What is Obsessive Compulsive Disorder (OCD)?
Find out what the diagnosis of OCD really entails and how to treat it.
Have you seen the movie As Good As It Gets? In it Jack Nicholson portrays a peculiar character with a series of wacky daily routines, including waking up to perform an eccentric foot ritual, dining at the same diner every day using his own home-brought utensils, demanding the same waitress every single meal (to the point of bailing her out of her troubles in order to get her back to work ASAP to serve him), returning home only to perform another elaborate ritual with his door’s dead bolt, and experiencing extreme germophobia when forced to take in a neighbor’s sweet-as-can-be puppy.
You may have known someone who was overly concerned with cleanliness or who had elaborate rituals for daily life. And you’ve probably thought “How absurd!” But Obsessive Compulsive Disorder (or OCD) is no laughing matter.
What is OCD really? Just because you like things clean or organized, does it mean you have the disease? And what if you have an OCD diagnosis? Is there anything you can do about it? I’d like to address these issues in my episode today.
Sponsor: The podcast version of this article is brought to you by Stitcher. With free Stitcher SmartRadio, you can listen to this and thousands of other podcasts on your mobile phone. Use promo code [qdt] and get a chance to win $1,000.
What Is OCD?
OCD is actually a type of an anxiety disorder, and it occurs in only about 3% of the population. Family history of anxiety disorders is common in those with OCD. Signs of OCD often begin in the young – in adolescence or early 20’s.
A diagnosis requires two components—obsessions and compulsions—just like the name suggests:
-
Obsessions are often recurrent, intrusive thoughts, images, or ideas that are distressing and anxiety-provoking; such as a fear of germs, the need for order, or fear of harm, etc. Jack’s poor character truly experiences all of the above.
-
Compulsions are stereotypical impulsive acts or rituals that are performed to help alleviate the anxiety-provoking obsessions and distress. Examples are repetitive hand-washings (as with Jack’s character in the movie), counting, rearranging, touching, and checking.
Consequences of OCD
These obsessions and compulsions are quite disturbing to the patient and their loved ones, mostly due to the intensity of anxiety experienced and the time required to carry out the compulsions. OCD interferes with a person’s social, educational, interpersonal, and occupational aspects of life. Overall, it’s quite a distressing and often disabling experience for those who suffer from it. Thankfully, Jack’s character works from home – not an option that many real-life patients with OCD can choose.
As if that weren’t enough, unfortunately several other psychiatric disorders are often associated and co-exist with OCD:
-
Tourette Syndrome (a disorder characterized by sound and movement tics with onset in childhood)
-
Other anxiety disorders
See Also: What Is Panic Disorder?
Treatment of OCD
Unfortunately, there’s no cure for OCD. It tends to be a life-long battle for most since unlike other types of anxiety disorders, OCD tends to be more resistant to treatment. Up to two-thirds of patients will have improvement with treatment over time, but full remission occurs in less than 20%.
There are two ways to treat OCD. First, there are several groups of medications that increase the brain chemical called “serotonin,” and improve symptoms in about half of all people with OCD. Unfortunately, not all respond to the medicines. And of those who do respond, symptoms are improved, not eradicated. Here are the two main groups of medicines prescribed:
-
Selective Serotonin Reuptake Inhibitors (SSRI’s): This group of drugs includes the generic fluoxetine, sertraline, and paroxetine. Studies show that they do improve OCD when compared to placebo, and none is really any better than the other at doing so. Slow transitioning to a higher dose is often necessary to obtain better results if the medication is tolerated well by the patient.
-
Clomipramine: This medication also increases serotonin in the brain, along with another chemical called “norepinephrine.” However, even though it is thought to be just as effective as the SSRI’s, it’s often not as well-tolerated because it can cause dry mouth, constipation, sedation, and urinary difficulties.. So it is therefore no longer the first choice for many patients.
Patients with OCD can also be treated with a type of psychotherapy called “Cognitive-Behavioral Therapy” (CBT), in which they are repetitively exposed to their obsessions but their compulsions are prevented. Studies show that CBT treatment can be effective and is often first-line for those with non-severe OCD that is not associated with any other psychiatric diagnoses previously mentioned. However, for other patients with OCD, both medication and CBT may be necessary to see the greatest improvement.
Thankfully, most of us who have been accused of “being OCD,” really don’t suffer from it at all. A bit of order and cleanliness doesn’t cause any harm for most of us. And some actually make a career out of it – just look at the Domestic CEO! But when it turns into an obsession that provokes stressful compulsions, the need for order can become a serious illness.
If you think you may suffer from OCD, please don’t be shy to discuss this with your doctor. As for Jack’s character, well, just as he asked “Is this as good as it gets?” even though his OCD didn’t get any better, life certainly did.
Have any questions or comments about this episode? Post them in Comments below or at the House Call Doctor Facebook page.
Sad woman image courtesy of Shutterstock.