Part Two: The “academic” side of OCD
Earlier this week, I shared an experience I was having with OCD. That experience was relatively minor, and a bit humorous. While annoying and intrusive, the experience was not disturbing. Wanting white clean teeth is a normal feeling and desire that many people have—the difference is that no matter how hard I try, I’m just not able to let it go.
In this post I want to go into a bit more detail about the disease that affects 1.6% of American Adults: the symptoms, the diagnosis, medication, and the research surrounding it.
Question One: So, what is OCD?
“Obsessions intrude suddenly into your mind and are unwanted, inappropriate, and distressing. Once an obsession occurs it captures your attention, and it is very difficult to think of anything else. Even if you are able to distract yourself from the obsession, the relief is only momentary because obsession occur again and again. OCD obsessions refers to unwanted, unwelcome, recurring thoughts that happen against your will and that are about unpleasant topics.”
Source: Overcoming Obsessive Thoughts : Christine Purdon and David Clark
Question Two: And in English that means?
An average human tends to produce over 25,000 thoughts a day. It’s a bit like a slot machine. The numbers, signs, and symbols are constantly running through the machine, and then by an outside force (pulling the lever in this case) the numbers stop. Let’s say one symbol is an ax—the chemically balanced brain might see it and think “hm, I could hack the person next to me with that”. Their next thought would likely be “that’s weird” and then they’d move on to spin the dial again. An unbalanced brain could think the same initial thought, but the response is different. They are unable to spin the dial again. Instead, thoughts of harming someone with the ax continues to plague them. Then they might think, “Wow to think that must mean I have violent tendencies”, and they run from the machine in fear. Eventually they might start avoiding casinos all together to avoid having obsessive thoughts.
A compulsion is an act repeated in the exact same way every time in an effort to “neutralize” a disturbing obsession. A study found that 61 percent of their sample of individuals with OCD had checking compulsions, 50 percent had washing compulsions, 36 percent had counting rituals, 34 percent needed to ask or confess, 28 percent showed symmetry and precision behaviors, and 18 percent showed hoarding (Overcoming Obsessive Thoughts). Checking can include counting, checking/seeking reassurance from other that harm hasn’t occurred, or mental self-reassurance (ie: determining how well characteristics of known pedophiles to match your own characteristics).
Question Three: So I’m actually OCD when?
Like any mental illness, OCD is difficult to diagnosis because worries and anxieties are a normal and expected part of life. However, OCD obsessions are more extreme than “normal” experiences. The American Psychiatric Association publishes the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) that is used by mental health professionals to diagnose mental illnesses. To be diagnoses with OCD:
- You must have either obsessions or compulsions.
- You must realize that your obsessions and compulsions are excessive or unreasonable.
- Obsessions and compulsions significantly interfere with your daily routine.
Your obsessions must meet these specific criteria:
- Recurrent and persistent thoughts, impulses or images are intrusive and cause distress.
- The thoughts aren’t simply excessive worries about real problems in your life.
- You try to ignore or suppress these thoughts, images or impulses.
- You know that these thoughts, images and impulses are a product of your own mind.
Compulsions must meet these specific criteria:
- Repetitive behavior that you feel driven to perform, such as hand washing, or repetitive mental acts, such as counting silently.
- These behaviors or mental acts are meant to prevent or reduce distress about unrealistic obsessions.
Basically obsessions are having thoughts that are intrusive, unwanted, uncontrollable, uncharacteristic, and you are trying hard to resist them. The compulsions are acts you feel an urge to perform are intended cope with negative feelings or consequences. They are intentional, repetitive, excessive and make you feel a loss of control.
Source: Mayoclinic.com .
Question Four: So, my treatment options are?
The first drug class of choice tends to be SSRIs, such as Lexapro, Prozac, and Paxil. If that doesn’t work, another type of antidepressant called a tricyclic antidepressant such as Clomipramine, are available. These drugs are likely to have more side effects than SSRIs.
A combination of the two can also be prescribed. Like any mental illness, therapy (in combination with these medications) such as cognitive behavior therapy can be extremely effective. A licensed practitioner will likely employ some type of Exposure and Response Prevention. This treatment involves slowly exposing the individual to the distressing thought, and working on adapting the mental response to the external event. For example, if you struggle with thoughts on hitting people—you might work on patting someone on the back and identifying the false thoughts that you are a violent person.
These treatments can be very effective at managing the distress and intrusiveness caused by OCD. However, the longer it goes untreated the more disruptive to the individual’s life it can become. I’ll explore how this was the case for me in the next section.
For more good information on treatment, and OCD in general, visit: http://www.ocfoundation.org/index.aspx
Question Five: What are some examples?
I shared a less serious example of a OCD experience in the last post. However, obsessions are more often about more disturbing topics such as harming self or others, thoughts or urges of sexual acts you find personally disgusting, or blasphemous thoughts and actions. The following two examples are from Overcoming Obsessive Thoughts:
Mario is a forty-three-year-old financial planner with two teenage daughters and a solid marriage that has just celebrated its twenty-second anniversary. He is a conscientious and hardworking university graduate who volunteers for a number of worth community causes, is well-like by neighbors and friends, and is admired for his determination and well-balanced approach to work, family, and community. And yet, Mario’s day is filled with unwanted thoughts of violence and aggression toward others; thoughts of kicking a pregnant woman who passes him on the street, of punching a colleague in the mouth for no apparent reason, or lunging toward his wife with the knife he is using to cut up vegetables. These unexpected and unwanted intrusive thoughts are extremely upsetting for Mario because they are totally against his character. After all, he is a fine, outstanding family man with strong moral values who is polite and gentle toward others. But here he is, plagued by violent and repulsive thoughts and images.
Cara is a twenty-four-year old mother of a four-year-old boy. She is a proud, loving parent who wants to provide the very best for her son. But shortly after arriving home with the infant, Cara, began having thoughts or doubts about whether she might sexually abuse the child. While changing her diaper or bathing her, she wondered if she felt sexually aroused. This doubt became so frequent and troubling that she avoided bathing or changing her daughter and relied on her husband or visiting friends to do so. Her days were fraught with high anxiety and fear.
Hopefully, this gives you a bit of background about OCD…I eased you into OCD with the light post….a more academic understanding…and more intense one is to come…..