Obsessive-Compulsive Disorder

Obsessive-Compulsive disorder (OCD) is a type of anxiety disorder characterized by distressing, intrusive thoughts, images and urges that create significant anxiety and distress to the person experiencing them, and by repetitive behaviours or rituals that the person feels compelled to perform. The rituals usually result in a temporary relief of the anxiety.

For example, a person may have intrusive thoughts about being contaminated with germs or a dangerous substance. These thoughts create significant anxiety in that person, who may then engage in excessive and repetitious washing of their hands and/or other body parts. Many people experience repetitive, distressing thoughts from time to time, especially when stressful events have occurred.

A person may even engage in repetitive behaviors, like checking whether or not they have their car keys with them. However, these thought and behaviours neither create a significant problem nor disrupt the person’s life. In contrast, people who have OCD experience obsessive thoughts and compulsive behaviors that are highly intense and very frequent. These thoughts and behaviours create significant distress and disruption in many areas of their lives. Indeed, individuals who have severe OCD may suffer from poor daily functioning, relationship problems and chronic underemployment.

Most people who have OCD experience both obsessions (thoughts, images) and compulsions (repetitive behaviors). However, a small percentage of individuals have obsessive thoughts without compulsions and an even smaller percentage report having compulsions without obsessions. Some people have more than one type of obsession and/or compulsion.

Types of Obsessions and Compulsions:

Most obsessive thoughts and images fall under one of the following categories:

Aggression – Thoughts of harming someone, often a loved one such as their child. For example, a mother may have a repetitive thought such as “what if I hurt my baby?”

Contamination – Having touched certain things like doorknobs, money or newspapers, or having handled chemical substance like pesticides, the person may believe he or she become contaminated with germs or poisonous substance and is sure to suffer dire consequences.

Symmetry/Exactness – Usually thoughts concerning less than perfect symmetry of one’s own body parts. For example, “My right arm is longer than my left one and that makes me horribly defected.” As well, everything needs to be perfectly exact and in order.

Somatic – Interpreting common bodily discomforts or malaise as a sign of a terrible, terminal illness. For example, “Why am I having a headache? I must have a brain tumour.”

Hoarding/Saving – A belief that almost anything within someone’s reach should become and remain theirs for fear they may miss it in the future and will terribly regret having let it go, or that they would not be able to cope without it.

Religious – Having unacceptable blasphemous ideas during prayer or in other situations, such as visualizing having sex with the Virgin Mary.

Sexual – Thoughts or images of performing unnatural sexual acts such as having sex with an animal. Please remember! Thoughts like the above may cross the minds of people who do not suffer from OCD from time to time. However, a person with OCD will have intrusive, repetitive thoughts that they may not be able to get out of their minds and that cause them significant distress and anxiety.

For example, a new mother who does not have OCD may think “what if I drop my baby when I walk down the stairs?” She may become a little bit anxious and may hold the baby tight when walking down the stairs. After a few times of walking up and down the stairs with the baby in her arms the issue would stop bothering her. A mother who has OCD may have that thought dozens of times every day. She may also have a repetitive image of the baby rolling down the stairs and remaining motionless at the bottom. As a result of these thoughts and images, she may experience extremely high levels of anxiety.

Types of compulsive behaviours:

Most compulsions fall under one of the following categories:

Checking – Checking the stove, the fireplace, the door etc. before leaving the house or before going to bed. The checking is repetitive and takes a long time. For example, a person with OCD may check the stove 7 times and look at it to make sure it is off for 10 minutes or more. At times, the person will go back and check things again and again, even after telling oneself that they remember having checked it and that it was OK.

Washing – Washing one’s hands 50-100 times every day. Taking a whole hour in the shower scrubbing one’s body over and over again. Also, washing clothes and bedding over and over again.

Repeating – This may apply to any behaviour that the person repeats many times. It can be, repeating what they say over and over again, or repeating an action, such as flicking the lights on and off several times without any apparent reason.

Ordering/arranging – Spending a long time on making sure that everything is ordered and arranged such as papers, setting the table while using a measuring tape, rearranging clothes and personal belongings, over and over again.

Counting – Counting things that do not have to be counted, such as how many times you petted your dog or how many cars pass by you when you are waiting at the lights.

Hoarding – Collecting unreasonable numbers of items such as clothing, toiletries, books, papers etc. Not being able to let go of things that you do not need or that may never fit you thus collecting huge piles of “things”. Hoarding may include one item, like shoes, or many items. Hoarding also pertains to money, for example, saving a lot of money in the bank and never spending any of it on anything but the bare necessities.

For more information, contact Dr Regev at her Vancouver office on West Broadway Tel: 604-671-7356

What Causes OCD?

There is no single cause for OCD that has been identified. However, there is growing evidence that biological factors contribute significantly to this disorder. Thanks to advances in medical technology, scientists have been able to identify some problems in communication between two parts of the brain: the frontal part (Orbital Cortex) and deeper parts (the Basal Ganglia).

In order to communicate between themselves, these parts of the brain use Serotonin, a neurotransmitter that has been known to affect mood, emotions, sleep and appetite. Scientists believe that changes in levels of Serotonin in the brain at specific times may be a factor in the development and maintenance of OCD. However, other factors such as relationship distress, family history, stress, and other social and environmental factors may contribute to this disorder.

Treatment Options:

There are two types of treatments that have been successfully used to treat individuals with OCD: the first types are the psychosocial treatments and the second, the biological treatments (e.g., medications). In some cases, a combination of the two is the treatment of choice.
Psychosocial Treatment – The treatment that has been found the most effective among the psychosocial group is Cognitive-Behavioral Therapy (CBT). Other treatments that have been found to be only somewhat effective are Behavioral Interventions and Cognitive Therapy. Cognitive-Behavioral Therapy explores the relationships between behaviours, thoughts, feelings and the environment. In treating OCD, two procedures have been found to be particularly helpful. The first is called Exposure (EX) and the second Response Prevention (RP). These two procedures are often practiced together.

Exposure means that the individual with OCD is exposed to situations that prompt obsessional distress. Exposure may be imaginary or real (in vivo). For example, an individual with contamination obsession, such as Jay from our case example, may be asked to touch a bathroom door handle, which would then result in some degree of anxiety. Response Prevention would follow immediately, as the client will be instructed to avoid performing the ritual, in this case, washing, despite the anxiety they may experience. The combination of EX and RP has been found to be highly effective and durable, and is superior to either treatment (EX or RP) on its own.

Biological Treatments:

Medication – Different types of medication have been found helpful in ameliorating OCD symptoms. Specifically, the Tricyclic Antidepressants, such as Imipramine, as well as Selective Serotonin Reuptake Inhibitors (SSRIs) such as Prozac and Paxil have contributed to a 50-60% recovery rate. Individuals with OCD have often needed high doses of SSRIs to alleviate their symptoms. Recently, clinicians have started to prescribe anti-psychotic drugs, such as Seroquel (Quetiapine Fumarate). Reports have been favourable but only future research will indicate if these drugs are superior to the more traditional medications.

Electro-Convulsive-Therapy (ECT) – ECT has been successfully used to alleviate OCD symptoms when clients have not responded well to anti-depressants. However, ECT is perceived as an extreme measure by both patients and clinicians and is only used as a last resort when other treatments have failed, and only with the patient’s consent.

Further Readings:

• Hyman, B. M. (1999). The OCD workbook: Your guide to breaking free from Obsessive-Compulsive Disorder. Oakland, CA: New Harbinger Publications.
• Steketee, G., & White, K. (1990). When once is not enough: Help for obsessive compulsives. Oakland, CA: New Harbinger Publications.
• Bear, L. (2000). The imp of the mind. New York: Little, Brown & Co.
• Van Noppen, B., Pato, M., & Rasmussen, S. (2003). Learning to live with OCD: Help for families. New Haven, CT: Obsessive