Obsessive-Compulsive Disorder (OCD)
ABOUT OBSESSIVE-COMPULSIVE DISORDER (OCD)
When you don’t feel in control of your own mind and behaviors, life can be terrifying at times.Obsessive-compulsive disorder (OCD) can often trap people in an endless cycle of recurring distressing thoughts (obsessions) and repetitive behaviors/rituals (compulsions). Although rituals may temporarily alleviate anxiety, they must be performed again when the thoughts return, which creates a neverending loop that can begin to take over your life.
People with OCD often aware that their obsessions and compulsions are senseless or unrealistic; which can make it all the more frustrating to cope with. Unfortunately, the more you try to stop your obsessions and compulsions, the more you feed the anxiety and distress you’re seeking to eliminate.
At My LA Therapy, our therapists are trained to help you face what you’ve been avoiding so that you can break the painful cycle of OCD and get your life back. We will help you transform the damaging habits and beliefs that have led you here by helping you confront the underlying causes head-on. We will gently guide you through the process of healing your inner conflicts and facing your fears so you can get free.
The DSM-5 emphasizes the following signs and symptoms in the diagnosis of OCD:
- Presence of obsessions, compulsions, or both – Obsessions are defined by 1) recurrent and persistent thoughts, urges, or images that are experienced, at some time during the disturbance, as intrusive and unwanted, and that in most individuals cause marked anxiety or distress; and 2) the individual attempts to ignore or suppress such thoughts, urges, or images, or to neutralize them with some other thought or action (i.e., by performing a compulsion). – Compulsions are defined by 1) repetitive behaviors (e.g., hand washing, ordering, checking) or mental acts (e.g., praying, counting, repeating words silently) that the individual feels driven to perform in response to an obsession or according to rules that must be applied rigidly; and 2) the behaviors or mental acts are aimed at preventing or reducing anxiety or distress, or preventing some dreaded event or situation; however, these behaviors or mental acts are not connected in a realistic way with what they are designed to neutralize or prevent, or are clearly excessive.
- The obsessions or compulsions are time-consuming (e.g., takes more than 1 hour per day) or cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
- The obsessive-compulsive symptoms are not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition.
- The disturbance is not better explained by the symptoms of another mental disorder (e.g., excessive worries, as in generalized anxiety disorder; preoccupation with appearance, as in body dysmorphic disorder; difficulty discarding or parting with possessions, as in hoarding disorder; hair pulling, as in trichotillomania; skin picking, as in excoriation; stereotypes, as in stereotypic movement disorder; ritualized eating behavior, as in eating disorders; preoccupation with substances or gambling, as in substance-related or addictive disorders; preoccupation with having an illness, as in illness anxiety disorder; sexual urges or fantasies, as in paraphilic disorders; impulses, as in disruptive, impulsive-control, and conduct disorders; guilty ruminations, as in major depressive disorder; thought insertion or delusional preoccupations, as in schizophrenia spectrum and other psychotic disorders; or repetitive patterns or behavior, as in autism spectrum disorder).
- Specified by “with good or fair insight”, “with poor insight”, and “with absent insight/delusional beliefs”.
OCD CAUSES AND FACTORS
The cause of obsessive-compulsive disorder isn’t fully understood. Factors that may increase the risk of developing or triggering obsessive-compulsive disorder include:
- Biological/Genetic Factors – OCD may be a result of changes in your body’s own natural chemistry or brain functions and it may have a genetic component, but specific genes have yet to be identified. The brain is a very complex structure. It contains billions of nerve cells — called neurons — that must communicate and work together for the body to function normally. Neurons communicate via chemicals called neurotransmitters that stimulate the flow of information from one nerve cell to the next. At one time, it was thought that low levels of the neurotransmitter serotonin were responsible for the development of OCD. Now, however, scientists think that OCD arises from problems in the pathways of the brain that link areas dealing with judgment and planning with another area that filters messages involving body movements. In addition, there is evidence that OCD symptoms can sometimes get passed on from parents to children. This means the biological vulnerability to develop OCD may sometimes be inherited. Studies also have found a link between a certain type of infection caused by the Streptococcus bacteria and OCD. This infection, if recurrent and untreated, may lead to the development of OCD and other disorders in children. Also, having parents or other family members with the disorder can increase your risk of developing OCD. Individuals with OCD have troubled relationships.
- Environmental Factors – Some environmental factors such as infections are suggested as a trigger for OCD, but more research is needed. There are environmental stressors that can trigger OCD in people with a tendency toward developing the condition. Certain environmental factors may also cause a worsening of symptoms. These factors include abuse, changes in living situation, illness, the death of a loved one, work-or school-related changes or problems, relationship concerns. Also, if you’ve experienced traumatic or stressful events, your risk may increase. This reaction may, for some reason, trigger the intrusive thoughts, rituals and emotional distress characteristic of OCD.
- Other – Maladaptive coping skills (e.g. suicidal behavior, poor quality of life); Lack of healthy activities (inability to attend work, school or social activities; contact dermatitis from frequent hand-washing); Other mental health disorders (OCD may be related to other mental health disorders, such as anxiety disorders, depression, substance abuse or tic disorders).
OCD usually first appears in childhood; begins in the teen or young adult years. OCD is usually considered a lifelong disorder, with symptoms beginning gradually and varying in severity throughout life/getting worse with greater stress. There’s a difference between being a perfectionist — someone who requires flawless results or performance, for example (personality disorder) — and having OCD. If you have OCD, you may be ashamed and embarrassed about the condition, but treatment can be effective. Treatment can help bring symptoms under control so that they don’t rule your daily life, which includes a combination of the following options:
- Supportive care – Your doctor may perform a physical exam to help rule out other problems that could be causing your symptoms and to check for any related complications. There is no lab test to diagnose OCD, though a complete blood count (CBC), a check of your thyroid function, and screening for alcohol and drugs are sometimes included. The doctor bases his or her diagnosis on an assessment (psychological evaluation) of the patient’s symptoms, discussing your thoughts, feelings, symptoms and behavior patterns (how much time the person spends performing his or her ritual behaviors). With your permission, this may include talking to your family or friends. A referral to a mental health provider will also be made.
- Psychotherapy – OCD will not go away on its own so, it’s important to seek treatment. Cognitive behavioral therapy (CBT), a type of psychotherapy, is effective for many people with OCD. The goal of cognitive behavioral therapy is to teach people with OCD to confront their fears and reduce anxiety without performing the ritual behaviors (called exposure therapy or exposure and response prevention therapy). Therapy also focuses on reducing the exaggerated or catastrophic thinking that often occurs in people with OCD. Exposure and response prevention (ERP), a type of CBT therapy, involves gradually exposing you to a feared object or obsession, such as dirt, and having you learn healthy ways to cope with your anxiety. ERP takes effort and practice, but you may enjoy a better quality of life once you learn to manage your obsessions and compulsions. In severe cases of OCD and in people who do not respond to medical and behavioral therapy, electroconvulsive therapy (ECT) or psychosurgery may be used to treat the disorder. During ECT, a small current is passed through electrodes placed on the scalp while the patient is asleep under general anesthesia This causes a brief seizure. Repeated ECT treatments have been found to help improve OCD symptoms in some cases. A newer, surgical form of brain stimulation called deep brain stimulation (DBS) involves implanting small electrodes into brain areas that are a part of the brain circuitry associated with OCD symptoms.
- Medications – Certain psychiatric medications can help control the obsessions and compulsions of OCD. Most commonly, antidepressants (SSRIs) are tried first, alone or in combination with antipsychotics.