What is Obsessive-Compulsive Disorder? Is it treatable?

We’ve all probably heard someone described as “so OCD” and you may have even identified yourself this way! Many fans insist on wearing their lucky shirts to watch all Alabama or Auburn football games and may even have other rituals that they always do leading up to Game Day. My Granny and I took a wonderful trip to Ireland together many years ago and had the opportunity to kiss the famous Blarney Stone, which would allegedly give us the gift of eloquence. Granny wanted to disinfect the stone prior to kissing it. Are these actions indicative of OCD? Probably not, at least not on their own. A key feature of OCD is that actions are time-consuming or cause significant distress in social, occupational, or other important areas of function. For example, if an Alabama fan may lose his job because of his insistence on wearing Alabama shirts daily in order to prevent the team from losing and thus affecting future prospects for the players, this might warrant evaluation for OCD, particularly if he is in danger of losing his job for not following the dress code. If my grandmother was spending over an hour disinfecting items to relieve her worries that she would develop an infection and die, we might want to consider an OCD diagnosis. (Fortunately, she is not doing this and approves this blog post!)

OCD has 2 main features: 1) obsessions: intrusive, repeated, or unwanted thoughts, images, sensations, or targets; 2) compulsions: physical and/or mental behaviors performed in response to obsessions. The goal of compulsions is to reduce distress or prevent a bad outcome. Many rituals are quite healthy on the surface, such as washing hands, checking door locks at night, and praying, but these become compulsions when they are causing significant problems for the person and they are doing them to stop the distress caused by their obsessions.

Approximately 2 percent of the world's population (70 million people) has OCD. OCD occurs all across the world, although specific content of obsessions and compulsions varies from culture to culture. John from Tuscaloosa worries constantly about sexually harming others. He may repeatedly review his day to confirm that he has not harmed anyone. Sherry from Florence cannot stop thinking that she may have been exposed to asbestos or black mold in her home or other buildings. She repeatedly checks all areas of her home and other areas she enters and spends hours washing her body, hair, and clothes to ensure they are not contaminated by asbestos. Jenny from Birmingham worries that she may have failed to turn off her curling iron and will start a fire that consumes her whole apartment building. She returns home after leaving for work to check but then is unsure if she checked “correctly” and returns 10 more times, arriving at work 2 hours late. Billy from Huntsville considers even numbers to be “good” numbers and must always turn his lights on and off 4 times. Tina from Mobile fears that she has sinned without realizing it and will go to hell if she dies suddenly. She pauses at the top of each hour to pray and repent.

As with many disorders, OCD symptoms have been recorded for centuries even if our current modern diagnostic criteria were not established until more recently. In olden times, women experiencing OCD compulsions were often accused of being witches. OCD symptoms can begin at any time in life but most commonly appear between ages 7 and 12 or in late adolescence/early adulthood. Some children experience a sudden onset of OCD symptoms after a strep infection. These symptoms typically improve when the infection is treated but may return with future strep infections. OCD begins in the postpartum period for a number of women, and pre-pregnancy OCD will often worsen after giving birth. Although most women will experience some occasional worries about dropping their baby or about the baby being ill, women with OCD experience these worries to an obsessive level and engage in compulsions such as researching infant symptoms online for hours, washing bottles multiple times, etc. Fathers and non-birthing mothers can also experience symptoms of OCD after a new baby arrives.

The International OCD Foundation estimates that individuals may take 14-17 years to receive an appropriate diagnosis. Think how much of life is missed during so many years! Indeed symptoms of OCD can have considerable overlap with other disorders such as Generalized Anxiety Disorder, ADHD, Autism, and Tourette’s Syndrome and other Tic Disorders. Up to 30 percent of individuals with ADHD will also demonstrate symptoms of OCD, and up to 60 percent of individuals with Tic Disorders such as Tourette’s Disorder will also display symptoms of OCD. There appears to be an underlying neurological component to these disorders.

Can OCD be treated successfully? The answer is a resounding YES! Until the 1960s, OCD was considered resistant to treatment. Thankfully, advances in research mean that there are now therapies available that help individuals with OCD manage their symptoms and enjoy their lives. The gold-standard treatment for OCD is Exposure and Response Prevention, which we are pleased to offer at Upward. This therapy consists of facing the obsession while avoiding the compulsion that is typically used to relieve it. Thus, Sherry might retrieve an item from her attic or visit an older building but not shower or wash her clothes upon returning home. Billy may only turn his lights on and off 1 time or 3 times. While these exposures initially feel quite uncomfortable, the body and brain learn quickly to tolerate this discomfort without engaging in compulsions. Jenny checks once to see if her curling iron is off and sees that her building does not catch on fire. Tina is able to receive peace from her faith and receive comfort from her morning prayer and scripture reading without her hourly repentance. If the thought of engaging in this kind of exposure work makes you feel nervous, please know that that is very normal. An experienced therapist with expertise in OCD treatment will be able to support you as you move through a strategic series of exposures and will set you up to be successful in your therapy.

If you are wondering if you or a loved one might have OCD, the International OCD Foundation has a brief screening tool here: https://iocdf.org/screener/. If this screen is positive for you, we would love to help you take control of your life and feel your best.