All of us can recall times when we have “had” to recheck that the iron was switched off, the door was properly locked, or our children were sound asleep. But what happens when this everyday concern for safety and security becomes an obsession with completing common tasks, with repeated checking and re-checking?
A mental disorder affecting some 2% to 3% of the population, Obsessive Compulsive Disorder, or OCD, is a condition where people feel the need to entertain certain repeated thoughts, perform certain actions in a repetitive fashion, or check on things repeatedly.
People appear to be unable to control either the repeated activities or thoughts, and both the activities and associated thoughts can occur to such a degree that it affects people’s daily lives.
Examples of OCD activities include checking that the lights are working, re-arranging objects, hoarding and repeated hand-washing. The cause of Obsessive Compulsive Disorder is unclear, although there is evidence of genetic influence, and risk factors include a history of stressful events and child abuse.
Symptoms of OCD
Symptoms of Obsessive Compulsive Disorder often develop in people before the age of twenty, and if left untreated, can last for decades.
Common symptoms include:
• A compulsion with completing or performing repetitive or ritualized tasks, to seek relief from obsession-related thoughts and anxiety. Such tasks can include repeatedly unlocking and locking doors, straightening or re-arranging objects.
• A fear of contamination, leading to an obsession with personal hygiene and cleaning.
• Intrusive, obsessive and sometimes unpleasant thoughts or images of a sexual nature, that can lead to disquieting thoughts about one’s sexual orientation, doubts, self-loathing and self-criticism.
• An obsession with counting objects, such as the number of stairs, and numerical sequences and patterns, such as only stepping on the blue tiles.
• Excessive hair-plucking, nail-biting or skin-picking.
• Primarily obsessional OCD involves the perpetuation of often sexual or violent thoughts, without actually acting upon the thoughts. Nevertheless, a person with this condition can become fearful that they might act out their obsessional thoughts, and may tend to avoid situations where that could eventuate. This can have an adverse effect on their lives.
Obsessive Compulsive Disorder absorbs a lot of people’s time and energy, both mentally and physically, every day, and can make it hard for them to fulfill on other responsibilities, such as work and family. Rationally, people with OCD understand that their thoughts and actions do not line up with reality. Nevertheless, they feel compelled to act as though their ideas are correct, to alleviate themselves from the intruding obsessive thoughts.
Diagnosis of OCD is usually undertaken by a clinical psychiatrist, psychologist or qualified mental health professional.
Treatment for Obsessive Compulsive Disorder
Medication, behavioral therapy (BT) and cognitive behavior therapy (CBT) are the most common forms of treatment for OCD.
A technique called “exposure and response prevention” (ERP) is used in behavior therapy and cognitive behavior therapy. It involves a person slowly learning to cope with the anxiety associated with not performing the ritualized behavior.
An example would be learning to tolerate the anxiety associated with sitting on a couch and not getting up to re-check an already locked door multiple times. A person can learn to adapt to such anxiety-producing situations, and realize that their overall anxiety levels have diminished.
Then they can progress to something more anxiety-producing, such as leaving the house once the door has been locked, without re-checking the door lock repeatedly. ERP is considered the most effective treatment for Obsessive Compulsive Disorder and has a strong evidence base.
Selective serotonin reuptake inhibitors (SSRIs) have been shown to be effective for people with OCD, as a first line treatment for those with moderate to severe symptoms, and as a second line treatment for those with mild symptoms.
There are diverging views on the outcomes between patients treated with a combination of medication and cognitive behavior therapy (CBT), versus those who only underwent CBT.
Obsessive Compulsive Disorder and Children
Cognitive behavioral therapy (CBT) is a proven first line of treatment for children and youth with OCD. A key component in the success of treatment is family involvement in observations and reports on the child’s behavior, and the positive reinforcement of alternative behaviors. As children and youth gain an understanding of their condition and develop coping strategies, they are more likely to show more confidence, be less self-critical and develop a greater number of friends.