October
2007
Obsessive Compulsive Disorder - OCD
Obsessive-Compulsive Disorder (OCD) affects 2-3% of Americans, and usually starts around age 10 or 21. OCD means having anxiety-provoking intrusive thoughts and repetitive behaviors. The intrusive thoughts are unwelcomed and can interfere with a person’s day. Obsessions include aggressive thoughts and impulses, fear someone will be harmed, or fears of germs or dirt. Compulsions are repetitive behaviors like washing hands over and over, checking to make sure the door is locked over and over, or counting things like the tiles on the floor. The compulsive behavior is to overcome the fears.
OCD symptoms overlap some other mental disorders. Trichotillomania is a type of compulsive behavior of hair pulling, so it can lead to bald spots on the head, eye browns, arms, etc. Skin picking and nail-biting can lead to infections. Hypocondriasis is the belief of having a specific disease. Other OCD related disorders include gambling addiction, kleptomania, sexual compulsions, autism, Tourette’s Syndrome, Body dysmorphic disorder, and anorexia nervosa.
Obsession: the person realizes that they are obsessing and that they aren’t hallucinating or in psychosis. But they have a hard time getting rid of the senseless, intrusive thoughts. Many obsessive thoughts have a theme: a small oversight will be disastrous, fear of contamination, desire to put things in order nice and neat, aggressive impulses like hurting someone, and sexual thoughts.
Compulsions: a behavior is done over and over to cool down the obsession. Some people count, others arrange things into a neat order, wash hands, pick skin, pull hair, others touch (like David Sedaris wrote in one of his books about touching people’s heads).
Quality of life is often hurt by OCD – in particular interpersonal relationships. There is shame and distress over the OCD and many patients won’t seek help due to the shame.
One study followed 144 OCD patients for 40 years. 2/3 had some improvement in OCD within 10 years, 1/5 no longer had OCD. However, 1/5 who recovered relapsed.
Treatment: it is difficult. For those with mild to moderate OCD, cognitive-behavioral therapy and medications can help. SSRIs or Clomipramine are drugs of choice.
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