Obsessive-Compulsive Disorder: Key Facts You Need to Know
OCD isn’t just liking things labeled or washing your hands often.
It’s common to hear someone casually refer to themselves as “so OCD” as they show off their perfectly labeled filing cabinet. While many people enjoy a color-coded Post-It note system, even the strongest type-A personality is not necessarily enough for a diagnosis of obsessive-compulsive disorder, or OCD.
The mental health disorder OCD entails having intrusive obsessions, compulsions, or both. Obsessions, according to the National Institute of Mental Health, are anxiety-inducing thoughts or urges, such as the fear of contamination, violence, or aggression, or a need for symmetry or perfect order. Compulsions are the repetitive behaviors—like washing hands excessively or following precise routines—the patient feels the need to do, often as a way to quiet the obsessions.
“People tend to think if you’re doing these things, that you do the ability or the volition to stop,” says psychiatrist Gail Saltz, MD. “And really, when you have OCD, you do not.”
What separates OCD from a mere desire for cleanliness or structure? A person with OCD cannot control and does not get pleasure from performing compulsions. These thoughts and rituals actually disrupt the person’s daily life and relationships.
On average, OCD appears around age 19, but the reason is not always clear. Research has found evidence of genetic, environmental, and psychological factors.
For mild to moderate cases of OCD, psychotherapy can treat the unwanted thoughts and behaviors. A common method is a type of cognitive behavioral therapy called exposure response therapy, which exposes the patient to the anxiety they obsess over (such as germs or objects arranged in the “wrong” order), without letting them perform the compulsion.
Medication can also help treat OCD, especially certain classes of antidepressants such as SRIs and SSRIs. (Learn more about the different types of antidepressants here.) These meds, combined with psychotherapy, can reduce or even eliminate the OCD symptoms. For some patients, however, symptoms may still present themselves, and part of treatment involves learning to manage symptoms on a day-to-day basis.
“Without treatment for OCD,” says Dr. Saltz, “people can ruin their lives. They cannot stop this behavior on their own. It’s really crucial—and the earlier, the better—to seek treatment.”
Dr. Michaelis is a clinical and media psychologist in New York City.
Gail SaltzDr. Saltz is a clinical associate professor of psychiatry at the NewYork-Presbyterian Hospital and Weill Cornell Medicine and a psychoanalyst with the New York Psychoanalytic Institute.
Khadijah WatkinsDr. Watkins is an assistant professor of psychiatry in the division of child and adolescent psychiatry at Weill Cornell Medicine and an assistant attending psychiatrist at NewYork-Presbyterian Hospital.
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A lot of people with OCD tend
to suffer in silence and
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they tend to sort of white knuckle it.
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Obsessive-compulsive disorder is
an anxiety based disorder where
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the individual experiences either
obsessions or compulsions or both.
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And obsessions are recurrent,
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unwanted thoughts that the person tries
to suppress, they don't really want.
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It can be thoughts about germs or
contamination, or
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unwanted thoughts about violence or things
that are unpleasant for the individual.
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And they try to suppress those
thoughts through compulsions.
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Compulsions, which often accompany
obsessions, but don't have to,
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you can have obsessive-compulsive
disorder that is pure obsession.
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It is usually a behavior that actually
doesn't necessarily make great sense in
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the context of the thought or obsession.
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It's a behavior that you don't want to
keep repeating over and over again.
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But you really feel that
you can't help yourself.
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I might feel as though I
have to wash my hands many,
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many times a day because I'm afraid
of getting germs and getting sick.
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To the point where my hands are red or
raw or
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peeling because I washed
them to that extent.
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People tend to think if you're doing
these things that you do have the ability
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or the volition to stop.
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And really, when you have OCD, you do not.
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Living with OCD for
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me on a daily basis is trying to get rid
of bad thoughts that I have constantly.
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Whether it could be something bad
happened to a family member or
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a close friend or even to myself.
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So to get rid of my bad thoughts,
different types of touching,
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physical touching or blinking my eyes.
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Or phrases that I say over and
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over in my mind just to get
rid of those bad thoughts.
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To diagnose someone with OCD,
you take a thorough history and
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you do a clinical evaluation.
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And you assess for the symptoms and
you assess for the duration of time and
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the degree of impairment and suffering.
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OCD runs in families, again,
there's clearly some genetic component,
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there's a biology to it.
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And there's also definitely an
environmental or psychological component
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because OCD often presents first
after very stressful periods.
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It gets worse in stressful periods.
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OCD can be treated with psychotherapy
and/or with medication.
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From mild to moderate OCD, most
clinicians would recommend psychotherapy.
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And in the case of OCD,
it's really usually exposure and
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response prevention style
of cognitive-behavioral.
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So you would expose someone to
something that they are afraid of or
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something that they are worried about.
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And then you will prevent them from doing
the action that relieves the anxiety.
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For instance, if I had a fear of germs,
you would expose me to,
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potentially, something
that has germs on it.
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And then you would prevent
me from washing my hands.
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Without treatment for OCD,
people can ruin their lives.
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They can not stop this
behavior on their own.
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They can suffer and destroy relationships
and become really housebound.
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So it's really crucial, and
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the earlier the better,
to seek treatment for OCD.
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Obsessive-compulsive disorder. Washington, DC: National Institute of Mental Health. (Accessed on January 12, 2021 at https://www.nimh.nih.gov/health/topics/obsessive-compulsive-disorder-ocd/index.shtml.)
Obsessive-compulsive disorder in adults: Epidemiology, pathogenesis, clinical manifestations, course, and diagnosis. Waltham, MA: UpToDate, 2020. (Accessed on January 12, 2021 at https://www.uptodate.com/contents/obsessive-compulsive-disorder-in-adults-epidemiology-pathogenesis-clinical-manifestations-course-and-diagnosis.) What is obsessive-compulsive disorder? Arlington, VA: American Psychiatric Association. (Accessed on January 12, 2021 at https://www.psychiatry.org/patients-families/ocd/what-is-obsessive-compulsive-disorder.)