent. These symptoms can cause distress and lead to behaviors that interfere with day-to-day activities. People with OCD may feel the urge to check things repeatedly or perform routines for more than an hour each day as a way of achieving temporary relief from anxiety. If OCD symptoms are not treated, these behaviors can disrupt work, school, and personal relationships and can cause feelings of distress. About 2.5 % of people suffer from OCD. Symptoms usually begin during childhood and the teenage years.
Symptoms And Signs
People with OCD may have obsessions, compulsions, or both.
Obsessions are intrusive, irrational thoughts or impulses that repeatedly occur. People with these disorders know these thoughts are irrational but are afraid that somehow they might be true. These thoughts and impulses are upsetting, and people may try to ignore or suppress them. Examples of obsessions include:
- Fear of germs or contamination
- Doubts about having done something right, like turning off the stove or locking a door
- Fear of forgetting, losing, or misplacing something
- Thoughts about harming or having harmed someone
- Desire to have things symmetrical or in perfect order
- Fears of saying or shouting inappropriate things in public
- Unwanted, forbidden, or taboo thoughts involving sex, religion, or harm
Compulsions are repetitive acts that temporarily relieve the stress brought on by an obsession. People with these disorders know that these rituals don't make sense but feel they must perform them to relieve the anxiety and, in some cases, to prevent something bad from happening. Like obsessions, people may try not to perform compulsive acts but feel forced to do so to relieve anxiety. Examples of compulsions include:
- Excessive hand washing or cleaning due to a fear of germs
- Constant checking of light switches, handles, taps, and locks to prevent perceived danger from flooding, break in, gas leak or fire. Checking can be a set number of times to a special or ‘magical’ number, and often takes hours at a time to the point where sufferers often avoid going out so they don’t have to go through the rituals again
- Counting and recounting money because a person can't be sure they added correctly
- Touching, tapping, counting or moving in a certain way or a certain number of times, often until something feels ‘just right’
- Checking that items are arranged ‘just right’ and constantly adjusting inconsequential items, such as pens on a table, until they are aligned to feel ‘just right’ as opposed to looking aligned
- Mental rituals or thought patterns such as saying a particular phrase, counting to a certain number, or imagining a particular imagery to ‘neutralize’ an obsessional thought
- Repeating specific prayers or actions related to religious obsessions
- Difficulty in throwing things away, such as old newspapers, magazines, books or clothes
- Excessive list-making or recording daily activities, either in writing or verbally
To be diagnosed with OCD, a person must have must have Obsessions, compulsions or both. And the Obsessions or compulsions are upsetting and cause difficulty with work, relationships, other parts of life and typically last for at least an hour each day.
Treatments
Treatment plan will often include both psychotherapy and medications, and combined treatment is usually optimal.
- Medication, especially a type of antidepressant called a selective serotonin reuptake inhibitor (SSRI), is helpful for many people to reduce the obsessions and compulsions.
- Psychotherapy, is also helpful in relieving obsessions and compulsions. In particular, cognitive behavior therapy (CBT) and exposure and response prevention therapy (ERT) are effective for many people.
Obsessive-compulsive disorders can make work, school, relationships and other parts of life difficult. Reducing stress, eating well, and avoiding situations that trigger obsessions and compulsions can help you feel better. Some ways that can help include:
- Learn about obsessive-compulsive disorders. Education about your condition can empower you and motivate you to stick to your treatment plan.
- Focus on your goals. Recovery is an ongoing process. Stay motivated by keeping your goals in mind.
- Stay busy. With these disorders, it is easy to become completely absorbed in an activity or thought. Try to stay occupied with work, hobbies, fitness or other activities. While staying busy is not always easy, simply doing other tasks helps keep your mind away from obsessions and compulsions.
- Find healthy outlets. Regular exercise, eating a healthy diet and getting adequate sleep can have a positive effect on your treatment.
- Know your triggers. Avoid situations you know bring on your symptoms. If you can't avoid something, ask your doctor to help you find coping skills to deal with anything triggering. Try stress management techniques such as meditation, muscle relaxation and deep breathing.
- Communicate. Talk openly and honestly with your friend or family member if you have any questions or concerns.
- Remember that relapses of OCD symptoms are common, and are a part of the journey to recovery..
A Psychiatrist can guide families on the best ways to act and react towards their loved one illness. Two key points are:
- Listening and validating:
It is important to let the person know that you understand the difference between the behavioral symptoms of OCD and the person: ‘I know this is not you, this is your OCD.’ This will help to diminish the person’s feelings of guilt and low self-worth and reduce their levels of stress and anxiety.
- Encouraging recovery
Recovery from OCD is a long process. People with OCD may be frustrated at their progress, and feel like giving up. Try to support them through their recovery, and acknowledge improvements.
Give yourself permission to set a basic safety plan based on the recommendations of trusted health organizations, and do not add to it.
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Disinfect surfaces once a day. Focus on the surfaces in your home that are frequently touched, and think about whether this is truly needed (for example, if you stayed home all day and had no visitors, do you really need to disinfect that doorknob?). This process shouldn’t take you more than a few minutes per day.
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Wash your hands with soap and water for 20 seconds after being outside or in public, before eating, after going to the bathroom, and after you’ve coughed/sneezed/blown your nose. If soap and water are not available to you, use hand sanitizer.
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Limit your social media and COVID-19 coverage intake. Find a few trusted sources that you can check consistently (such as the CDC or the WHO) and set limits on your consumption (once a day, or no more than half an hour a day, etc.).
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Do your best to contain the anxiety that COVID-19 brings. This can be done by limiting your news intake (see above) or setting up a check-in time with the family.
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Focus on controlling the things that you can. We cannot control the future, nor should we let uncertainty drive us to hopelessness. We can fight this by concentrating on what is within our control.
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If you want to do more than this, pick a person to help you figure out what might be a reasonable and rational safety measure to take.