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[ Newsletter - December 2013 ]

Obsessive-Compulsive Disorder (OCD)
By: Mareli Fischer

OCD is an anxiety disorder with two main symptoms, namely intrusive thoughts and compulsive rituals. The intrusive thoughts or so called obsessions, produce uneasiness, worry and feelings of apprehension for the individual. The compulsions, or repetitive behaviour patterns, are aimed at reducing the anxiety.  Symptoms of this disorder can be very alienating to the diagnosed individual, and may impair functioning in various areas of life, such as work and relationships.

People who suffer from OCD usually realize that their obsessions and compulsions are  irrational, and this may add to their distress.  For many people, OCD starts during childhood or adolescence. Most people are diagnosed by the end of their teenage years, or early twenties. Symptoms of OCD may come and go and be better or worse at different times in the individual's life.

Obsessions/intrusive thoughts:

  • These thoughts persist despite the person's best attempt to control or ignore them.
  • Obsessive thought content varies from person to person, and also in clarity and vividness.
  • A relatively vague obsession could involve a general sense of disarray or tension accompanied by a belief that life cannot proceed as normal while this imbalance remains.
  • A more intense obsession could be a preoccupation with the thought or image of someone close to them dying.
  • Obsessions may concern the possibility that someone or something other than oneself—such as God, the Devil, or disease—will harm either the person with OCD or the people or things that the person cares about.
  • Other obsessions may involve inappropriate aggressive thoughts, such as harming the elderly, impulses to violently attack a person or child, or to shout abuse at someone.
  • They may be of an inappropriate sexual nature, such as thoughts or images of kissing, fondling, engaging in oral sex, intercourse or even rape with strangers, acquaintances, family members, co-workers etc.  Like other unwanted intrusive thoughts or images, everyone has some inappropriate sexual thoughts at times, but people with OCD may attach significance to the unwanted sexual thoughts, generating anxiety and distress. The doubt that accompanies OCD leads to uncertainty regarding whether one might act on the intrusive thoughts, resulting in self-criticism or loathing and low self-esteem.
  • Blasphemous thoughts are also a very common, and very distressing obsession experienced by people who suffer from OCD. This can range from bad thoughts or images during prayer,  to thoughts of being possessed or impulses to say blasphemous words or commit blasphemous acts during religious services.

Compulsions/rituals

  • People with OCD perform certain actions over and over again, or according to a strict ritual, because of an inexplicable feeling that they are compelled to do so, or in an attempt to mitigate anxiety caused by obsessive thoughts. The person might feel that these actions somehow either will prevent a dreaded event from occurring, or will push the event from their thoughts. However, this relief is always only temporary.
  • Excessive skin picking (dermatillomania) and hair plucking (trichotillomania) and nail biting (onychophagia) are all on the Obsessive-Compulsive spectrum, and examples of rituals.
  • Other common compulsions include counting specific things, such as breaths or steps, or counting in a specific way, like in intervals of 3. Other sufferers neaten or straighten items, wash their hands repeatedly,  checking and re-checking locks. touch items a certain number of times. and believing in magical numbers or superstitions
  • It is important to note the difference between habits and rituals. Some people do certain things over and over again, and they do not necessarily perform these actions compulsively. For example, bedtime routines, learning a new skill, and religious practices are not compulsions. Habits tend to bring efficiency to one's life, while compulsions tend to disrupt functioning and quality of life decreases.

Primarily obsessional OCD

Some individuals do not display overt compulsions or rituals such as these described above. While ritualizing and neutralizing behaviours do take place, they are mostly cognitive in nature, involving mental avoidance and excessive rumination. The nature and type of primarily obsessional OCD varies greatly, but the central theme for all sufferers is the emergence of a disturbing intrusive thought or question, an unwanted/inappropriate mental image, or a frightening impulse that causes the person extreme anxiety. The fears associated with primarily obsessional OCD tend to be far more personal and terrifying for the sufferer than what the fears of someone with traditional OCD may be.

Causes of OCD

OCD  symptoms are caused by the interaction of biological and psychological factors. An evolutionary psychology view is that moderate versions of compulsive behavior may have had evolutionary advantages, for example constant checking of hygiene, the hearth, or the environment for enemies would have helped our forefathers survive. Similarly, hoarding may have had evolutionary advantages for survival.  In terms of biology, OCD has been linked to abnormalities with the neurotransmitter serotonin, which regulates anxiety in the human brain.

Treatment options

OCD is usually treated with psychotherapy or medication, or a combination of the two.  

  • Cognitive behavior therapy (CBT) is especially useful for treating OCD. It teaches the individual  different ways of thinking, behaving, and reacting to situations that help him or her feel less anxious or fearful without having obsessive thoughts or acting compulsively. One type of CBT called exposure and response prevention  (ERP) is especially helpful in reducing compulsive behaviors in OCD.
  • ERP therapy involves the person with OCD facing his or her fears and then refraining from ritualizing. This is extremely anxiety provoking and difficult initially, but eventually the anxiety starts to wane and can sometimes even disappear. A concrete example of ERP therapy in action would involve someone with OCD who has issues with germs. They might be asked to touch a toilet seat and then refrain from washing their hands. The therapist will teach the patient an alternative, healthy method of reducing anxiety.
  • Psychiatrists or GP's may prescribe medication to help treat OCD symptoms The most commonly prescribed medications for OCD are anti-anxiety medications (anxiolytics) and antidepressants.

Resources and Helpful Reading Material:

  • The Anxiety and Phobia Workbook by Edmund J. Bourne
  • Devil in the Details: Scenes from an Obsessive Girlhood by Jennifer Traig
  • Cognitive-Behavioural Therapy for OCD by David A. Clark
  • Movie: As Good As It Gets



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