Until quite recently, the problem of Obsessive Compulsive Disorder (or OCD) has been treated with suspicion and misunderstanding. Often those who suffer from it suffer alone, fearing social alienation, loss of job, or even ridicule from those who know them. They are plagued with thought and behaviour patterns so intense and yet so irrational that they slip into an attitude of self deprication and adopt an unmotivated, reclusive lifestyle.

The truth is that the OCD sufferer is not alone. OCD is now recognized to be a relatively common psychological condition, affecting 2.5% of the population. Although OCD can develop at any time, 60% of those diagnosed with OCD developed the condition by the age of 25; some cases have even been described as early as the age of two. Males and females are affected in roughly the same proportions. However, psychologists have noted a consistent preponderance of males among children with OCD.

What Is OCD?

OCD has two components.

• Intrusive unwanted thoughts, images or impulses (these are the Obsessions), and
• Repetitive, almost ritualistic behaviours (that is, the Compulsions) that generally reduce the distress and anxiety provoked by the obsessions (see Table 1).

Generally, individuals with OCD are able to acknowledge the excessive or unnecessary nature of their symptoms, although in severe cases this insight may be lost.

Typical Obsessions and Compulsions

Typical obsessions include fears of contamination, such as the fear of getting dirty or making oneself or others ill by contact with certain things; fear of harming oneself or another person even though one never would; and the need for orderliness or exactness. Other frequent fears are that one may somehow be responsible for something terrible happening, like a fire, a death or a burglary, by forgetting to check things like the stove or door, or sometimes by forgetting to engage in superstitious behaviours like touching wood. Often, obsessions may have disturbing religious or sexual themes. An increasingly common obsession today is a preoccupation with AIDS.

Common compulsions include washing one’s hands repeatedly, often with strong soaps or cleansers in a ritualistic fashion; checking the house, appliances or locks repeatedly; engaging in other repeated behaviours like cleaning, hoarding, and counting. Often there is associated doubting about everything one thinks, says or does. OCD sufferers have difficulty throwing things out, and may feel compelled to check an envelope many times or perhaps even rip it open and spread it out completely before throwing it out.

A rarer form of the illness is termed “primary obsessional slowness” in which everything takes far longer than necessary because of ruminating thoughts and perfectionism.

Associated Problems

Many psychological conditions are associated with OCD. Depression is extremely common, occurring in up to two-thirds of cases. Similarly, other anxiety disorders, particularly irrational fears (ie., phobias) are often found. Along with these emotions comes anger, frustration, irritability, insomnia and withdrawal from social circles. Some women with OCD also display a compulsion to pull out their hair or to bite their nails severely. Many individuals who suffer from OCD have also one or more chronic tics or uncontrollable muscular twitches.

Identifying the Problem

A few screening questions have been developed by health professionals who help people with OCD. Ask yourself the following two questions:

1. Have I ever been bothered by thoughts that kept coming back to me, that didn’t make sense, and that I couldn’t get rid of or put out of my mind?
2. Have I ever had to repeat some act over and over that I could not resist repeating, like constantly washing my hands, counting things, or checking things?

If you answered positively for either of the two questions, check Table 1 to see if you have at least THREE of the signs listed. Remember ALWAYS consult your physician or a psychologist if you think there may be a problem.

Treatment

Just 10 years ago, people suffering from OCD usually had to live with their disorder with little hope for treatment or recovery. Today, behavioral (or cognitive – behavioral) therapy combined with drug treatment therapy and education of the individual as well as the family has dramatically increased hopes for recovery. With concerted, consistent effort, well over 70% of people attain clinically significant improvement.

Selected References You May Find Useful:
Rapoport (1991). The Boy Who Couldn’t Stop Washing. Penguin Books.
Steven Levenkron (1991). Obsessive Compulsive Disorders: Treating and Understanding Crippling Habits. Warner Press.

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Diagnostic Criteria For Obsessive Compulsive Disorder

Obsessions or compulsions, as defined below, cause marked distress, are time- consuming, or significantly interfere with the person’s normal routine or functioning.

Obsessions

• Recurrent and persistent ideas, thoughts, impulses, or images that are experienced as intrusive and senseless;
• The person attempts to ignore or suppress such thoughts or impulses or to neutralize them with some other thought or action;
• The person recognizes that the obsessions are the product of his or her own mind.

Compulsions

• Repetitive, purposeful, and intentional behavior that is performed in response to an obsession, or according to certain rules or in a stereotyped fashion;
• The behavior is designed to neutralize or to prevent discomfort or some dreaded event or situation;
• The person recognizes that his or her behavior is excessive or unreasonable.