What is OCD? 

OCD or obsessive-compulsive disorder (OCD) is an anxiety disorder characterized by persistent unwanted thoughts often accompanied by repetitive, ritual-like behaviors that seem to occur beyond the individual’s conscious control. While everyone struggles with intrusive thoughts from time to time, OCD affects one’s ability to cope with day-to-day living to a significant extent. Individuals diagnosed with OCD typically spend more than one hour per day engaged in compulsive behaviours and this has a negative impact on an individual’s relationships, productivity and ability to cope with everyday stressors. 

People suffering from OCD often experience extreme distress. Although they might realize that their thoughts and behaviours are irrational, harmful and futile, they may feel overwhelmed by the urges that drive them to compulsive actions and feel unable to implement behavioural changes despite their best efforts. OCD has a marked effect on people’s quality of life. They often avoid situations out of excessive or irrational fears or in an attempt to maintain a sense of order and control over external outcomes. The rituals commonly associated with OCD – tapping, counting, checking and rechecking the home environment for safety hazards – may take up hours per day.  Even though scientists continue to grapple to identify the factors that cause OCD, there are a number of therapies that have proven to alleviate the symptoms of OCD and that can help patients to let go of obsessive thoughts and adopt a more realistic view of life. 

Symptoms of OCD

Obsessive-compulsive disorder is distinguished by repetitive mental concepts that play over repeatedly in the minds of sufferers. For the person who develops compulsions to relieve his/her mental pain and anxiety, these intrusive thoughts are nearly impossible to get rid of and usually cause great discomfort, repugnance or distress. Obsessions are commonly linked to a corresponding fear or anxiety and symptoms can be grouped in the following categories:

Fear of contamination or germs

The fear of being in contact with dirt, germs or secretions (such as saliva, semen, urine or faeces) are called contamination obsessions and are followed by cleaning compulsions. The individual will adopt excessive washing rituals which can by their frequency even cause dermatological lesions. 

Fear of harm or danger

Irrational fears of catastrophe or danger can cause sufferers to engage in compulsive behaviours directly linked to the fear (like compulsively checking whether doors are locked or whether appliances have been switched off) or might involve more abstract beliefs that certain behaviours will protect the individual from some disaster. Superstitions and obsessions with misfortune are often coupled with conjuring practices. In this way, the fear of bad luck, superstitious fears in relation to a number or a specific colour, religious fears linked to sacrilege or blasphemy may push the subject to repeat a number, gesture, word or prayer several times. 

Fear of losing something valuable

Obsessions of accumulation drive the person to compulsively and uncontrollably hoard unwanted items to the point of obstructing access to certain spaces to and interfering with everyday life. A person suffering from a hoarding obsession will likely feel embarrassed about the situation and avoid inviting other people into their homes. 

Fear of disorder

Order and symmetry obsessions are countered by routines that emphasize structure and tidiness, and TV shows and the popular media often home in on this type of OCD in their depiction of the condition. The fear that things are out of place or that symmetry is disturbed triggers the urge to constantly rearrange items or to tidy up incessantly.   

Apart from these main categories of OCD, there is also a link between obsessive-compulsive disorder and food disorders. Often, the behaviours associated with eating disorders, like obsessive thoughts about food, excessive calorie-counting, food rituals like cutting food in particular ways or hoarding food items, are comparable to the symptoms of OCD. 

What are the causes of OCD?

So far, scientists have not been able to identify a definitive cause for obsessive-compulsive disorder. As is the case with other mental health conditions, OCD correlates with biochemical changes in the brain that is observable on a brain scan. OCD is specifically linked to the neurotransmitter serotonin. However, this does not mean that changes in brain chemistry cause OCD. 

There are several theories surrounding the potential causes of the disorder. These theories range from neurobiological and genetic explanations to psychological theories of human behaviour and the impact of environmental factors and adverse life events. 

The latest research suggests that OCD is at least partly a genetic condition. People suffering from OCD are much more likely to have at least one other family member with OCD. In a study of the prevalence of OCD in identical twins, researchers found that 52% of identical twins both had OCD, while only 21% of fraternal twins both suffered from the condition. This is further evidence of a genetic cause for OCD. 

OCD may be linked to Paediatric Autoimmune Neuropsychiatric Disorders associated with Streptococcal Infection (PANDAS). A 1998 study found that some children developed OCD after a severe strep throat infection and identified the basal ganglia as the brain region that corresponds with OCD. Streptococcal infections were thought to trigger an immune response that interacted with the basal ganglia and led to the onset of OCD symptoms. 

Theories that environmental factors, like stress, parenting style, or traumatic life events cause OCD, has not been sufficiently proven.  However, these factors may contribute to the onset of OCD in individuals already predisposed to the disorder. If OCD is left untreated, everyday anxiety and stress in a person’s life will increase the severity of OCD symptoms. Pregnancy is another risk factor for developing OCD, and the onset of OCD or the exacerbation of symptoms are thought to be linked to fluctuations in the levels of estrogen, progesterone and oxytocin during and after pregnancy.  

How is OCD treated?

Although scientists still debate the causes of OCD, and despite the fact that OCD is a chronic mental health condition, it is important to remember that OCD is treatable and that people suffering from obsessions and compulsions can find relief when seeking help. Cognitive behavioural therapy (CBT) and medication, often used in combination, are the most common treatment options for people suffering from obsessive-compulsive disorder. OCD often presents as a behavioural cycle: obsessive thoughts cause anxiety, which leads to compulsion and eventual, though partial and temporary relief. CBT works by teaching patients techniques and cognitive skills that disrupt the OCD cycle, thereby enabling them to redirect their anxiety to more productive thoughts and actions. 

Exposure therapy is a type of CBT particularly helpful in the treatment of OCD. This technique is based on gradually subjecting the patient – under the close supervision of a therapist – to the circumstances or thoughts that trigger their anxiety-driven compulsions. By desensitizing patients to these triggers, they learn to overcome or reduce their anxiety, relieving them from the need to engage in compulsive rituals to soothe their distress. 

Because OCD is linked to the production of serotonin, patients who do not respond well to psychotherapy alone may benefit from treatment with selective serotonin reuptake inhibitors (SSRIs). These include the antidepressants fluoxetine, fluvoxamine, paroxetine and clomipramine. For the treatment of OCD, SSRIs are generally prescribed at a higher dosage than when used to treat depression. It may also take longer – up to 10-12 weeks – before these medications begin to alleviate the symptoms of OCD.

In addition to formal therapies, a number of self-help strategies may help keep OCD symptoms under control. Getting enough sleep, eating regular meals, building a support network, and engaging in some form of physical activity all contribute to overall mental health. And because stress and anxiety can worsen the symptoms of OCD, relaxation techniques like yoga, mindfulness and meditation can be included in the daily routines of those suffering from the condition.   

Children with OCD

OCD affects approximately one out of 100 children and is more common than juvenile diabetes. As is the case with adults, OCD in children is not a sign of bad behaviour or a lack of self-control. Rather, OCD is a chronic but treatable medical condition that likely stems from genetic factors rather than parenting style or stressful life events. OCD manifests in children in much the same way as in adults. Kids suffering from OCD will have persistent and disturbing worries, doubts and fears which they will attempt to soothe by engaging in compulsive rituals which they believe will protect them from negative outcomes. Children may not be able to articulate these fears, though, and parents may only notice some outward signs that may point to the condition. Signs to look out for are persistent lateness or slowness (since compulsive behaviours may eat up a significant portion of kids’ time), repeated requests for reassurance from adults, the urge to hoard useless objects, a perfectionist streak, and a need to do things “just right”. 

OCD and Anxiety

OCD is one of five classes of anxiety disorders and, although symptoms may overlap, is distinct from Generalized Anxiety Disorder (GAD), Posttraumatic stress disorder (PTSD), Panic Disorder, and Social Anxiety disorder. Although all anxiety is, to some extent, unfounded, the fears that drive compulsive behaviour are often highly irrational. And while people suffering from anxiety may experience a range of worries and fears, they do not typically engage in compulsive behaviours to counter these fears. Rather, general anxiety manifests as biased or excessively negative thinking and catastrophizing. 

The thought patterns associated with OCD differ from those associated with Generalized Anxiety Disorder. While people with general anxiety will worry excessively about real-life issues, such as finances, relationships or health, people with OCD will dwell on one particular topic and worry about things far beyond what can be considered everyday concerns. There is often an element of magical thinking to the thought processes of OCD: that rituals and compulsions will miraculously guard an individual against misfortunes in a way that often has nothing directly to do with the fear in question. 

OCD and depression

Although obsessive-compulsive disorder (OCD) (an anxiety disorder) is clinically distinguishable from depression (a mood disorder) there is a high rate of comorbidity between the two conditions – up to 67%. It is estimated that two-thirds of people suffering from OCD will experience at least one episode of major depression in their lifetime. 

Scientists do not yet fully understand the reasons for this high rate of comorbidity, but it is fairly clear that OCD predisposes individuals to depression and that the two conditions result from a similar chemical imbalance of serotonin in the brain. Although OCD and depression may require different therapeutic strategies, it is common for medical practitioners to prescribe selective serotonin reuptake inhibitors (SSRIs) that may be helpful in treating both conditions. Transcranial magnetic stimulation (TMS) has also proven helpful in simultaneously alleviating the symptoms of depression and OCD. 

Last updated at: 2021.05.04

Author: Willemien Froneman