How to Help: A Beginners’ Guide to Understanding Obsessive-Compulsive Disorder (OCD)

What Is OCD?

You’ve probably heard stereotypes about obsessive-compulsive disorder (OCD) from people you know or from the media that leave you wondering, “What is OCD exactly?” People even commonly say things like, “You are so OCD,” when someone is engaging in compulsive behaviors. But OCD isn’t something you are; it’s a set of specific anxious thoughts and behavioral urges you experience.

According to Psychology Today, obsessive-compulsive disorder, or OCD, is an anxiety-based disorder in which people experience recurring and unwanted feelings, thoughts, images, or sensations called obsessions. They might engage in compulsive, repetitive behavior because they want to reduce or temporarily hold off the distress they feel when they don’t carry out the compulsions.

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How Common Is OCD?

Obsessive-compulsive disorder is more common than you may think. A study from the National Institute of Mental Health found that 1.2% of American adults experience OCD every year, and 2.3% of American adults experience symptoms at some point throughout their lives. Around 5 million Americans and an estimated 1 in every 200 children experience OCD at some point throughout their lives.

Anyone can experience symptoms of obsessive-compulsive disorder, no matter their gender or socioeconomic, racial, or ethnic background. OCD indicators can also begin at any age, but it’s common for younger people to exhibit them. Intrusive obsessions and compulsions often begin to show during childhood, teenage years, or young adulthood. On average, obsessive-compulsive disorder traits appear when a person is around 19 years old, with males often developing symptoms at a younger age than females.

OCD Symptoms

Despite how common the symptoms are, most people are secretive about their experiences. While symptoms vary, most people with OCD experience:

Obsessions: Intrusive and recurring thoughts, images, or urges that you might try to ignore or suppress but can’t without causing anxiety and distress
Compulsions: Repetitive behaviors or mental acts that you feel compelled to carry out in response to your obsession. Although compulsions are attempts to counter anxiety and distress, these actions aren’t necessarily tied to resolving the source of anxiety, or are excessive.

The Diagnostic and Statistical Manual of Mental Disorders (DSM–5) notes that people with OCD experience obsessions, compulsions, or a combination of both. Most people with OCD resort to compulsions as a result of their obsessions. Repetitive behaviors vary based on the person, but they often include actions like hand washing, cleaning, rearranging, counting objects, frequently seeking reassurance, or checking on things to the point they interfere with regular life and social interactions.

Symptoms may also include things other people can’t observe and can change over time. Mental compulsions can appear in the form of obsessive thoughts, which cause people to pray silently or repeat phrases to themselves to prevent anxiety.

In children, symptoms are like those exhibited by adults, but they can easily go unnoticed or seen as “phases”. Children who seem overly worried or have obsessive behaviors may have OCD, and a visit to a pediatrician or therapist may be in order if these traits are observed. Children often use ritual as security, but a child with OCD might experience rituals–like checking for monsters under the bed–that persist beyond the expected developmental stages, for an extended period of time, or that become distressing. Children with OCD may exhibit obsessions with:

Germs
Offending God
Magical thinking
Catastrophizing
What-ifs
Feeling “just right”

OCD in children can easily be confused with attention deficit hyperactivity disorder (ADHD) or other learning issues. These behaviors may be symptomatic of OCD or another challenge:

Distractibility
Avoidance of tasks or interactions
Tapping
Symmetric touching
Anxiety
Slowness on tasks or exams

What Causes OCD?

The root causes of OCD aren’t yet understood, but the obsessive-compulsive behaviors stem from a need to relieve feelings of anxiety or distress.

Researchers think chemistry in the brain is responsible. The brain may not correctly respond to serotonin, which is known as the “happy chemical.” Head trauma is also associated with OCD.

Environmental and genetic factors come into play with an OCD diagnosis as well. Traumatic events in childhood, such as physical or sexual abuse, lead to higher risk. Strep throat may also cause or worsen OCD in some kids, which is a condition called PANDAS.

That said, genetic influence is the most well-known cause of OCD. Those diagnosed often have a family member with OCD, making them at a 25% higher risk themselves. Studies on twins also confirm genetic influence. Though there is a chance, it is important to remember that if you are a parent with an OCD diagnosis, there is not a guarantee that it will pass on to your children.

How Is OCD Diagnosed?

A doctor or licensed mental health care professional (i.e., psychologist or psychotherapist) must diagnose the presence of obsessions and/or compulsions using the criteria from the DSM-5. The behavior must be time-consuming, cause distress, and impair one’s ability to work or function in social settings.

Expect both physical and psychological evaluations on the road to diagnosis. Medical professionals may, for example, complete a blood test to rule out any symptoms caused by illness, medications, drugs, or other conditions, especially in sudden onsets in children or the elderly.

How Is OCD Treated?

Psychotherapy and medication have been found to help reduce symptoms and improve psychosocial functioning in individuals diagnosed with obsessive-compulsive disorder. Optimal treatment typically involves both simultaneously.

There are three “well-established treatments” for obsessive-compulsive disorder:

- Exposure and Response Prevention (ERP): ERP focuses on the thoughts or situations that lead to obsessions and compulsions and gradually helps reduce anxiety. In this, the client is exposed to a trigger and are encouraged to choose to not respond to it.
- Cognitive Therapy (CT): CT focuses on reducing and challenging irrational thoughts that could be contributing to their OCD symptoms.
- Cognitive Behavioral Therapy (CBT): A combination of ERP and CT, CBT is a short-term, goal-oriented therapy in which clients are challenged to cope with and change their cognitive distortions and damaging behaviors.

In addition to individual therapies, many with OCD engage in family and group therapy. These provide psychoeducation and focus on problem-solving and effective communication with the patient and their family members. It is usually done in conjunction with other treatment and aims to help the family members of someone with OCD cope and provide support.

Medications like serotonin reuptake inhibitors (SRIs) and selective serotonin reuptake inhibitors (SSRIs) are used to treat OCD. The drugs increase the amount of serotonin in the brain, which is why they’re prescribed for anxiety and depressive disorders. Options may include antidepressants like clomipramine or new medications such as fluvoxamine, paroxetine, fluoxetine, and sertraline.

Therapy and medications take time to work. You may not see improvement for a long time, so don’t give up on treatment if you don’t see immediate results. Mindfulness practices can help in the meantime. Mindfulness is a self-awareness practice that involves focusing on the present moment without judgment. While it takes time to master, practicing daily mindfulness can help alleviate OCD symptoms.

What Is It Like Having OCD?

Every person with OCD experiences it differently. The disorder varies in intensity and can have a variety of mild to severe effects. People with OCD also tend to experience other mental health issues. According to the DSM-5, most of the people who have OCD experience other chronic conditions throughout their lives, such as:

Anxiety disorders: An estimated three-fourths of people with OCD also have a generalized anxiety disorder or panic disorder.
Manic depression or bipolar disorder: Around half of those diagnosed with OCD also have a mood disorder, with extreme and recurring mood swings.
Tic disorder: Up to 30% of diagnosed OCD patients have a tic, and studies show Tourette’s syndrome is common in boys under seven years old with early-onset OCD. This symptom is also seen in female patients.
Body dysmorphic disorder: A type of OCD, body dysmorphia involves focusing too much on outer appearances and perceived imperfections.
Trichotillomania: Often called TTM, this impulse-control condition is a mild to severe compulsion to pull hair from the body. It is classified in the DSM-5 as an obsessive-compulsive or related disorder and affects around 2% of the population. About half of people with TTM receive treatment.
Excoriation disorder: Also known as skin picking, this physical impulse-control condition often affects females.
Hoarding disorder: People with hoarding disorder collect and save items with no apparent value, which leads to clutter and persists until the living area is unusable. Hoarding occurs in 2% to 6% of the population, usually males or people between the ages of 55 and 94.

Quality of Life with Obsessive-Compulsive Disorder

Obsessive-compulsive disorder is the 10^th leading cause of disability because people with OCD often have a significantly impaired quality of life. Severe symptoms of obsessions and depression, along with marital status, predict how severe the impairment is. However, many people hide their OCD well.

Obsessive-compulsive disorder can manifest in many ways, and obsessions vary. Some may feel compelled to wash their hands five times in a row, while others ruminate about getting a disease or losing control. People with OCD may think about contamination, show a strong desire for order, or focus on taboo thoughts around on religion, sex, or self-harm. Some obsessions fall completely outside of these typical diagnostic behaviors.

For many people, the disorder starts as excessive worry exhibited around ages 8 to 12. Kids might check the clock methodically while waiting for the bus to arrive, fear choking, or organize belongings repeatedly because they perceive that something bad may happen if they don’t. Obsessive thoughts or actions can take over large blocks of the day, even if the tasks seem pointless to observers.

Traumatic life events can trigger OCD or cause it to worsen, and some people may not even experience an outbreak of symptoms until a traumatic event. Some women even develop OCD during pregnancy or after giving birth.

People with OCD explain that it feels like having two brains, rational and irrational, constantly at war inside their heads. Reassurance that their fears are unlikely to come to fruition often only makes the problem worse. It’s a serious mental disorder that can cause pain and shame, which may make it difficult to seek treatment—many people with these indicators do not get help. However, treating OCD can help improve quality of life.

Social Effects for Young People with OCD

Students with obsessive-compulsive disorder often have symptoms that can hinder social development. Classmates may notice the compulsive behavior and ridicule them for being different or “crazy,” which may lead young learners to feel embarrassed and hide their compulsions. Children may withdraw from old friends or social activities to avoid explaining their behavior, hurting others, or encountering germs. They also might feel they do not have time for others or show up late because completing their compulsions took too much time.

If you have OCD, you might feel:

Agitation when you’re interrupted
Stigmatized by mental illness
Embarrassed by your behavior
Afraid of name-calling and being found out
Depressed and alone
The pressure to fit in or hide compulsions
Too tired to be social

Many people with OCD feel isolated over time because they may withdraw from society. The more time spent on obsessions and compulsions, the more mentally and physically exhausted they become, and the further they retreat.

Effects on Relationships

Because kids and adults with OCD often face isolation, their relationships with other people can suffer. Isolation can result in difficulties in:

Recognizing others’ emotions
Knowing how to respond in certain social situations
Expressing feelings appropriately
Problem-solving or generating new ideas
Flexibility in situational changes
Figuring out how others may react
Refraining from impulsivity
Acting appropriately for the situation
Feeling accepted by others
Creating long-lasting friendships

Many adults with OCD don’t decide to get help until they try to make a significant life decision, like getting married. The doubt and anxiety about making a perfect choice can be all-consuming. A major transition often allows the OCD to manifest itself around a person’s need for certainty in the situation.

Typically, relationship-based obsessive compulsion is either centered on the relationship overall or focused on a partner. Those with OCD may compare their partners to other people, making endless lists of pros and cons, or ask everyone they know to weigh in on the issue. Both result in compulsive behaviors such as:

A constant need for reassurance
Checking in on feelings and behaviors
Monitoring doubts
Recalling experiences where they felt sure
Comparing with others’ relationships
Consulting everyone on the relationship

A person with OCD might place high importance on their romantic relationships. Negative events may cause them to doubt their worth and how the world sees their partner, too. They might even have extreme beliefs about what the end of a relationship could mean. These extreme beliefs lead to feelings of vulnerability, negative emotions, and obsessive thoughts.

Going to College with OCD

If you’re going to college and experiencing symptoms of OCD, you’re not alone. Like with any other health condition, treatment can help you keep your life on track, better understand your disorder, and learn how to control yourself.

Medication alone is not usually the answer. You might need to consider Cognitive Behavior Therapy (CBT), a standard therapy for treating OCD, or other therapeutic options. Treatment can help you control your compulsions and better deal with the anxiety that causes them, as performing the rituals makes OCD worse over time.

Many colleges or universities offer health centers or counseling services you can seek for help. Student health insurance programs often cover the cost of treatment. They can often help you find a cognitive behavior therapist if they don’t have their own, but private practice is generally more expensive.

Campuses may also have support groups for students with OCD. They provide regular encouragement and emotional support helpful in recovery.

OCD and Suicide

Obsessive-compulsive disorder is chronic and distressing, which leads many patients to other mental illnesses like major depression and can even result in suicidal thoughts. Studies show 52% of patients suffer from suicidal ideation, and the Karolinska Institute in Sweden discovered in 2016 that people with OCD are ten times more likely to commit suicide.

Contrary to previous beliefs about the disorder, OCD is a predictor of suicidal tendencies. Anywhere from 5% to 25% of people with OCD attempt to end their lives at some point. Although the levels are less than many other disorders and illnesses, monitor suicidal thoughts carefully. Previous attempts are the best indicators of future attempts.

You’re also at greater risk of suicide if you have OCD along with addiction or other psychiatric disorders. If you feel suicidal, call the national prevention lifeline. It’s free, confidential, and available day or night.

Resources

The following is a list of resources you can turn to for more information on OCD, whether you are an individual with the condition, love someone who has it, or are working with OCD patients.

Getting Help with OCD

The Semel Institute for Neuroscience and Human Behavior – UCLA: This institute offers intensive treatment for people with OCD and/or hoarding disorders.
Rogers Behavioral Health: With a variety of locations, Rogers Behavioral Health has residential and intensive outpatient programs for those with OCD and anxiety.
Find a Therapist Directory: The Anxiety and Depression Association of America created a searchable list of mental health providers who specialize in OCD and related disorders.
National Institute of Mental Health: This page assists individuals with or close to someone with any mental health challenge find a variety of types of assistance, from crisis lines to help finding low-cost resources.

OCD Support for Friends and Family

How to Help Your Child: A Parent’s Guide to OCD: This comprehensive guide created by the Obsessive Compulsive Foundation of Metropolitan Chicago helps parents navigate the waters of assisting their child with their OCD needs.
Managing OCD in Your Household: The International OCD Foundation created this step-by-step guide to ensuring a household with a family member who has OCD runs smoothly.
Helping a Child with Obsessive-Compulsive Disorder: This is a quick guide to supporting your child with OCD.
How to Support a Friend: This piece lists simple ways anyone can support a friend with OCD.
What Not to Say to Someone with Obsessive-Compulsive Disorder: Sometimes when we mean to be supportive, we accidentally say things that are hurtful. This article explains some of the common phrases and why to not say them.
Loving Someone with OCD: As the title suggests, this is all about how to best love someone with OCD. The article is highly empathetic to the challenges the loved ones face as well.

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