• MentalHealthIO

Just stop worrying about it: OCD

Updated: Aug 13, 2020

Khushi Patel and Shree Modukuri 



Before leaving for an important event, you always make sure you have everything you need for the day. Your mind is going through the checklist of all the things you need- phone, chapstick, charger, mask, wallet, drivers license, etc. After everything is gathered and ready to go, you feel the need to check if you have everything once again. Doing this makes you late and in frustration you say “for crying out loud why does my OCD mess everything up!” In this moment individuals who actually suffer with OCD would laugh at you because you do not know the half of it. Sufferers have to deal with obsessions and/or compulsions that cause significant distress to daily life; not just being late somewhere because they were double checking if they got everything they needed for the day.


THE DIFFERENCE BETWEEN AN ACTUAL DIAGNOSIS AND A SELF-DIAGNOSIS

Due to the symptoms of OCD being so widespread across the internet, many people are often quick to diagnose themselves with it. Although the internet can be a helpful tool when you feel like something is wrong, the practice of self-diagnosing actually harms the OCD community by detracting from those who actually have the disorder. Self-diagnosing can create false experiences with the disorder and underestimate the suffering that comes with actually having it, especially with the misconception that OCD is just wanting things to be in “the right order.” By self-diagnosing, individuals often risk jumping to conclusions based on a few experiences, perpetuating false myths about OCD to others, and possibly negatively affecting their own health by incorrectly diagnosing themselves with a disorder they do not have.

This is why an actual diagnosis from a mental health professional is absolutely necessary. By addressing your concerns with an expert, false diagnoses can be prevented, which ends up helping both the individual and OCD community. With an actual diagnosis, the myths and prevalent false beliefs about OCD won’t be spread, OCD itself will be taken more seriously, and the professional actually will be able to evaluate the individual and look at small details related to symptoms that are specific to the person and can’t be found online. 


WHAT IS OCD? 

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), obsessive compulsive disorder (OCD) is under the Obsessive-compulsive and Related Disorders class. OCD is often a chronic disorder in which an individual experiences recurring, uncontrollable obsessions (repetitive, unwanted thoughts) and/or compulsions (repetitive, unwanted behaviors) that have to be constantly repeated. 

 

Obsessions are defined by:

  1. Recurrent and persistent thoughts, urges or images that are experienced, at some time during the disturbance, as intrusive, unwanted, and that in most individuals cause marked anxiety or distress

  2. The individual attempts to ignore or suppress such thoughts, urges, or images, or to neutralize them with some thought or action (i.e., by performing a compulsion).

Compulsions are defined by:

  1. Repetitive behaviors (e.g., hand washing, ordering checking) or mental acts (e.g., praying, counting, repeating words silently) that the person feels driven to perform in response to an obsession, or according to the rules that must be applied rigidly.

  2. The behaviors or mental acts are aimed at preventing or reducing distress or preventing some dreaded event or situation. However, these behaviors or mental acts either are not connected in a realistic way with what they are designed to neutralize or prevent or are clearly excessive.

The obsessions and compulsions have to be time consuming (take more than 1 hour per day) or cause significant distress to aspects of daily life such as social or occupational. Accompanying these criteria, the DSM states to be diagnosed it has to be specified if one has good or fair insight, only poor insight, only absent insight/delusional beliefs, and/or the obsessive/compulsive beliefs are tic related. 

  • Good or fair insight: one “recognizes that obsessive-compulsive beliefs are definitely or probably not true or that they may or may not be true.” 

  • Poor insight: one thinks the obsessive-compulsive disorder beliefs are only probably true.

  • Absent insight/delusional beliefs: one believes the obsessive-compulsive disorder beliefs are completely true. 

  • Tic related: it is understood that the individual has a current or past history of a tic disorder.


WHAT CAUSES IT?

Although OCD “... is not due to the direct physiological effects of a substance (e.g., drug of abuse, a medication) or a general medical condition,” individuals with this condition often have certain areas of the brain that function differently compared to those who don’t. Research has suggested that OCD interferes with communication among different parts of the brain, including “the orbitofrontal cortex, the anterior cingulate cortex (both in the front of the brain), the striatum, and the thalamus (deeper parts of the brain).” Issues with neurotransmitters- such as serotonin, dopamine, glutamate- are also involved.

However, despite this connection with the brain, there is still no definite cause of OCD; like many disorders, it is a combination of genetic (people with first-degree relatives [such as a parent, sibling, or child] who have OCD have a higher risk of getting OCD themselves), environmental (like childhood trauma or following a streptococcal infection), behavioral, and cognitive factors. 


SYMPTOMS AND EFFECTS ON DAY TO DAY LIFE

In order to be diagnosed with OCD, the individual must be experiencing obsessions, compulsions, or both. These obsessions/compulsions must be “...take more than 1 hour per day or cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.” 


Common obsessions are:

  • The fear of germs/contamination

  • The fear of harming oneself/others

  • The fear of not being morally good/religious

  • Perfectionism or exactness, having things symmetrical or in a perfect order

  • Unwanted forbidden or taboo thoughts involving sex, religion, or harm

Common compulsions are:

  • Hand washing or cleaning frequently

  • Ordering and arranging things in a particular, precise way

  • “Checking” behaviors (making sure the stove is off so the house won’t burn down, checking the door multiple times so somebody won’t break in, etc.)

  • Repeating (a phrase or action) a certain number of times

  • Can be with counting, arranging, positioning, touching, etc.

Many individuals have rituals or actions that can look like obsessions and/or compulsions, however, these individuals are rational and can control their thoughts about these supposid obsessions and/or compulsions. Individuals who suffer from OCD cannot cannot control their thoughts and/or behaviors that take form in obsessions and/or compulsions when they know it is unwarranted. Additionally, these individuals do not gain pleasure from these actions, rather a brief relief from the anxiety these thoughts cause may be experienced. 


WHO SUFFERS? WHEN DOES IT BEGIN?

OCD affects individuals in all stages of life. Children, adolescents, and adults can suffer from OCD. Most often OCD begins to develop in childhood through adolescence, around 19 years old. According to the American Psychiatric Association, about 1.2% of Americans have OCD in which more women are affected than men.


TREATMENTS?

There are a variety of treatments for OCD, typically medication- or therapy-based. The most effective treatment is Cognitive Behavioral Therapy, or CBT. CBT uses two techniques- Exposure and Response Prevention therapy (ERP) and Cognitive Therapy (CT). ERP is when the therapist gradually exposes the patient to situations that trigger their obsessions and compulsions. Similar to exposure therapy for phobias, ERP causes the patient to be able to suppress their compulsions for increasingly longer periods of time. For example, somebody with a germ obsession may be asked to touch a surface and wait longer and longer before washing their hands. CT on the other hand involves the patient recognizing the thought patterns that cause them anxiety in order to help modify/lessen them. This technique relies on self-talk, which involves telling oneself that their thoughts are irrational to help with their disorder. 

A common medication used to help with OCD is Serotonin reuptake inhibitors (SRIs), which helps the brain maintain a strong level of the neurotransmitter serotonin by preventing it from being reabsorbed by the neurons.


Citations

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