Nearly 1 in 40 Americans is paralyzed by the need to perform irrational rituals: Washing their hands over and over, locking the front door 5 times before they can leave the house or counting to 7 before entering a room. Unusual habits like these are manifestations of obsessive compulsive disorder (OCD).
The onset of this crippling anxiety disorder generally happens in adults around age 21 and can inflict children near age 10. Typically, there is a significant delay between symptom onset and treatment due to the patient's own embarrassment and the long-held but false belief that little can be done about OCD.
Quality of life for the OCD sufferer is greatly compromised because of shame, distress and time spent carrying out compulsive behaviors. One study found that 13% of OCD patients have attempted suicide.
Would you know if you or a loved one was suffering from OCD?
OCD is a two-fold anxiety disorder that consists of:
- Obsessions: Involuntary thoughts, ideas, images or impulses that become disturbing or distracting and won't go away. Examples include a preoccupation with dirt or germs; fear or worry of accidentally harming people; or an extreme need for order and symmetry. Some people with OCD harbor obsessions around sexual, religious or violent images that they themselves find disturbing or repugnant, but cannot stop.
- Compulsions: Behaviors or rituals one feels compelled to act out again and again. Excessive hand washing or cleaning; double-checking of locks, appliances or switches; and ordering or arranging things "just so" are common types of compulsive behavior. Rituals such a praying, counting or tapping before simple everyday acts like shaking hands or driving to the supermarket can also be symptoms of OCD. These repetitive behavioral patterns are performed to create a sense of control, help the person feel safe, and neutralize the anxiety created by the obsession.
The symptoms for OCD can range from mild to severe. While OCD sufferers know their behavior is irrational, they often can't stop it on their own. Also, they're often ashamed or unaware they even have a treatable disorder. Unfortunately, OCD can be easily mistaken for another mental health issue such as depression, bipolar disorder or attention deficit anxiety disorder (ADHD), making it all the more difficult to diagnose, or resulting in the wrong treatment.
The number 1 risk factor for OCD is family history. According to Dr. David Tolin, director of the Anxiety Disorders Center at the Institute of Living, "We know there's a very strong genetic component. It seems to affect men and women in equal numbers. Boys tend to develop this disorder earlier, whereas, girls develop it in later years, or even in early adulthood years."
The Brain's Worry Circuit
The human thinking process takes us from the very front of the brain, known as the prefrontal cortex, to an area called the caudate nucleus, part of the basal ganglia, which plays a role in switching gears from one thought to another. Called the "worry circuit," this route is responsible for habit formation. In brain imaging studies of OCD patients, this pathway differs from "healthy" brains; it is unclear exactly what kind of neural coding is responsible for OCD symptoms or their resolution. Research has also shown that levels of serotonin, the neurotransmitter that can help keep obsessive thoughts at bay, is lower in OCD patients.
Treatment of OCD relies on therapy or a combination of 2 therapies. "One is medication, typically SSRIs, or selective serotonin reuptake inhibitor antidepressants," says Dr. Tolin. "The other is a form of counseling called cognitive behavior therapy, where we use a process called exposure ." Exposure involves putting the OCD patient in repeated contact with the feared stimulus. Over time, this process helps diminish the anxiety related to the fear, of germs per se. Response prevention is also an important component, which involves teaching the patient not to engage in their typical obsessive rituals, such as constant washing to remove suspected dirt.
To see if you or someone you know suffers from some level of OCD, take this quiz .