National Anxiety Foundation, Helping Sufferers of Panic, Anxiety and Obsessive-Compulsive Disorders

Information on OCD

A Case History

What Is It?

Some Examples

Interesting Facts about OCD

Can I Be Helped?

Some medications used in the treatment of OCD

Reading Lists

OBSESSIVE-COMPULSIVE DISORDER (OCD)

The purpose of this information is to explain Obsessive-Compulsive Disorder. We hope that it may help you to decide if you may have this disorder. It suggests a reasonable approach to promote proper detection and treatment of OCD.

This is intended for educational information only. Treatment for appendicitis is not a 'do it yourself' project. Neither is treatment for OCD. If you believe, after reading this, that you might have OCD, you should see your physician who can either diagnose and treat you, or refer you to a specialist.

A CASE HISTORY

Bob saw his psychiatrist for treatment of depression for six months before he finally had the courage to bring up his other 'secret' problem. Since childhood he had a compulsion to count things. He had to count the letters in words and in people's names. If the letters added up to any number except 9 he felt a sense of release and could stop counting. He knew it was silly but nevertheless he had a fear that if he did not do this something bad could happen to his mom or dad. He seemed unable to stop doing this. He did poorly in school because he was distracted by his secret compulsion to count letters when he should have been paying attention to the teacher's lessons. He was later bothered as a teenager by upsetting sacrilegious mental images when he was in church. Having these sacrilegious images made him feel that he lost his soul for eternity.

In addition to these two problems, he was having trouble driving. When he felt a bump as his tire rolled over a little stone, he would think he may had accidentally run over a pedestrian. He would instantly check his rearview mirror for the injured person he feared was lying on the road. Relieved to not see an injured person, he would start to drive forward. Obsessing that the injured person might have been flung entirely off the road by the impact, he would then stop, and back up his car to the scene, and search the ditch and weeds. These obsessions and compulsions were taking over his life but he was too embarrassed to tell anyone about them, even his psychiatrist, up till now.

His psychiatrist explained that this was caused by OCD, a metabolic-physiological abnormality, and was treatable with one of about six special medications that work on a chemical in the brain called serotonin. After the medication began to work, they would employ special psychological maneuvers to help overcome this problem.

The psychiatrist told him that with the combined treatment an average person can expect improvement in 3 months. This knowledge filled him with hope for a better future.

What is it?

Anxiety about thoughts or rituals over which you feel you have little control is typical of OCD. OCD can take so many different forms. Let's try to make sense of it.

Obsessions are thoughts, often intrusive and upsetting.

Obsessions are to be distinguished from ruminations or worries about routine life issues such as finances, children or job security. Some examples of obsessions in OCD may be thoughts or mental images of an upsetting nature like violence, vulgarities, harm to self or harm to others. Obsessions may be of special numbers, colors, or single words or phrases . . . sometimes even melodies.

Here are some examples.

Obsessions with:

GERMS

DIRT

DOUBT

ORDER

SYMMETRY

REPUGNANT SEXUAL THOUGHTS

REPUGNANT RELIGIOUS THOUGHTS

REPUGNANT IMAGES

HORRIFIC IMAGES

VIOLENT IMAGES

FEAR OF FORGETTING

FEAR THAT A MISTAKE WILL HARM A LOVED ONE

Compulsions are behaviors.

A compulsion is a repetitive behavior in response to an urge. It is difficult to stop this behavior. Obsessions provoke compulsions. Examples include washing the hands too many times, showering too frequently or washing things about the home like clothes or floors or even groceries.

How much is too much? Many experts agree that engaging in more than an hour a day raises suspicions of OCD. Compulsions are often performed repetitively and in some stereotyped or ritualistic fashion. You may be bothered by urges to perform rituals like repeatedly turning off and on a light switch until it 'feels right'.

Here are some more examples.

Compulsions to repeatedly:

WASH HANDS

SHOWER

CHECK LOCKS

CHECK STOVES

TOUCH THINGS

COUNT ITEMS

ORDER THINGS

CLEAN THINGS

PERFORM SILLY RITUALS UNTIL IT 'FEELS' RIGHT.

The list of all possible obsessions and compulsions is long and varied. Fortunately OCD seems to bother each person with OCD in only a few particular ways. We do not know why OCD bothers each person in a different way. It does seem that it is almost as if OCD 'knows' what would bother you the most and hones in on that. For example, if you are a particularly religious person you might be plagued by repugnant religious OCD thoughts that are a lot more upsetting to you than they would be to a person with below average concern about religion.

Often the obsession comes first and the compulsion seems to be a response to the obsession. For example, a person may have an obsessive fear of ingesting or absorbing illegal drugs from indirect contact with people they suspect to be taking illegal drugs. Such a person may obsessively fear losing his mind from using a restaurant's public rest room after seeing someone they suspect may be a drug addict using the facility. After leaving the restaurant, he may have to throw away his shoes and floor mats in his car that may have been 'contaminated'. He may have to scrub his hands in bleach exactly ten times perfectly. Other articles of clothing may have to be washed repeatedly or thrown away. He may be afraid to take medicine that has been touched by a pharmacist who he thinks might be using marijuana after hours, fearing that some of the residue might have contaminated their medicine.

There is no pleasure in carrying out these rituals. There is only temporary relief from the anxiety caused by the obsession.

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