Obsessive Compulsive Disorder – OCD
Do I suffer from OCD?
Obsessive Compulsive Disorder is the 4th most common mental health disorder. Between 2-3% of the population suffers from OCD, and over a third of all cases start in childhood or adolescence. Women have twice the risk of developing OCD, though the symptoms tend to differ between the genders: While women suffer more from obsessions, men tend to suffer more from compulsive actions. In order to answer the question “Do I suffer from Obsessive Compulsive Disorder?”, we should check whether the symptoms meet the first criteria for the diagnosis of OCD – the presence of obsessions and compulsions.
Obsessions are thoughts, images or urges which are typically not based in reality, but result in anxiety and distress and the need to ignore them or suppress them. Compulsive rituals are the tool through which an individual suffering from OCD tries to suppress the obsession. Compulsions are expressed via physical or mental repetitious rituals that are not directly connected to the imagined situation and have no objective impact on anxiety levels, but they assist the individual in relaxing and believing that through them a disaster has been averted.
What are the characteristics of Obsessive Compulsive Disorder?
Most individuals with OCD suffer from both obsessions and compulsive rituals. Obsessions manifest as irrational, intrusive and disturbing thoughts which result in high levels of anxiety. They can take the form of an obsessive “wish” (e.g. wishing someone harm), uncontrollable urges (e.g. the need to clean or tidy up), obsessive images (e.g. imagining people we meet as nude), obsessive ruminating or hesitating (e.g. difficult in making decisions), and more.
Compulsive rituals manifest as behaviors which may not be rational, but the individual with OCD feels he must perform them to avoid some negative consequence, and in order to reduce the level of anxiety. The compulsions – which manifest as the need to wash hands, clean the home, and so on – tend to take on the form of a single or a few rituals which repeat themselves. Another common type of compulsions is repetitive checking of gas connections, electric switches, doors, etc in order to ensure they have been secured correctly. Other compulsions include orderliness, a need for symmetry, touching or avoiding certain objects, counting objects, or repeating certain words or phrases.
I have disturbing thoughts, does that mean I have OCD?
We all experience disturbing thoughts which can demand our attention for hours at a time, small rituals which we believe may help us succeed or ward off evil, or disquieting thoughts such as “Did I remember to lock the door?”, but this does not mean we have OCD.
People who suffer from Obsessive Compulsive Disorder experience exaggerated obsessions and compulsions, typically at least an hour a day. The experience causes significant impairment to their daily social/work/academic functioning, and causes significant levels of anxiety and distress. Individuals with OCD often realize their obsessions or compulsions are irrational or exaggerated, but are unable to change their reactions.
In order to diagnose someone with OCD, we often rule out thoughts which fixate on a single item, as this may indicate other mental disorders. Also, we must rule out substance abuse or a medical condition as the source of the obsessions or compulsions.
How do you treat OCD?
There are three main theories of the cause of OCD, and how to treat it. The first is the psychodynamic theory, which states people with OCD suffer from an unresolved conflict between the id and the ego, where the ego produces compulsions to defend against the uncomfortable obsessions produced by the id. Treatment consists of delving into the unconscious conflict and resolving it via psychodynamic therapy. Research has found that this type of therapy is less effective for OCD and in some cases even exacerbates the symptoms by leading patients to engage even more in their obsessive thoughts.
The second treatment model is based on the neurological theory which postulates that people with OCD experience overstimulation of certain parts of the brain which result in the inability to suppress their repetitious thoughts and compulsions. Another neurological explanation states that here is insufficient activity of Serotonin, just as in depression. This theory offers medication as the best treatment course (e.g. Cipramil, Cipralex, Prozac, Paxil, Zoloft, Luvox, and other SSRI-class medications) by increasing the levels of Serotonin in the brain. Success rates vary between 40%-60%, though there are many potential side effects.
The third treatment model is Cognitive Behavioral Therapy (CBT), which states that people with OCD are unable to divert their attention from intrusive thoughts and unable to resist compulsive urges. In Cognitive Therapy, people with OCD learn to trust themselves and their logic, and not give in to their fears or use defense mechanisms such as perfectionism and rigid control. In Behavioral Therapy, people with OCD are exposed gradually to anxiety-provoking situations and are instructed to avoid using compulsive rituals in order to discover that these rituals do not decrease anxiety in the long run and do not affect the situation. CBT can be performed in individual or group settings, and research has shown Cognitive Behavioral Therapy to be effective in 55%-85% of individuals suffering from OCD.
In the last year, a research article published in the Journal of Anxiety Disorders has shown that CBT can assist patients who do not improve with medication, both in the short and long run.  In addition, among patients with OCD who improved with medication, a significant increase in improvement was found when combining medication with CBT as opposed to patients who only received medication.