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Obsessive-Compulsive Disorder: Summary

Stop Obsessing! Chapter 1. Do You Have Obsessions or Compulsions? Chapter 2. The Lives of Obsessive-Compulsives The Stop Obsessing! Audio-Tapes Tape 1-1: Common Features & The Four Challenges

Obsessions are repetitive, unproductive thoughts that almost all of us have experienced from time to time. We can be driving down the road, ten minutes from home, heading for a week's vacation. Suddenly the thought enters our mind, "Did I unplug the iron after I finished with that shirt?" Then we think, "I must have . . . but I don't know, I was rushing around so at the last minute. Did I reach down and pull the cord out of the socket? I can't remember. Was the iron light still on as I walked out the door? No, it was off. Was it? I can't leave it on all week; the house will burn down. This is ridiculous!" Eventually we either turn around and head home to check as the only way to feel relieved, or we convince ourselves that we did indeed take care of the task.

This is an example of what can take place inside the mind of any of us when worrying about a particular problem. Obsessive-compulsive disorder, however, is much more serious. In the mind of the person with obsessive-compulsive disorder, this pattern of thought is exaggerated, highly distressing and persistent.

The second form of the problem is : compulsions: repetitive, unproductive behaviors that people engage in ritualistically. As with obsessive thoughts, there are a few compulsive behaviors in which the average person might engage. As children, we played with superstitions, such as never stepping on a sidewalk crack or turning away when a black cat crossed our path. Some of these persist as we become adults: many of us still never walk under a ladder.

Intense anxiety and even panic can come whenever the person attempts to stop the ritual. The tension and anxiety build to such an intense degree that he surrenders once again to the thoughts or behaviors. Unlike an alcoholic, who feels compelled to drink but also enjoys the drinking experience, the obsessive-compulsive person achieves relief through the ritual, but no pleasure.

We have written a self-help book specifically for anyone suffering from OCD, titled Stop Obsessing! How to Overcome Obsessions and Compulsions, by Dr. Edna Foa and Dr. Reid Wilson (Bantam Books). For further information, see Resources.

There are seven common features of obsessions and compulsions. The first three are related to obsessions and worrying in general; the last four are for people who experience both obsessions and compulsions. Listen to which ones fit you.

1. Your obsessions involve a concern with disastrous consequences. You are usually afraid that some harm will come to you or others. For instance, you'll forget to lock the doors of your house, and someone will break in and harm your family. Or you'll neglect to thoroughly wash your hands, and you'll develop some dreaded disease. Some people have compulsions, and they don't have that sense of obsession. They don't really know what they're worried about. But usually you will get a sense of dread, like something terrible is going to happen.
2. There are times when you know your obsessions are irrational. Some people believe their worries are accurate reflections of reality, and it's hard for them to get a perspective. But for most people there are times when you know that your worries are senseless. During good times, when you're not under stress, and you're not involved in your ritual or really worried, you can say, "This is crazy. This doesn't make any sense." You know that you're not really going get sick if you fail to wash your hands five times. You don't really believe that your boss will humiliate you if you make one typing error. Nonetheless, when you start to worry, you believe those fearful thoughts.
3. You try to resist your obsessions, but that only makes them worse. You want to get rid of these worries because they cause so much fear. But when you fight these thoughts it often makes them more intense. This gives us a clue to one of the ways we can start to change this negative pattern. If resisting the thoughts makes them worse, what might help lessen them? ...Believe it or not, accepting your fearful thoughts will help lessen them! We'll talk more about acceptance in a few minutes.
4. Compulsive rituals provide you temporary relief. Some people just worry, and they don't have compulsive rituals, so this one wouldn't fit them. But when people do use compulsions, they provide relief and restore a sense of relative safety, even if just for a little while.
5. Your rituals usually involve specific sequences. This means that you often have a set pattern for how you wash, or check or count or think in order to be released from your distressing worries.
6. You try to resist your compulsions too. If your compulsions are brief, and don't interfere with your daily living, then you can probably tolerate them. But if the rituals are inconvenient and take a while to perform, then you probably try to avoid the rituals or to complete them as soon as possible.
7. You seek out others to help with your rituals. Compulsions can be so distressing that you enlist the help of those close to you. You may ask family members to help count for you, or friends to check behind you, or your boss to please read over a letter before you seal it up.

These seven features should give you a better sense of your symptoms.

Until recently OCD was regarded as a rare condition, but studies now indicate that up to 3% of the population, or nearly 6 million Americans, will experience an obsessive-compulsive disorder at some point in their life. Symptoms tend to begin in the teen years, or in early adulthood. About one third of people with OCD showed the first signs of a problem in childhood.

Men and women are equally likely to suffer from OCD, although men tend to show symptoms at an earlier age. Cleaning compulsions are more common in women, while men are more likely to be checkers.

No one can say for certain what causes obsessive-compulsive disorder. At one time researchers speculated that OCD resulted from family attitudes or childhood experiences, including harsh discipline by demanding parents. Recent evidence suggest that biological factors may contribute to the development of OCD. Some recent tests have found high rates of OCD in people with Tourette's Syndrome, a disorder marked by muscle tics and uncontrollable blurting of sounds. Many researchers believe this suggests a linkage between OCD and brain disturbances.

There is a tendency for OCD to run in families, and many people with OCD also suffer from depression. The exact relationship between OCD and depression has not been established.

There have been great strides in the treatment of OCD in recent years, and many people with the disorder report that their symptoms have been brought under control or eliminated. Traditional psychotherapy, which works by helping an individual analyze his problem, is generally of little value in OCD. But many people with OCD benefit from a form of behavior therapy in which they are gradually exposed to circumstances that trigger their compulsive behavior.

For example, a hand washer might be urged to touch an object she fears is contaminated, and then be discouraged form washing her hands for several hours. The goal is to eliminate or cut down on anxiety and compulsive behavior by convincing the individual with OCD that nothing will happen if she fails to perform the compulsive ritual.

Behavior therapy works best when the feared situation can be easily simulated. It is more difficult if the anxiety-producing situation is hard to create.

Medication can play a prominent role in the treatment of OCD, and is particularly helpful for patients who are bothered by obsessions.

In some cases family therapy can be a valuable supplement to behavior therapy. Family counseling sessions can help both the individual with OCD and his family by increasing understanding and establishing shared goals and expectations.

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