Overview

What is OCD, and what does it mean?

OCD is short for Obsessive-Compulsive Disorder. An obsession is when a person has intrusive and unwanted thoughts, images, feelings, and/or ideas. They are often recurring. A compulsion is when a person feels compelled to do something over and over again. It can be handwashing, cleaning/organizing, and checking on certain items/action. These actions have to affect daily, work, and social functioning and cannot be resolved by reasoning. For example, the person may logically know that they locked the front door, but the OCD compels them to check it over and over again.

OCD tends to affect 2 to 3 % of the US population, from children to adults. Average age diagnosis is around 19, with more females affected compared to males.

What are the four types of OCD?

There are four main types of OCD: contamination, perfection, doubts about harm and checking, and forbidden thoughts.

Contamination has to do with a fear of contamination of germs. People with this type of OCD regularly clean the area, cleanse their bodies often, and show extreme fear towards any objects they suspect have been contaminated.

Perfection has to do with extreme orderliness in objects and thoughts. People with this type have rituals such as arranging items in a certain way, moving things around until it meets their satisfaction, and/or looking for a perfect symmetry or organization every time.

Doubt about harm and checking is when a person has intrusive thoughts and images about accidentally hurting somebody due to their careless actions. Because of this fear, they obsessively recheck things like making sure the stove is off, all the switches are off, and constantly checking the door to see if they’re locked.

Forbidden thoughts are usually unwanted thoughts and images of taboo situations. These situations often involve a religious, sexual, and/or violent context.

What causes OCD to get worse?

Stress usually plays a role in worsening the symptoms of OCD. Therefore, it is essential to practice stress management and find the technique to either reduce or cope with stressful situations.

What are intrusive thoughts?

Intrusive thoughts are unwanted thoughts that get “stuck” in the mind. They often cause distress because they can be violent and disturbing. Examples include killing a loved one, using a sharp object to hurt others, and more. Usually, these thoughts do not linger for long, meaning that they come and go very quickly. People who experience intrusive thoughts worry if there’s something wrong with themselves. That’s OK – as long as you do not act or have an urge to act on those thoughts, it’s nothing to be concerned about.

Causes

What causes OCD?

The causes of OCD are unknown. It could be several different factors, including genetics/biology and environment.

Genetics/biology. Scientists suspect there is an association between certain genes and OCD. Those genes have not been identified yet. Changes in biological factors could also contribute to the development of OCD, such as natural chemicals in our bodies.
Environment. OCD-associated symptoms and behavior can be learned from others over time (family members, friends, etc.).

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Symptoms

People with OCD tend to perform the following rituals (compulsions) to alleviate their stress and anxiety related to the disorder.

Typical symptoms of obsession:

Fear of contaminations
Fear of blurting out insults
Fear of losing something important
Disturbing sexual thoughts or images
Orderliness and symmetry can be a big worry

Typical symptoms of compulsion:

Excessively hand washing and/or showering
Excessively cleaning or rearranging items
Excessively checking locks, doors, and light switches.
Counting a specific number over and over
Excessively seeking approval or reassurance

These symptoms of obsession and compulsion are not always present together. Some may only have an obsession, others may only have a compulsion, and some may have both cases presented in a mixed form.

Diagnosis

How is OCD diagnosed?

OCD is diagnosed based on the symptoms listed on DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, 5th Edition: DSM-5) and a self-assessment questionnaire. Your healthcare provider may also do a physical exam or order blood tests to rule out any underlying health conditions.

Treatment

How to treat OCD?

There are a few ways to treat OCD: medications, psychotherapy, TMS, and lifestyle modification.

Medications. SSRIs and Tricyclic Antidepressants (TCAs) can treat OCD. SSRIs are Selective Serotonin Reuptake Inhibitors, a set of drugs that inhibit the reuptake of serotonin in the presynaptic neuron. Serotonin neurotransmitters play a significant role in regulating happiness and mood. The result is an increased amount of serotonin in the brain, so they can act on their target neuron for a more extended time. TCAs have a similar mechanism of action for serotonin; however, in addition to serotonin, TCAs inhibit norepinephrine reuptake.
Psychotherapy. Cognitive Behavior Therapy (CBT) can help alleviate some of the anxiety associated with OCD. CBT’s goal is to help people cope with stressful situations by changing their thoughts, attitudes, and beliefs toward the situation. This requires a collaborative effort from the therapist and the patient. For example, a therapist may gradually expose the patient to a scenario that triggers the symptoms of OCD until they learn to cope with stress and anxiety.
Transmagnetic Stimulation (TMS). The FDA has recently approved TMS for treatment-resistant OCD, meaning these patients have seen minimal to no effective improvement from the medications and psychotherapy. TMS works by triggering the neurons and changing their neural network. It is a non-invasive, painless, and safe way to treat OCD.
Lifestyle modification. Lifestyle changes with diet, yoga and exercising have been beneficial to decrease stress and anxiety due to OCD.

Specialty Clinic of Austin can offer all of the above ways to help you with OCD. Contact our office at 512-382-1933 for more information.

How to stop OCD rituals?

Ideally, management of anxiety could help reduce the OCD rituals. However, in some cases, this may worsen the symptoms rather than helping them. It is recommended that you seek professional help to safely and gradually stop OCD rituals.

Sources:

Holland, K. (2020, September 21). Intrusive Thoughts: Why We Have Them and How to Stop Them. Healthline. https://www.healthline.com/health/mental-health/intrusive-thoughts#causes
Kellner, M. (2010). Drug treatment of obsessive-compulsive disorder. Obsessive-Compulsive Spectrum Disorders, 12(2), 187–197. https://doi.org/10.31887/dcns.2010.12.2/mkellner
Mayo Clinic Staff. (2018, November 27). Transcranial magnetic stimulation – Mayo Clinic. Mayo Clinic. https://www.mayoclinic.org/tests-procedures/transcranial-magnetic-stimulation/about/pac-20384625
Mayo Clinic Staff. (2020, March 11). Obsessive-compulsive disorder (OCD) – Diagnosis and treatment – Mayo Clinic. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/obsessive-compulsive-disorder/diagnosis-treatment/drc-20354438
Mayo Clinic Staff. (2020b, March 11). Obsessive-compulsive disorder (OCD) – Symptoms and causes. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/obsessive-compulsive-disorder/symptoms-causes/syc-20354432
Moraczewski J, Aedma KK. Tricyclic Antidepressants. [Updated 2020 Dec 7]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK557791/