Obsessive-compulsive disorder, also known as OCD causes people to suffer in silence and secrecy and can destroy relationships and the ability to work. It may bring on shame, ridicule, anger, and intolerance from friends and family. Although it has been reported in children, it strikes most often during adolescence or young adult years. The illness can affect people in any income bracket, of any race, gender, or ethnic group and in any occupation. If people recognize the symptoms and seek treatment, OCD can be controlled.
OCD plagues people with intrusive, unwanted thoughts or obsessions, which are rarely pleasant. People who have these obsessions recognize that they are senseless. Still, they are unable to stop them. They may worry about becoming contaminated by dirt or germs and believe they will be tainted by touching doorknobs or common objects. Others may fear becoming violent or aggressive, or they may have an unreasonable fear they will unintentionally harm people. Some may struggle with blasphemous or distasteful sexual thoughts, while others become overly concerned about order, arrangement or symmetry.
In an attempt to ease the anxiety related to their obsessions, people often develop ritualistic behaviors, called compulsions. Often, these reflect the patient’s obsessions. For example, an obsessive fear about contamination often leads to compulsive hand washing, even to the point where the person’s hands bleed. Others repeatedly touch a specific object or say a name or phrase in response to an obsession. An extreme and intrusive fear of making mistakes on the job may result in a person completing tasks extremely slowly, even to the point that the job is never finished. Obsessions may also result in compulsive collecting of useless items such as magazines and newspapers until they clog entire rooms of homes and endanger occupants’ safety.
The most common of many compulsions are washing and checking. Other compulsive behaviors include counting (often while performing another compulsive action such as hand washing), repeating, hoarding, and endlessly rearranging objects in an effort to keep them in precise alignment with each other. These behaviors generally are intended to ward off harm to the person with OCD or others. Some people with OCD have regimented rituals while others have rituals that are complex and changing. Performing rituals may give the person with OCD some relief from anxiety, but it is only temporary.
These obsessions are unwanted ideas or impulses that repeatedly well up in the mind of the person with OCD. Persistent fears that harm may come to self or a loved one, an unreasonable belief that one has a terrible illness, or an excessive need to do things correctly or perfectly, are common. Again and again, the individual experiences a disturbing thought, such as, “My hands may be contaminated–I must wash them”; “I may have left the gas on”; or “I am going to injure my child.” These thoughts are intrusive, unpleasant, and produce a high degree of anxiety. Often the obsessions are of a violent or a sexual nature, or concern illness.
People with OCD usually have considerable insight into their own problems. Most of the time, they know that their obsessive thoughts are senseless or exaggerated, and that their compulsive behaviors are not really necessary. However, this knowledge is not sufficient to enable them to stop obsessing or the carrying out of rituals.
Because victims of OCD realize their obsessive thoughts and behaviors are senseless and unnecessary, they may try to hide their problem. They fear people will think they are “crazy” or silly, and they may feel that they’re all alone. Of course, nothing could be further from the truth. OCD affects as many as 2 percent of all Americans. Research indicates that, like depression and bipolar disorder, OCD is caused by an imbalance of the neurotransmitter called serotonin. This brain chemical, one of many that allows the nerve cells to communicate with one another, is thought to regulate mood and sleeping patterns.
Most people with OCD struggle to banish their unwanted, obsessive thoughts and to prevent themselves from engaging in compulsive behaviors. Many are able to keep their obsessive-compulsive symptoms under control during the hours when they are at work or attending school. But over the months or years, resistance may weaken, and when this happens, OCD may become so severe that time-consuming rituals take over the sufferers’ lives, making it impossible for them to continue activities outside the home.
Other research links the illness to biological responses to threats. According to this theory, healthy people become accustomed to a stimulus that – although originally thought to be a threat – turns out to be harmless. People with OCD, however, never develop an “immunity” to the stimulus and continue to feel anxious. Over time, their anxiety develops into obsessions which, in turn, give rise to the compulsive behavior. Other theories focus on the psychological reactions to a traumatic incident during childhood, major stress. and a biological vulnerability that can be triggered by stress.
Researchers have found that certain antidepressant medications help alleviate obsessive behaviors by increasing the amount of serotonin and improve communication between the nerve cells. Other than medication, behavior therapy has proven very successful in helping people with OCD overcome the anxiety that they feel if they do not complete their compulsions. In behavior therapy, a patient is exposed to the feared object or obsession, but prevented from completing the compulsive behavior. For example, people who fear contamination may be encouraged to touch dirty laundry and be denied the chance to wash their hands for a specified period of time. Most often, behavior therapy includes guidelines or a “contract” in which the patient and treatment team agree on certain goals.
In conclusion, families may participate in therapy by attending information sessions about the situations that may cause symptoms to worsen and the ways that loved ones can help the patient overcome the illness. Often family members can help the patient honor the terms of the treatment contract, and can also help to identify whether the patient is experiencing emotional difficulties. It is important for family and friends to create a strong and supportive environment in which they learn to appreciate progress in their loved one’s functioning and view small improvements as a success.