Introduction to OCD

What is OCD?

Obsessive Compulsive disorder is an anxiety disorder that involves two main components – obsessions and compulsions. Those that suffer from OCD spend excessive time performing rituals (mental or otherwise) to ward off unwanted thoughts or feelings. In return, they reinforce a negative behavioral pattern that interferes with their personal and professional lives.

What Causes OCD?

There is no single attributable factor to OCD. Some experts argue that it is a malfunction of one or more fear processing centers in the brain, such as the amygdala (as brain scans have confirmed). Others believe that it may be caused by damage to the outer structure of neurons known as the myelin sheath. This outer covering is used to transmit electrical impulses in the brain.

What is clear is that the patient has little control over these factors. Although some report the onset of OCD after recreational drug use (possibly the result of subsequent chemical disturbance in the brain), it often arises without rhyme or reason.


How many people have OCD?

More than you think. A recent estimate put the figure at 2% of the U.S. population.

What are common symptoms of OCD?

OCD can cause an array of symptoms from emotional fragility to sleeping problems. Most patients report having unwanted thoughts accompanied by anxiety-like symptoms including an elevated pulse, breathing problems, irritability, and general detachment from surroundings. Depending on the severity of the OCD, symptoms of depression may also be present. These include insomnia, loss of interest in past hobbies, as well as a general sense of dread and despair.

An OCD sufferer may begin to obsesses about whether or not they have depression and the implications that the condition may cause. This is one of the primary gateways into a “suicide OCD” theme. Do not waste your time researching depression or comparing your current symptoms to those that coincide with the disorder. This is counterproductive and will aggravate your OCD.

When does OCD start?

OCD can often be traced back to the patient’s childhood, where “quirky” behaviors like avoiding cracks in the pavement were considered a “phase”. A stressful event in a person’s life or a culmination of multiple stressors may set off the OCD such that it becomes clinically diagnosable. So while some patients may report that their OCD appeared out of the blue, it may have actually be sitting dormant waiting for the right opportunity to cause havoc.

Who is your typical OCD victim?

There is little evidence to suggest commonality among those who suffer from OCD. What can be said is that those with a family history of anxiety disorders may be predisposed to the condition. Otherwise, everyone is a potential victim.

What is an Obsession?

An obsession refers to any unwanted thoughts/images/feelings an OCD sufferer may experience that drives them to perform compulsions. The type or content of the obsession is irrelevant and should not be analyzed for meaning.

What are some examples of common obsessions?

Common obsessions or “themes” of OCD may include the following:

– Fear of hurting oneself/others
– Fear of sexually attacking others
– Fear of one’s perceived sexual orientation
– Fear of being contaminated

The content of the obsession is meaningless and will often change as you become desensitized to a particular theme.

Will by obsessions land me in prison or a mental hospital?

Disclosing the content of your unwanted thoughts can obviously be frightening. Rest assured that you will not be locked away in a mental asylum by sharing your symptoms with a mental health professional. If anything, it indicates you are an upright citizen that abhors the thoughts.

Are obsessions always fictional events/scenarios, or can they have occurred in the past?

Some suffers begin to obsesses about things they may have done or said in the past. These obsessions carry no more merit than the ones mentioned above and should be dismissed.

What is Pure OCD?

Pure OCD is the name given to a type of OCD where no outward compulsions are present. The suffer performs mental compulsions such as analyzing or neutralizing their thoughts in an attempt to alleviate their anxiety. Physical compulsions such as avoidance may develop with time.

Why am I hearing voices? Do I have schizophrenia?

OCD sufferers often engage in internal dialogue that they fear may be the start of schizophrenia. Unless you are actually hearing voices from an external source (ie. as if someone is actually talking to you), you don’t have this condition. Worrying about having schizophrenia is a common theme and shouldn’t be obsessed over.

Can an obsession come in the form of urges/impulses?

Obsessions can masquerade as urges and impulses. You may feel like you are on the brink of doing something horrible due to your OCD. Although these give a realistic dimension to the condition, they should be ignored. OCD often manipulates your emotions to highten the degree of realism. For instance, if you have Harm OCD, you may feel like you no longer care about the person(s) involved in your obsession. However, you still cognitively know that this is not true. These feelings are not be analyzed and to be accepted from what they are. OCD by nature causes a disconnect between your emotions and rational mind.

What is a compulsion?

A compulsion is an outward action or internal ritual performed to relieve the anxiety caused by an obsession. Compulsions come in many forms and can take up a significant amount of time, thus interfering with daily obligations. Someone with contamination OCD may spend several hours a day showering and washing their hands. This is an extreme case where OCD has been allowed to run its course for far too long. However, even less involved compulsions such as checking the door several times before leaving the house can cause problems for people heading to work or elsewhere.

Compulsions reinforce your brain’s association between a feared stimulus and a feeling of uneasiness. Thus, whenever possible, they are best avoided and the accompanying unease must be tolerated.

What is reassurance seeking?

Reassurance seeking is a common compulsion where the sufferer enlists the input of third parties to confirm that they have done nothing wrong. For instance, the sufferer may feel that they have said something offensive to a spouse or family member. To eliminate their unrelenting anxiety, they may confront the person to ask whether they were offended by a particular statement. Although their reply may be temporarily comforting, the OCD sufferer will begin to doubt the response by questioning the person’s intentions or considering other possible contingencies.

What is checking?

Checking is another characteristic compulsion involved in OCD. Someone with hit-and-run OCD (a form of Harm OCD) may return to a site where they believe they may have run someone over. An OCD sufferer may also return to their home several times to verify that they have turned off the stove. In either case, the checking is destructive.

How is OCD Diagnosed?

OCD is best diagnosed by a mental health professional (either a psychologist or psychiatrist) following a careful assessment. Your initial appointment will likely include a brief exploration of your background and the progression of your OCD symptoms. Clinicians can diagnose OCD with the help of tests like the Yale Browning Obsessive Compulsive Scale (YBOCS). It’s very important that you don’t hold back anything from your mental health provider such that the best course of treatment can be devised.

How can I tell loved ones about my diagnosis?

Telling family members and friends about your OCD diagnosis can be a challenging feat. While you might not want to disclose the content of your particular obsession(s), you can always tell them that you have been struggling with anxiety and it has become overwhelming.

Inadvertently, some OCD patients will encounter destructive comments from loved ones. These may include rude demands for you to “snap out of it” or “get over it.” Furthermore, some people will also claim to have OCD themselves based on the limited knowledge they have about the condition. If you want to get better, ignore these comments and don’t engage others in arguments. Better yet, give them some reading material about OCD (Brain Lock by Jeffrey Schwartz is a good choice) such that they can better grasp what is going on.

Can you have OCD at a sub-clinical level?

OCD can definitely be present at the sub-clinical level where the obsessions and compulsions don’t interfere with your daily life. Many people are confronted with full-blown OCD after the condition has remained relatively dormant in their lives.

What if I was misdiagnosed?

A common concern among newly diagnosed OCD patients is that they have been misdiagnosed. What if they are actually psychotic or schizophrenic? These worries can turn into new obsessions and are best ignored. You need to live with the possibility that you may have something else and trust that your mental health provider will help get you through it regardless.

Should I see a psychologist or psychiatrist for treatment?

Whether or not treatment of OCD necessitates a psychiatrist is a hot topic. What’s suggested is that you first visit with a therapist that specializes in Cognitive Behavioral Therapy, which is a first-line treatment for most anxiety disorders. The therapist can assess your current state and refer you to a psychiatrist if necessary. If you go directly to a psychiatrist, you may also be asked to pursue therapy first if circumstances permit. Some factors which influence whether a psychiatrist needs to be involved is the severity of the OCD, the presence of co-morbid or existing psychiatric conditions, the content of the obsessions, the patient’s existing use of psychiatric medications, etc. etc.

What can aggravate OCD?

OCD generally worsens with time if left untreated. This is because the sufferer continues to engage in compulsions which strengthen the fear association they have with certain stimuli. There are other factors that can further aggravate OCD. These include stress, excessive free time to obsess, poor lifestyle habits, etc.

Are there often co-morbid disorders?

OCD can often co-occur with other conditions. The most common of these is depression. Depression results from the patient feeling helpless against the OCD and can be further strengthened by the content of the obsessions. Fortunately, cognitive behavioral therapy and medications are effective in treating both of these conditions.

Other co-morbid disorders include bi-polar disorder (manic depression), various forms of anxiety and other psychiatric conditions. Some of these may interfere with successful treatment of the OCD which is why a mental health professional is best consulted.

Can OCD mimic the symptoms of other psychiatric conditions?

OCD is extremely agile at mimicking other disorders. OCD sufferers often go through stages where they fear they have schizophrenia, psychosis, anti-social disorder, and a number of other psychiatric disorders. Please remember that those who have many of these conditions are either unable or uninterested in identifying their mental health issues. Conversely, those with OCD often express excessive concern in the content of their thoughts and demand to find the root of the problem.

Can OCD trigger other psychiatric conditions?

There is a common myth that OCD can spiral into other disorders like schizophrenia. There is no medical basis to support this statement. What can happen is that these conditions appear later in life, after the OCD has surfaced. Regardless, this is not something you should worry about.

How is OCD treated?

OCD is treated with a combination of cognitive behavioral therapy (CBT) and anti-depressant medications. This combination yields the most successful treatment outcomes both in the short and long-term. Some patients choose to pursue therapy independent of medication and are successful. However, in many instances medication can make the patient more receptive to treatment and less obsessive while the treatment takes effect.

Can your treat OCD on your own?

Due to financial limitations or feared embarrassment, some may choose to pursue treatment on their own or “ride out” the OCD. Either of these choices is not recommended. OCD patients benefit from learning to identify faulty beliefs in their thought patterns and confronting their fears in a safe and structured manner. Therapy helps you accomplish both of these challenges.

There is nothing to be embarrassed about in reaching out for help. Doing so is actually much more heroic than engaging in destructive behaviors to drown out the mental torture. Don’t let anyone tell you otherwise.

As far as riding out the OCD is concerned, this is a wishful thinking approach. OCD will strengthen unless you have the will to break the cycle. Medication and therapy will make this much less torturous.

Can you fight OCD with logic?

Fighting OCD with logic is the equivalent of using gasoline to put out a fire. Analyzing OCD thoughts further entrenches you in the confines of the disorder. This is because you are dedicating so much brain power to a particular obsession, which is causing your brain to interpret the thought as important. You cannot out-wit OCD, so let the thoughts be. If anything, convince yourself to analyze them later and distract yourself in the meantime. Eventually, you will forget to analyze the thoughts altogether. The better you get at doing this, the less intense the OCD will become.

Does OCD get worse if not treated?

OCD does get worse as time lapses without treatment. OCD sufferers are often convinced they can outsmart the disorder when in fact they are adding fuel to the fire. If you are currently suffering from OCD and haven’t already done so, find a qualified therapist in your area.

How do OCD medications work?

OCD medications work by acting on the chemicals in your brain (known as neurotransmitters) that regulate your mood. The class of medications preferred for treatment of OCD are known as SSRIs (serotonin reuptake inhibitors). These control the flow of the neurotransmitter Serotonin in the brain, which is responsible for a feeling of well-being. A shortage of this chemical is believed to be involved in OCD and depression.

Older medications influence transmitters like Dopamine or a combination of Serotonin and Norepinephrine (SNRIs). The use of these medications has been largely phased out due to their side effects.

In some instances, an SSRI may need to be used with a mood stabilizer such as Lithium. This is common in cases where a patient is diagnosed as bi-polar.

What types of medications are used to treat OCD?

As mentioned above, SSRIs are the medication of choice for OCD. Most patients react favorably to such medications (although they may have to experiment with one or more before finding the right one). In some instances, the patient may be prescribed a benzodiazepine on a “pro re nata” or as needed basis. These medications, such as lorazepam or clonazepam are fast-acting anxiety agents. While effective, they are habit-forming and some report worsening depression while on them. Your mental health professional will be able to determine whether or not they are right for you.

If you were diagnosed with one or more co-morbid conditions, an SSRI may not be suitable. Likewise, if your case of OCD is unresponsive to these medications, anti-psychotics such as Rispideral or Seroquel may be recommended. These medications tend to have more profound side effects and thus they are rarely recommended as a first course of action.

Are OCD medications dangerous?

OCD medications are not dangerous assuming the patient takes them per instructions and is monitored in the first few weeks of starting or changing a dose. Some people may experience adverse reactions with certain anti-depressant medications, and thus it is very common for an OCD sufferer to shuffle between a few before finding the right one.

How long do I have to take medications?

You should expect to take your OCD medications for at least a few months. They can take anywhere from two to six weeks to take effect. This is due to the fact that the medication needs to accumulate in your body before it has noticeable effects. You should communicate any concerns you have about your medication to your doctor such that an appropriate course of action can be taken early on.

What are the common side effects of OCD medications?

A number of side-effects are attributed to SSRIs including headaches, nausea, insomnia, and excitability. Fortunately, these tend to diminish with time. The severity and frequency of these symptoms will vary according to the anti-depressant used. Your anti-depressant will arrive with an information booklet from the pharmacy that dictates serious side effects that should be watched for. Among these is suicidal thoughts/behavior or mania-like symptoms. Don’t let the suicide warning scare you into a new OCD theme. Take your medication as prescribed and stay in touch with your doctor.

Can medications be used alone in treating OCD?

Medications alone can be used to treat OCD. However, their efficacy is improved when combined with therapy. Medications mediate the flow of the intrusive thoughts, however the patient will still have them and must learn to respond accordingly.

Are OCD medications addictive?

Aside from the benzodiazepine class of medications, no OCD medications are not addictive.

How affordable are OCD meds?

Many OCD medications are available in generic form and are thus affordable. If you have health insurance that covers such drugs, you may opt for a brand name.

Is my first OCD medication guaranteed to work?

Your first OCD medication may or may not work for you. You may need to switch medications or your dosage may need to be changed. It can be an arduous and frustrating process but it is well worth it.

Do OCD medications only hide your symptoms?

OCD medications do not “hide” or “mask” your symptoms. What they do is make them more manageable. Your anxiety won’t be quite as intense when you have an intrusive thought, and thus you will be more likely to dismiss it. It is your responsibility to avoid performing compulsions to help the medication work its magic.

How do I know I actually need medication?

Determining whether you need medication or can go it alone is not straight-forward. You need to assess the severity of your symptoms and their effect on your lifestyle. OCD can make going through the day a roller coaster ride with drastic swings in emotions. If the condition is allowed to run its course, you may begin to feel a sense of apathy. This occurs when your emotional response system has become so drained that you don’t feel much of anything. At this point, you will begin to miss the anxiety that accompanied your intrusive thoughts and will begin to think that you have completed your transformation into a psychotic person. This is a highly uncomfortable state that can be treated with medications.

Your doctor will assess your emotional state and make recommendations as necessary.

Are there natural remedies?

There are many purported “natural” remedies for OCD circulating online. Some of the ones that I’ve read about include Inositol, St. John’s Wart, Vitamin B-12, etc. I even found someone claiming that mercury fillings were the cause of OCD.

The bottom-line is that supplements, diet, exercise routine, etc. will not cure OCD. They may help lessen the symptoms, but you are much better off using medication that has a proven track record.

What is Cognitive Behavioral Therapy (CBT)?

Cognitive Behavioral Therapy or CBT is used to treat a plethora of anxiety disorders, among them OCD. CBT is concerned with reframing thinking patterns and modifying behavior in response to unwanted thoughts. The end result is that our emotions become re-calibrated. In CBT, the patient learns to identify faulty thinking patterns that are characterized by cognitive distortions and learns to reframe their thoughts as to reduce anxiety. The most crucial component to CBT is exposure and response prevention or ERP.

What is Exposure and Response prevention (ERP)?

ERP is a form of classical conditioning where the patient learns to dissociate certain stimuli with an anxious response. This is done by means of exposing the patient to fear-provoking thoughts/images/situations and preventing a response in the form of a compulsion. Repeated exposure without a compulsive response will teach the brain to dismiss the stimuli and thus eliminate anxiety.

Can I be treated in an in-patient setting?

Most CBT programs are conducted on an out-patient basis. If the compulsions get out of hand and begin to consume the patient’s life, then in-patient treatment may be required. Regardless, it is up to the patient to regularly conduct exposures to ensure a good treatment outcome.

How does CBT differ from conventional psychotherapy?

CBT differs from conventional psychotherapy in that little time is spent analyzing your past, the content of your thoughts, etc. etc. Instead, treatment is tailored to teach you to live in the moment without pondering all the “what ifs”.

What is involved in CBT?

CBT consists of periodic sessions with a therapist that will help you re-structure your thoughts and devise exposure exercises that you can perform to combat the OCD. Homework is often assigned and crucial to successful treatment.

How effective is CBT?

CBT is extremely effective so long as the patient believes in the process and is committed to following through with homework assignments. Some of these assignments may include avoiding reassurance seeking for an entire day or exposing yourself to sharp objects in the house. Medication can help patients pursue CBT with greater ease.

How does one attain good treatment outcomes?

Good treatment outcomes are entirely dependent on the patient’s willingness to undertake exposure exercises. The practitioner’s involvement is limited to working with the patient to devise exposures that gradually desensitize them to feared stimuli.

How long does CBT take?

CBT treatment can take three months or more to complete. The severity of the case at hand as well as the intensity and frequency of exposures will determine treatment completion timeline. If the patient is being medicated, treatment may take longer to complete as the appropriate anti-depressant is found.

Should I enroll in group sessions or individual sessions?

Some OCD treatment centers offer group and individual sessions. Group programs are structured like individual sessions with the added benefit of interaction with other OCD sufferers. Accountability is also increased. An assessment with a mental health provider will help you determine which treatment format is best for you.

How long does it take to enroll in such a program?

Due to the high number of OCD sufferers seeking treatment, some programs may be backlogged. This is especially true for those offered at no fee through government programs. If you are having difficulty enrolling in a conventional treatment program, you may consider treatment over the phone or internet. This may be cost-prohibitive but beneficial for some.

What type of time commitment should I expect?

Aside from setting time to attend your therapy appointments, expect to set aside an hour a day to perform your exposures. These may vary from purposely triggering unwanted thoughts to writing down imagined scenarios that are anxiety-provoking. You will work with your mental health provider to devise an exposure hierarchy and corresponding exercises that can be completed gradually.

How much does CBT cost?

The cost of CBT varies depending on the format chosen and treatment length. Group treatment is often cheaper with the caveat of less individual attention. Some treatment centers may offer fee incentives to those with financial hardship. Talk to your local center for details.

Will I be exploring past conflicts in therapy?

Past conflicts may be relevant in traditional psychotherapy, however they are of little concern in CBT. CBT is tailored to put you in the present moment and quieten the internal dialogue concerned with the past and future.

Is CBT uncomfortable?

The ERP component of CBT can be uncomfortable, especially in the initial stages where your brain is highly sensitized to certain stimuli. As you undertake exposures and avoid compulsions, the fear association will diminish and your anxiety levels will subsequently drop. This can take a few days to several weeks. The secret is repeated and consistent exposure.

What are some examples of the techniques used in CBT?

Some of the techniques employed in CBT include thought reframing and exposures. The first involves flagging cognitive distortions in our thought patterns and reframing these inaccurate perceptions to get a more grounded view. Exposures are the primary tool against OCD and help you confront the content of your obsessions.

How can I relieve anxiety while practicing CBT/ERP techniques?

You will learn several methods for coping with anxiety while undertaking exposure exercises. One of these will be proper breathing technique. Keep in mind that the point of CBT is to diminish anxiety in the long-term, which means you will have to experience it in the present. SSRIs can be helpful in diminishing anxiety as can other anti-anxiety agents.

What If I don’t get better?

The primary fear of most OCD sufferers, aside from acting out on their obsessions, is whether or not their condition will improve. Rest assured that you will eventually get better with the right treatment plan. Most people will respond to the correct combination of medication and/or therapy. Current life circumstances may circumvent proper treatment at the present, but in the long run most cases can be successfully treated.