Do I have OCD?
Many of us have probably heard the common phrase "I'm so OCD," but it's crucial to understand that OCD goes beyond wanting things in order or being excessively clean. It's a deep and complex issue that warrants more understanding and empathy. It’ also important to increase awareness and reduce stigma around seeking a diagnosis so that those suffering can feel more comfortable seeking the help they need.
OCD, or Obsessive-Compulsive Disorder, is a condition that involves the presence of obsessions and compulsions. These obsessions and compulsions can cause considerable distress for the person experiencing them, making it a challenging and difficult experience. It's important to note that these symptoms are ego-dystonic, meaning they are not beneficial for the person going through them. In other words, they are not something the person desires or wants.
Some people have described their OCD symptoms as only occurring in their minds. Sometimes people informally refer to this phenomenon as "Pure O", though this is somewhat a misguided way of referring to someone whose OCD involves mental compulsions rather than no compulsions at all.
All people with OCD display compulsive urges of some sort, even if they are not outwardly visible. Examples of mental compulsions include ruminating, contingency planning, praying, counting, and self-reassuring.
Specific OCD subthemes are distinct for each person with OCD. These subthemes can include contamination, symmetry, harm (hit-and-run, suicide, violence), sexual or religious taboos (pedophilia, sinning, demonic possession), relationships, sensorimotor experiences (blinking, swallowing, breathing), existence (meaning of life, nature of reality), and many more.
OCD is relatively common with a 12-month prevalence of about 1.2%, or over 4 million people.
While OCD is a highly treatable disorder, it usually takes the average person 7-10 years to be properly diagnosed. In part, this is due to undertrained professionals misinterpreting OCD symptoms for anxiety or psychosis. It's also due to the stigma associated with some manifesting sub-themes, such as suicide and sexual harm.
Obsessions
Obsessions are recurrent and persistent thoughts, urges, or images that are experienced as intrusive and unwanted. Intrusive thoughts often present disturbing content that goes directly against the person's values. In truth, the person is the exact opposite of the fears that OCD shows them, which is why these thoughts can be even more disturbing. Obsessions can show up as:
Urges
Possibilities
Images
Doubts
Sensations
Compulsions
Compulsions are repetitive behaviors or mental acts that an individual feels driven to perform in response to an obsession or according to rules that must be applied rigidly. Compulsions are usually referred to as "rituals" in OCD treatment and aim to mitigate or neutralize the anxiety that comes with OCD symptoms. Some people are only disturbed minorly by compulsive behaviors, while others might perform rituals for up to 8 hours per day. Many people realize that their compulsions are not reasonable, but they still feel an intense urge to do them anyway. Types of compulsions include:
Checking
Counting
Handwashing
Rereading & rewriting
Reassurance Seeking
Avoidance
Ruminating
Praying
Googling
How do people develop OCD?
Temperament
Research suggests that people with OCD have a tendency to internalize stress, greater negative emotionality, and behavioral inhibition during childhood. People with OCD also tend to be highly sensitive, creative, and conscientious. Leading to greater perceived feelings of moral responsibility and more focus on negative possible outcomes.
Genetics
Genetic inheritance of OCD is at least in part related to having family members with the disorder. Research has found that individuals with a first-degree relative who has OCD are two times more likely to develop the disorder, while those who developed OCD in childhood are 10 times more likely to have the disorder. Dysfunction in the orbitofrontal cortex, striatum, anterior cingulate cortex, and thalamus has been indicated to play a role in symptom manifestation. People with OCD also have a larger amygdala than the average person without the disorder.
Environment
Different environmental factors might also increase an individual's risk of developing OCD. These include perinatal events, premature birth, abuse during childhood, and other stressful or traumatic events. Some individuals may develop a sudden onset of Obsessive-compulsive symptoms after experiencing an infection such as step throat. This has been referred to as pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANS or PANDAS). More information can be found on the International OCD Foundation website.
How is OCD treated?
Cognitive Behavioral Therapy: In a nutshell, CBT is an umbrella for treatment models that focus on the structured targeting of disordered thoughts, feelings, and behaviors. The idea that many CBT therapists espouse is that therapeutic healing comes when we learn to challenge our negative thinking errors and begin to act in accordance with a positive and healthy outlook.
Exposure and Response Prevention (ERP)
The International OCD Foundation has labeled ERP the "gold standard" treatment for OCD. In a nutshell, ERP is a behavioral treatment. The person with OCD approaches, or exposes themself to, a distressing situation. Then, they prevent themselves from engaging in any type of compulsion. This might look like someone touching a dirty towel that they consider to be contaminated without washing their hands until their anxiety levels reduce by about half. ERP is a behavioral therapy treatment and does not care much about labeling the meaning of thoughts. Individuals create a fear ladder or hierarchy with lower levels at the bottom and more serious triggers at the top. Then gradually, with the help of a therapist they begin to put themselves in situations involving their triggers.
Inference-Based Cognitive Behavioral Therapy (I-CBT)
I-CBT is a meta-cognitive model for treating OCD. Rather than exposing people to their fears, it asks them to identify the obsessional sequence, paying special attention to obsessional doubts. Obsessional doubts, says I-CBT, are the basis for all other OCD symptoms, and if we rid ourselves of the doubts, we rid ourselves of OCD. I-CBT targets that initial doubt that causes people with OCD to ask, "What if..?" It believes that faulty reasoning is at the heart of obsessional doubt and it aims to empower the client to trust in their senses and avoid going into the "OCD Bubble".
Acceptance and Commitment Therapy (ACT)
ACT is a form of CBT that aims to empower individuals to defuse from their OCD thoughts, or to place less importance on them and gain psychological flexibility. It encourages people to live a full, values-based life without letting OCD get in the way.
Medication
Medication alone is not considered the first line of treatment for OCD, however, it can be an effective tool for lowering OCD symptom baselines. It is best used in conjunction with specialized OCD-focused therapies. Popular medication choices for OCD include clomipramine, fluvoxamine, sertraline, and paroxetine.
How Can I Know if I Have OCD?
If you suspect that you or a loved one may be experiencing symptoms of OCD, it is crucial to seek a professional evaluation for a conclusive diagnosis. However, recognizing potential warning signs and understanding common symptoms of OCD can be helpful in initiating conversations and seeking appropriate support.
Awareness of Intrusive Thoughts and Doubts
People with OCD often experience intrusive thoughts, images, or doubts that continually invade their minds (specific thoughts feel very “sticky”), causing significant distress. These thoughts might often feel irrational, bizarre, or disturbing. If you find yourself constantly plagued by unwelcome thoughts that feel sticky despite your best efforts to find relief or a solution, it may be an indicator of OCD.Recurring Ritualistic Behavior
Do your attempts to alleviate pain and suffering related to disturbing thoughts or fears follow a specific pattern or rule? Do loved ones ever say that your rules are excessive? Asking for repeated reassurance, compulsive Googling and worrying, repeatedly checking things (e.g., doors, appliances), arranging objects symmetrically, or adhering to strict rituals are some examples of compulsive behaviors. If you find yourself engaging in such repetitive activities that feel difficult to control or resist, it may be a sign of OCD.Impact on Daily Life and Functioning
OCD symptoms often disrupt an individual's daily life, affecting their ability to function at work, school, or social activities. Recurrent thoughts or rituals can consume a significant amount of time, leading to distress and interference with personal relationships, work productivity, or overall quality of life. If you notice that your obsession-compulsion cycle is significantly impinging on your daily activities and causing distress, it is advisable to seek professional help.Emotional Distress and Anxiety
The thoughts and rituals associated with OCD generate intense anxiety, fear, or distress. Individuals with OCD may experience panic attacks or overwhelming anxiety when unable to perform their rituals or when their intrusive thoughts become more intense. If you find that your anxiety levels are consistently high due to persistent obsessions or compulsions, it is advisable to consult a mental health professional.Family History and Chronicity
OCD can have a genetic component, meaning it can run in families. If you have close family members, such as parents or siblings, with diagnosed OCD, you might have an increased likelihood of developing the disorder. Additionally, pervasive and chronic symptoms that persist for extended periods are indicative of OCD. If you identify a family history of OCD or recognize that your symptoms have persisted for a significant amount of time, it is crucial to reach out for professional assessment and support.
Identifying potential symptoms of OCD is an essential step towards seeking appropriate professional help. However, it is essential to remember that only a qualified mental health professional can diagnose OCD accurately. If you suspect you or someone you know may be experiencing OCD symptoms, reach out to licensed mental health professionals who can provide a comprehensive evaluation, diagnosis, and beneficial treatment options. Remember, early recognition and timely intervention pave the way to effective management and a proactive approach to mental well-being.
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Do you think you or a loved one might have OCD? Reach out to inquire about a formal assessment, or check out our resources page to learn more.
This blog post is for informational purposes only and should not be considered a substitute for professional medical advice, diagnosis, or treatment.