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Disorder (OCD)

"Getting dressed in the morning was tough because I had a routine, and if I deviated from that routine, I'd have to get dressed again. I knew the rituals didn't make sense, but I couldn't seem to overcome them until I had therapy."

Obsessive-compulsive disorder is characterized by anxious thoughts or rituals you feel you can't control. If you have OCD, as it's called, you may be plagued by persistent, unwelcome thoughts or images, or by the urgent need to engage in certain rituals.

You may be obsessed with germs or dirt, so you wash your hands over and over. You may be filled with doubt and feel the need to check things repeatedly. You might be preoccupied by thoughts of violence and fear that you will harm people close to you. You may spend long periods of time touching things or counting; you may be preoccupied by order or symmetry; you may have persistent thoughts of performing sexual acts that are repugnant to you; or you may be troubled by thoughts that are against your religious beliefs.

The disturbing thoughts or images are called obsessions, and the rituals that are performed to try to prevent or dispel them are called compulsions. There is no pleasure in carrying out the rituals you are drawn to, only temporary relief from the discomfort caused by the obsession.

A lot of healthy people can identify with having some of the symptoms of OCD, such as checking the stove several times before leaving the house. But the disorder is diagnosed only when such activities consume at least an hour a day, are very distressing, and interfere with daily life.

Most adults with this condition recognize that what they're doing is senseless, but they can't stop it. Some people, though, particularly children with OCD, may not realize that their behaviour is out of the ordinary.

OCD strikes men and women in approximately equal numbers and afflicts roughly 1 in 50 people. It can appear in childhood, adolescence, or adulthood, but on the average it first shows up in the teens or early adulthood. A third of adults with OCD experienced their first symptoms as children. The course of the condition is variable, symptoms may come and go, they may ease over time, or they can grow progressively worse. Evidence suggests that OCD might run in families.

Depression or other anxiety disorders may accompany OCD. Some people with OCD have eating disorders. In addition, they may avoid situations in which they might have to confront their obsessions. Or they may try unsuccessfully to use alcohol or drugs to calm themselves. If OCD grows severe enough, it can keep someone from holding down a job or from carrying out normal responsibilities at home, but more often it doesn't develop to those extremes.

There are several generally accepted subdivisions of OC's. Amongst them are Washers, Checkers, Cleaners, Hoarders, Repeaters, Orderers, and Pure Obsessives.

Washers are those OC's that generally have a fear of germs, dirt, or contamination from substances like bodily fluids, dirt, dust, bacteria, viruses, excretions, and the like. Washers that are compulsive can spend hours washing themselves, or parts of their body, to the exclusion of all else, trying to rid themselves of "contamination". They may also avoid contact with things to avoid being "contaminated". One of the most striking things about the spread of contamination is that the "contaminant" can (in the OC's mind) be spread from object to object without actual physical contact.

Cleaners are those OC's that feel that other things are contaminated or dirty, and spend much time cleaning their surroundings. For instance, a cleaner might spend hours dusting their home, and then go back and start again as soon as they have finished, because dust has settled in the interim.

Checkers have a problem remembering or being sure that they have or have not done something, and therefore go back to check whether they have or not. For instance, a woman might turn off the stove, but be compelled to go back and check 20 times, or even 100 times to be sure that it is indeed turned off.

Hoarders collect things...almost anything. They usually cannot even stand to throw away garbage, and often will let it just sit around them. An inability to get rid of things is the significant symptom of this class of OC.

Repeaters are OC's that feel compelled to do things a "right" number of times. This may serve to protect them from some imagined danger, or prevent possible harm to themselves or a family member. Repeaters generally fear that if they do not do things the "right" number of times, something bad will happen, although some may just have to do things "just right" for no apparent reason.

Orderers have to have things organized absolutely "the right way". An orderer might be reluctant to let anyone touch their possessions, lest they be misarranged. Orderers might spend hours just aligning a piece of paper on a desktop, or straightening a bookshelf.

The last type is the Pure Obsessive, which is also the most difficult OC to treat. These OC's suffer from obsessive thoughts of a disturbing nature, generally. An example might be a person who constantly obsesses over whether they will hurt their child, even though they know they wouldn't...they can't stop worrying that they might.

If you are not sure if you suffer from OCD,  you may wish to complete the OCD Screening Test at the bottom of this page.

How Common Is OCD?

For many years, mental health professionals thought of OCD as a rare disease because only a small minority of their patients had the condition. The disorder often went unrecognised because many of those afflicted with OCD, in efforts to keep their repetitive thoughts and behaviours secret, failed to seek treatment. This led to underestimates of the number of people with the illness. However, a survey conducted in the early 1980s provided new knowledge about the prevalence of OCD. The survey showed that OCD affects more than 2 percent of the population, meaning that OCD is more common than such severe mental illnesses as schizophrenia, bipolar disorder, or panic disorder. OCD strikes people of all ethnic groups. Males and females are equally affected.

What Causes OCD?

No one can say for certain what causes obsessive-compulsive disorder. At one time researchers speculated that OCD resulted only from family attitudes or childhood experiences, including harsh discipline by demanding parents. Recent evidence suggest that biological factors may also contribute to the development of OCD.

There is a tendency for OCD to run in families. OCD is sometimes accompanied by depression, eating disorders, substance abuse disorder, a personality disorder, attention deficit disorder, or another of the anxiety disorders. Coexisting disorders can make OCD more difficult both to diagnose and to treat. The fact that OCD patients respond well to specific medications that affect the neurotransmitter serotonin gives more credence to the belief that the disorder has a neurobiological basis.

Treatment of OCD

Behaviour Therapy - Traditional psychotherapy, aimed at helping the patient develop insight into his or her problem, is generally not helpful for OCD. However, a specific behavior therapy approach called "exposure and response prevention" is effective for many people with OCD. In this approach, the patient deliberately and voluntarily confronts the feared object or idea, either directly or by imagination. At the same time the patient is strongly encouraged to refrain from ritualizing, with support and structure provided by the therapist, and possibly by others whom the patient recruits for assistance. For example, a compulsive hand washer may be encouraged to touch an object believed to be contaminated, and then urged to avoid washing for several hours until the anxiety provoked has greatly decreased. Treatment then proceeds on a step-by-step basis, guided by the patient's ability to tolerate the anxiety and control the rituals. As treatment progresses, most patients gradually experience less anxiety from the obsessive thoughts and are able to resist the compulsive urges.

Studies of behaviour therapy for OCD have found it to be a successful treatment for the majority of patients who complete it. For the treatment to be successful, it is important that the therapist be fully trained to provide this specific form of therapy. It is also helpful for the patient to be highly motivated and have a positive, determined attitude.

The positive effects of behaviour therapy endure once treatment has ended. A recent compilation of outcome studies indicated that, of more than 300 OCD patients who were treated by exposure and response prevention, an average of 76 percent still showed clinically significant relief from 3 months to 6 years after treatment (Foa & Kozak, 1996).

One study provides new evidence that cognitive-behavioural therapy may also prove effective for OCD. This variant of behaviour therapy emphasizes changing the OCD sufferer's beliefs and thinking patterns. The ongoing search for causes, together with research on treatment, promises to yield even more hope for people with OCD and their families.

Medication - Clinical trials in recent years have shown that drugs that affect the neurotransmitter serotonin can significantly decrease the symptoms of OCD. The first of these serotonin reuptake inhibitors (SRIs) specifically approved for the use in the treatment of OCD was the tricyclic antidepressant clomipramine (AnafranilR). It was followed by other SRIs that are called "selective serotonin reuptake inhibitors" (SSRIs).  Large studies have shown that more than three-quarters of patients are helped by these medications at least a little. And in more than half of patients, medications relieve symptoms of OCD by diminishing the frequency and intensity of the obsessions and compulsions. Improvement usually takes at least three weeks or longer. If a patient does not respond well to one of these medications, or has unacceptable side effects, another SRI may give a better response. For patients who are only partially responsive to these medications, research is being conducted on the use of an SRI as the primary medication and one of a variety of medications as an additional drug (an augmenter). Medications are of help in controlling the symptoms of OCD, but often, if the medication is discontinued, relapse will follow. Indeed, even after symptoms have subsided, most people will need to continue with medication indefinitely, perhaps with a lowered dosage. (See Medication Page).

How to Get Help for OCD

If you think that you have OCD, you should seek the help of a mental health professional. Family doctors or clinics,  may be able to provide treatment or make referrals to mental health centres and specialists.

What the Family Can Do to Help

OCD affects not only the sufferer but the whole family. The family often has a difficult time accepting the fact that the person with OCD cannot stop the distressing behaviour. Family members may show their anger and resentment, resulting in an increase in the OCD behaviour. Or, to keep the peace, they may assist in the rituals or give constant reassurance.

Education about OCD is important for the family. Families can learn specific ways to encourage the person with OCD to adhere fully to behaviour therapy and/or medication. Self-help books are often a good source of information. Some families seek the help of a family therapist who is trained in the field. Also, in the past few years, many families have joined one of the educational support groups that have been organized throughout the country.

Most Frequently Questions About OCD

1. Are all people with OCD 'washers' or 'checkers'? No. OCD manifests itself in a large variety of ways, and individuals usually suffer from a combination of symptoms. Most people with OCD also share common difficulty with daily activities, such as tardiness, perfectionism, procrastination, indecision, discouragement and family difficulties.

2. If I have any of these symptoms or behaviours, does it mean that I have OCD? That depends much upon the degree in which the symptoms or behaviours interfere with your thinking, reasoning, and/or life functioning. If you feel you have any of these symptoms or symptoms of a similar nature, see a competent psychotherapist experienced with OCD and discuss your symptoms.

3. Is OCD considered to be an anxiety disorder? Yes. The obsessions cause anxiety, which results in a need to perform compulsions which provides temporary relief.

4. Is OCD just a fad? No. Throughout history, new disorders have been discovered, and more information has been gathered about those illnesses. Cases of OCD have been documented throughout the centuries. The secretive nature of OCD kept many away from doctors and other health care workers. After effective treatments were developed, more people stepped forward with their symptoms or were diagnosed by clinicians who now knew to look for the condition.

5. Why doesn't an individual with OCD "just stop" their behaviour? Most truly wish they could. Probably the biggest reason why they do not "just stop" is anxiety. The person with OCD suffers intense anxiety over whatever their symptoms focus upon. They want to "make sure" that whatever they are focusing upon is taken care of. OCD is a disease of doubt, therefore the person with OCD feels they can never be sure that whatever it is is really taken care of. Often this will show in the form of a compulsion such as hand washing. The person cannot, no matter how hard they try, feel that their hands are really clean. There is always a "what if" such as "what if I missed a teeny tiny little spot?" and so they continue to wash, just in case. With a compulsion, the anxiety rises to unbearable and terrifying levels if the compulsion is not allowed to take place.

6. Is a person with OCD crazy? No. A person who does not recognize that their behaviours and thoughts are abnormal is "psychotic." Most people with OCD are aware that their behaviour does not make sense. People with OCD are not crazy.

7. Is OCD acquired or are people born with it? Persons are generally considered to have been born with a predisposition for OCD. This predisposition however does not always manifest itself. Sometimes the OCD is triggered by a traumatic or stressful event, even an illness (strep throat), but one must first have the predisposition toward OCD to develop the disorder.

8. Are there any other disorders related to OCD? Tourette's syndrome is strongly related to OCD, and many people have both. Several other disorders appear similar to OCD, including Body Dysmorphic Disorder (BDD), Trichotillomania (hair pulling), and impulse control disorders, but it is not clear whether or not these disorders are truly related to OCD. Other disorders, such as major depression, social phobia, and panic disorder are more common in people with OCD.

9. Are OCD and depression related? Approximately 60-90% of OCD sufferers have also suffered at least one major episode of depression at some point in their life. Some schools of thought feel the OCD causes the depression while others believe the OCD and depression simply tend to coexist.

10. Why do so many people with OCD hide their symptoms? Usually because of feeling shame for doing/thinking such bizarre things, coupled with a fear of being considered "weird", "strange" or crazy.

11. What is the prognosis for OCD with treatment? Very good, especially if the patient is determined to work hard. Up to 80% of OCD sufferers improve significantly with proper treatment of behavioural therapy and medication. Slips and relapses of thinking or behaviour may occur but if the person is determined, these slips can usually be caught and treated before blossoming into a full blown OCD episode.

12. What are some of the treatment methods for OCD?  The two most effective treatments for OCD are drug therapy and behaviour therapy. It is generally most effective if the two can be used together.

13. What medications are used for drug therapy? The most effective medications for OCD are the SSRI's (selective serotonin reuptake inhibitors) Prozac, Paxil, Luvox,and Zoloft as well as the tricyclic Anafranil. These are the only medications proven effective for OCD thus far. Other medications are frequently added to improve the effect.

14. Is marijuana a good treatment for OCD? Although marijuana is now legal in California for medicinal purposes, it is not a good treatment for OCD. It may provide some short term relief, but it causes symptoms to later worsen. Marijuana can also interfere with OCD medications and make depression more severe.

15. Can stress affect OCD? Yes. It is typical to notice a worsening of OCD symptoms during stressful periods. Stress does not cause OCD, but a stressful event (like the death of a loved one, birth of a child, or divorce) can actually trigger the onset of the disorder or exacerbate it.

16. Do obsessions ever change over time? Obsessions may change themes over time. Sometimes a person simply adds new ones to old ones and sometimes the old ones are completely replaced by newer ones.

17. Is OCD contagious? No, it is not.

18. Does everyone with OCD have obsessions and compulsions? Approximately 80 percent of people with OCD have both identifiable obsessions and compulsions; about 20 percent have only obsessions or compulsions.

19. Can trying to reason out an obsession help?  Usually not. Trying to reason out or make sense from an obsessive thought usually only strengthens the thought.

20. Are there any techniques to help stop an obsession before it strengthens? Yes there are, the most effective way to stop obsessions is to actually stop the compulsions. When one stops the compulsions, the obsessions will initially get stronger, but over time they will decrease and become less anxiety-provoking.

21. What is scrupulosity as it relates to OCD? Some people with OCD worry excessively that they may have done or said something blasphemous. Fears and worries may vary according to the person's religion. For example, an Orthodox Jewish person may worry incessantly that he did not perform a religious ritual correctly; while one who was raised Catholic may worry and fear that they did not say enough rosaries or confess enough sins. They may fear they have a hidden sin they have not repented, so they keep examining all their daily thoughts and actions in an attempt to make sure they didn't miss any sins. Others may simply fear doing anything because they fear whatever they do might be wrong, upsetting the God or gods they believe in.

22. What is a YBOCS? The YBOCS, or Yale-Brown Obsessive Compulsive Scale, is a scale clinicians use to grade the severity of OCD in a patient. It is based on the amount of interference, distress, and control the person has related to their OC behaviours.

A Test for Obsessive-Compulsive Disorder

PART A Please select YES or NO.

Have you been bothered by unpleasant thoughts or images that repeatedly enter your mind, such as:

1. overly concerned with contamination (dirt, germs, chemicals, radiation) or acquiring a serious illness such as Aids? YES/NO

2. over-concern with keeping objects (clothing, groceries, tools) in perfect order or arranged exactly? YES/NO

3. images of death or other horrible events? YES/NO

4. personally unacceptable religious or sexual thoughts? YES/NO

Have you worried a lot about terrible things happening, such as:

5. fire, burglary, or flooding the house? YES/NO

6. accidentally hitting a pedestrian with your car or letting it roll down the hill? YES/NO

7. spreading an illness (giving someone Aids)? YES/NO

8. losing something valuable? YES/NO

9. harm coming to a loved one because you weren't careful enough? YES/NO

Have you worried about acting on an unwanted and senseless urge or impulse, such as:

10. physically harming a loved one, pushing a stranger in front of a bus, steering your car into oncoming traffic; inappropriate sexual contact; or poisoning dinner guests? YES/NO

Have you felt driven to perform certain acts over and over again, such as:

11. excessive or ritualised washing, cleaning, or grooming? YES/NO

12. excessively checking light switches, water taps, the oven/cooker, door locks, or hand brake? YES/NO

13. counting; arranging; evening-up behaviours (making sure socks are at same height)? YES/NO

14. continually collecting useless objects or inspecting the garbage before it is thrown out? YES/NO

15. repeating routine actions (in/out of chair, going through doorway, re-lighting cigarette) a certain number of times or until it feels just right YES/NO

16. need to touch objects or people? YES/NO

17. unnecessary re-reading or re-writing; re-opening envelopes before they are mailed? YES/NO

18. continually examining your body for signs of illness? YES/NO

19. always avoiding colours ("red" means blood),), numbers ("l 3" is unlucky), or names (those that start with "D" signify death) that are associated with dreaded events or unpleasant thoughts? YES/NO

20. needing to "confess" or repeatedly asking for reassurance that you said or did something correctly? YES/NO

Scoring Part A

If you answered YES to 2 or more questions, please continue with Part B.


The following questions refer to the repeated thoughts, images, urges, or behaviours identified in Part A. Consider your experience during the past 30 days when selecting an answer. Select the most appropriate number from 0 to 4.

1. On average, how much time is occupied by these thoughts or behaviours each day?

0 - None

1 - Mild (less than 1 hour)

2 - Moderate (1 to 3 hours)

3 - Severe (3 to 8 hours)

4 - Extreme (more than 8 hours)

2. How Much distress do they cause you?

0 - None

1 - Mild

2 - Moderate

3 - Severe

4 - Extreme (disabling)

3. How hard is it for you to control them?

0 - Complete control

1 - Much control

2 - Moderate control

3 - Little control

4 - No control

4. How much do they cause you to avoid doing anything, going any place, or being with anyone?

0 - No avoidance

1 - Occasional avoidance

2 - Moderate avoidance

3 - Frequent and extensive

4 - Extreme (housebound)

5. How much do they interfere with school, work or your social or family life?

0 - None

1 - Slight interference

2 - Definitely interferes with functioning

3 - Much interference

4 - Extreme (disabling)

Sum of Part B (Add items 1 to 5)

Scoring Part B

If you answered YES to 2 or more of questions in Part A and scored 5 or more on Part B, you may wish to contact your doctor or a mental health professional to obtain more information on OCD and its treatment. Remember, a high score on this questionnaire does not necessarily mean you have OCD, only an evaluation by an experienced clinician can make this determination.

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On this page:

Obsessive-compulsive Personality Style   Getting Help

Treatment of the Obsessive-compulsive Personality Style

What is Obsessive-compulsive disorder?   How common is OCD?  

What causes OCD? Treatment of OCD     How to get help with OCD   

How can the family help?

Frequently asked questions about OCD   A test for OCD

The Obsessive-compulsive Personality Style

Obsessive or compulsive behaviour is so commonly demonstrated in so many people, at least to some minimal extent, that its significance is sometimes missed. It is important to distinguish between those people with obsessive-compulsive character styles and those individuals whose lives are diminished and made so difficult by Obsessive-compulsive character disorder (OCD).

The obsessive-compulsive personality style is often characterised by a driven, pressured tension to do the correct or necessary thing. Spontaneous expressions, personal choices, or any genuine feelings are difficult for a person with this style of character to show.  This rule-bound person is uncomfortable with freedom, and release from one concern will lead to anxiety and quick replacement with another pressing concern as the subject for constant thinking. Perfectionism and procrastination are often present and related to the fear of doing the wrong thing. Similarly, difficulty in decision making reflects fears of self expression; which may be wrong. Social behaviour can be without much feeling, and stilted, with an emphasis on correct behaviour.

Consciously, a person with an obsessive-compulsive style, rather than a disorder, sees themselves as conscientious, responsible, hardworking, morally and otherwise correct, and trying hard to be the right kind of person. They experiences themselves as duty bound to follow an externally determined set of rules or principles and not as a free agent with respect for their own wishes and judgment.

They tend to see others as authority figures, to which they are subject, or that others are subjects of their authority. This lends a one-up/one-down flavour to relationships, which are often formal with much attention to the proper role behaviour as parent, spouse, superior, subordinate, etc. Power struggles are often present within relationships, particularly where role-relationship rules are at all unclear or where there may be disagreement concerning such rules. Obsessive-compulsive Character Disorder is very much more debilitating and is described below.

How to Get Help with This Style of Personality

If you think that you have an obsessive-compulsive style of personality, and you feel that this may cause problems in your life and relationships, you should seek the help of a mental health professional.

Treatment of the Obsessive-compulsive Personality Style

Those people with this style of personality respond well to psychotherapeutic help. The theme of therapy is the gradual challenging of their tight defences and the gradual acceptance and expression of those feelings and thoughts that they usually either hide away or are unaware of. Explanations and insights concerning how the way of being that they have adopted arose, and which requires so much safety, is usually very helpful. “Getting the story straight” about the history that motivates this need for control and proper behaviour can yield the kind of sympathetic understanding for the self that these individuals require. The person needs to learn slowly that these extreme guarantees of safety are no longer necessary, and that new patterns of thinking and behaving, while anxiety provoking, do not lead to anywhere near the danger that is anticipated on a feeling level. In a sense, the person with an obsessive-compulsive personality style needs to be desensitised to his or her own feelings.

What Is Obsessive-compulsive Disorder?

“I couldn't do anything without rituals. They transcended every aspect of my life. Counting was big for me. When I set my alarm at night, I had to set it to a number that wouldn't add up to a "bad" number. I would wash my hair three times as opposed to once because three was a good luck number and one wasn't. It took me longer to read because I'd count the lines in a paragraph. If I was writing an essay, I couldn't have a certain number of words on a line if it added up to a bad number. I was always worried that if I didn't do something, my parents were going to die. Or I would worry about harming my  parents, which was completely irrational. I couldn't  wear anything that said London because my parents were from London. I couldn't write the word "death" because I was worried that something bad would happen.”

1996 Mindscape Limited

Designed By David Lloyd-Hoare Bsc(Hons) MBACP(Accred) INLPTA

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Obsessive Compulsive