o c d:

story by | renae m. reinardy, PsyD, LP

Very few people would say that they live a totally stress free life. In fact, I don’t think I have ever heard anyone say that! However, there is a difference between our everyday stress and an anxiety disorder. Anxiety disorders are quite common and according to the National Institute of Mental Health, affect 25% of teens and 18% of American adults. There are a variety of conditions that fall under this label including generalized anxiety disorder [GAD], panic disorder, agoraphobia, specific phobia, social phobia, obsessive compulsive disorder [OCD], and post traumatic stress disorder [PTSD].

OCD is a common anxiety disorder and is the fourth most common mental disorder. This condition affects millions of adults, adolescents, and children. In the United States it is estimated that 1 in 50 adults and 1 in 100 children suffer from this condition. In fact, OCD is nearly as common as asthma in our population.

Howard Hughs, Michelangelo, Cameron Diaz, David Beckham, Howie Mandel, Charles Darwin, and Howard Stern are names that you may not immediately group together, but all have openly discussed or have been thought to suffer from OCD. As with the personality differences of these well known people, OCD can come in many different flavors, from contamination fears to religious scrupulosity. Its presentation also occurs on a continuum of severity and can cause mild to severe impairment in daily functioning.

what is the oc of ocd?

Obsessions include unwanted, involuntary thoughts, impulses, or images that repeatedly enter one’s mind. Common obsessions include fears of contamination, harm coming to loved ones, losing control and doing something violent or sexually inappropriate, “just right” feelings, religious or moral scrupulosity, and fears of hitting someone when driving. Many people experience these thoughts, but people who suffer from OCD attach meaning and significance to them which can spiral into haunting obsessions. Obsessions are extremely frustrating because for most people with OCD, they know that the thoughts do not represent reality, but they feel too powerful to ignore.

Compulsions are the physical or mental actions performed deliberately and repeatedly in order to decrease anxiety that is experienced due to the obsessions. Examples include hand washing, cleaning, tapping, checking, praying, repeating, rereading, counting, achieving symmetry, and avoidance behaviors. People with OCD use the compulsions to get relief from the troubling obsessions, however within a short amount of time the obsession often comes back and the compulsions need to be repeated. Usually, OCD ups the ante, and a compulsion that was once good enough, no longer relieves the anxiety and compulsions evolve to become longer and more complex.

OCD is a term that gets used loosely in our everyday life. People who describe their symptoms as “I am so obsessed with Jersey Shore”, or “I am totally OCD about my husband leaving the toilet seat up” do not typically warrant a diagnosis. OCD tends to look more like the following examples: meet “katie”

Katie just started the sixth grade. She is liked by adults and has gotten excellent report cards, but many people do not know about the sacrifices she makes in her attempts to be a perfect child. Katie suffers from academic, counting and contamination OCD. Her day involves counting her steps to make sure that she never lands on an odd number or finishes with the “wrong” foot. If she gets distracted, she has to go back to where she began and start over. If she ends in a “just wrong way” she believes something bad will happen to her parents. She wakes up at 5:00am to start her daily cleaning ritual. She is afraid she will contract HIV and spread it to her family. She carefully gets into the shower and washes her body in the order of least to most contaminated body parts each two times to avoid an odd number. This usually takes a little over an hour and requires quite a bit of soap. When the shower is finished she cannot use towels in fear of re-contaminating herself or contaminating family members, so she drips dry. After air drying, she carefully puts on her socks to avoid contaminating her feet and carefully gets dressed; counting each movement she makes to ensure that she ends on a safe even number. If Katie did not re-contaminate herself or her environment in any way she can avoid re-showering, however this is often not the case and she is frequently late for school. As if the morning routine where not stressful enough, it is only compounded by the fatigue she experiences from being up late from perfecting her school work. Katie often asks her teachers for extra worksheets, because unbeknownst to them if she makes an error, it is not acceptable to simply erase. She needs to start over from the beginning. If she is writing a sentence, she needs to make sure that there is an even number of words. The pressure is high since her mind tells her that her parent’s wellbeing depends on her compliance with these rules. She often gets stuck rereading sentences in her books to ensure totally comprehension and often tries to find ways to mentally reconcile math problems that include odd number answers.

meet “beth”

Beth is a new mom to a 3-month-old daughter. Beth has experienced some minor symptoms of OCD in the past, but has noticed a dramatic increase in her symptoms over the past few months. She is currently experiencing violent and sexual obsessions which are relieved through avoidance, reassurance seeking, and religious compulsions. She is terrified by images and thoughts of stabbing her infant and sexually abusing her while changing her diaper. She has no history of abusing children and is distressed that she is having these obsessions. In order to avoid her fears, Beth only holds her baby when other people are around, no longer uses or looks at sharp objects, constantly asks ‘did I just hurt the baby?’ and prays in a specific way. If she says part of the prayer in a different tone or order, she needs to start over. She now spends a few hours a day praying. Most of the child rearing is left up to her husband and she continues to be terrified that she will suddenly lose control even though everyone keeps giving her reassurance that she is a good mom.

how do you know if it is OCD?

To accurately diagnose OCD, it is necessary to be able to identify the obsessions that are producing distressing emotions and the compulsions that serve as attempts to relieve the individual of his or her uncomfortable emotions.

OCD has been linked to genetic causes, neurotransmitter dis-regulation [especially serotonin and dopamine], and structural abnormalities in the brain. Research shows that after treatment, the brain activity of people with OCD can change and look more like those of people without the disorder. The onset of OCD is often gradual, but there is a subtype that has a sudden onset and is likely related to streptococcal infection [PANDAS].

Whether OCD develops gradually or rapidly, people find that their symptoms are overpowering and cause them much distress and impairment. Individuals often notice changes in their mood, physical state, and everyday behaviors. OCD can be private or can involve rules that control not only the individual, but also the entire family.

Although OCD appears to be fairly common, it takes an average of 9 years to be accurately diagnosed and 17 years from onset of symptoms to participating in effective