OCD Information & Treatment
By Wayne K. Goodman, M.D.
Obsessive-compulsive disorder (OCD) is an illness that affects thoughts and actions and is believed to be rooted in a biochemical imbalance of the brain. OCD is classified as an anxiety disorder in the Diagnostic and Statistical Manual (DSM-IV) published by the American Psychiatric Association. This puzzling illness is characterized by recurrent and disturbing thoughts (called obsessions) and/or repetitive, ritualized behaviors that the person feels driven to perform (called compulsions). Obsessions can also take the form of intrusive images or unwanted impulses. The majority of patients have both obsessions and compulsions, but a minority (about 20 percent) have obsessions alone or compulsions alone (about 10 percent). The person with OCD usually tries to actively dismiss the obsessions or neutralize them by engaging in compulsions or avoiding situations that trigger them. In most cases, compulsions serve to alleviate anxiety. However, it is not uncommon for the compulsions themselves to engender anxiety, especially when they become very demanding.
A hallmark of OCD is that the person recognizes that her thoughts or behaviors are senseless or excessive. However, the drive can be so powerful that the person caves in to the compulsion even though she knows it makes no sense. One woman spent hours each evening sifting through the household trash to ensure that nothing valuable was being discarded. When asked what she was looking for, she nervously admitted, “I have no idea, I don’t own anything valuable.” Some people who have had OCD for a long time may stop resisting their compulsive drives because they feel it’s just easier to give in to them.
Examples of obsessions and compulsions
Common types of obsessions include concerns with contamination (e.g., fear of dirt, germs or illness), safety/harm (e.g., being responsible for a fire), unwanted acts of aggression (e.g., unwanted impulse to harm a loved one), unacceptable sexual or religious thoughts (e.g., sacrilegious images of Christ) and the need for symmetry or exactness.
Common compulsions include excessive cleaning (e.g., ritualized hand washing); checking, ordering and arranging rituals; counting; repeating routine activities (e.g., going in/out of a doorway) and hoarding (e.g., collecting useless items). While most compulsions are observable behaviors (e.g., hand washing), some are performed as unobservable mental rituals (e.g., silent recitation of nonsense words to vanquish a horrific image).
Most OCD sufferers have multiple types of obsession and compulsion. Someone with OCD may complain primarily of obsessive-compulsive symptoms involving asbestos contamination, but a detailed interview may disclose that he /she silently counts floor tiles and hoards junk mail.