Written by Dr. Inez Van Roy on
December 23, 2021
Written by Dr. Inez Van Roy on:

Medically Reviewed by our Medical Affairs Team

Do you constantly worry about dirt or germs? Do you need to check the locks on your door more than once before leaving home? Do you feel compelled to wash your hands many times in a day, sometimes even scrubbing them raw? If so, obsessive-compulsive disorder (OCD) may be affecting your life. Is OCD an anxiety disorder? Does obsessive-compulsive personality disorder exist? What causes obsessive thoughts and compulsive behaviors? How can we cope with this? All these questions, and maybe more will be answered below.

What Is Obsessive-Compulsive Disorder?

OCD is one of the mental disorders recognized in the Diagnostic and Statistical Manual (DSM). Older versions of the DSM categorized OCD as an anxiety disorder. The most recent version (5th) recognizes OCD as a mental disorder. The clinical picture stays the same. It looks like recurrent distressing thoughts, mental rituals, and/or repetitive behaviors. 

 

Patients seem to show these symptoms to reduce anxiety. It can take a while before people get diagnosed with OCD. This is because people are experts in covering up their compulsions and obsessions. They might feel ashamed and it might be a secret behavior. 

What is an obsessive-compulsive personality disorder?

So, OCD is not an anxiety disorder anymore. Is it a personality disorder? 

 

This is where things get difficult. To explain this let’s take a deeper look at the 4th version of the DSM. This book used to divide mental disorders into Axes.

 

OCD used to be part of Axis I, under the anxiety disorders. Those are all mental health conditions, excluding personality disorders and mental retardation. 

 

OCD was described under Axis I, a clinical disorder like anxiety disorder. Obsessive-compulsive personality disorder (OCPD) was part of Axis II. This axis has all the personality disorders on it. An example of another disorder on this axis is a borderline personality disorder. 

 

Today they are still recognized as two distinct disorders. That means that you can have OCD and OCPD, or only one of those.

 

The symptoms of OCPD are different as well. The American Psychiatric Association defines OCPD as the following pattern: 

 

  • a preoccupation with details
  • perfectionism
  • excessive devotion to work and productivity
  • over-consciousness
  • inability to discard worthless objects
  • inability to delegate tasks
  • miserliness
  • rigidity and stubbornness.

 

As you can read below, the symptoms of obsessive-compulsive personality disorder are not the same as the ones for OCD. They can also impact your life in a negative and debilitating way. 

Mental Health Signs and Symptoms

 

Your sister Amy can’t stop cleaning before you come over. She is afraid of making you sick if she does not clean all the door handles five times. These door knobs need to be cleaned in a specific order. She feels the need to do this five times exactly as this is a good number. Sometimes she needs to begin again as she isn’t sure if she has done it five times or more (or less)! Amy suffers from OCD and you would like to help and understand. Keep reading below how we can break down her symptoms.

 

Obsessions, compulsions, or both are the main symptoms of OCD.

Obsessions

Obsessions consist of the following pattern.

 

  1. Thoughts, pictures, or urges that recur and persist. These are generally recognized as unpleasant, intrusive, or unwanted in most cases. They generate a lot of worry or discomfort in most people.
  2. Those with OCD try to ignore, neutralize or suppress these thoughts or images by using their compulsions. These compulsions might be other (repetitive) thoughts or actions.

 

Compulsions

Compulsions consist of two characteristics.

 

  1. As a reaction to an obsession, or rigid rule, the person shows repetitive behaviors or mental acts.
  2. These acts or behaviors should prevent or reduce the distress or dreaded situation or event. There is no realistic connection (or the connection seems excessive) between the compulsion and the distress.

 

If you notice that these symptoms have an intense impact on your daily life then you should consult a doctor or mental health professional. Intrusive thoughts can intervene with your well-being, professional and educational growth. 

 

If you have suicidal ideations and need emergency help, you can call 911. Another number that is free and 24/7 available in the USA is 1-800-273-TALK (8255). This is the National Suicide Prevention Lifeline (Lifeline). You can also text the Crisis Text Line. You can text HELLO to 741741.

 

What Causes Obsessive-Compulsive Disorder?

 

Pinpointing the exact cause of OCD isn’t easy. We don’t know yet. 

 

We believe that the interaction between genetics, biology, and environment could be a major risk factor for this mental illness. If OCD or mental illness runs in the family and you are in contact with the below stressors then OCD is more probable.

 

While genes and environment are important, your thoughts might also play a role. An OCD working group believes that some dysfunctional beliefs are common.

 

  • An inflated sense of responsibility or an overestimation of threat.
  • A deep belief about the need or the importance of intrusive thoughts or the need to control.
  • Intolerance of uncertainty or perfectionism.

 

In short, if you have OCD that is not your fault. Parents can’t help it either. Even with perfect education we still have our genes to fight. That might be a battle you don’t win.

Genetics

OCD can happen to all ages. Usually, there is onset in childhood or early adulthood. It might just be diagnosed later in the night. The genetic linkage is likely of modest effect. At this point, we don’t know yet what the genetic determinants are. The studies that do find candidate genes for OCD are not easy to replicate. 

Brain Structure and Functioning

Is the brain structure the same for people with OCD? This is a great question. As we can expect, research shows that people with OCD show a disorder-specific pattern in the brain. People with OCD show a reduction in the rostral and dorsal anterior cingulate/ medial prefrontal cortex. This reduction is functional and structural.  

Research also found that the insula and basal ganglia were bigger. 

 

These areas might be enlarged due to increased activity right there. This is logical as these areas are associated with habit-forming and emotional attribution. We could say that people with OCD form more “automatic habits”  in the form of compulsions. 

 

The prefrontal area would in normal circumstances disengage from this behavior. It would inhibit intrusive thoughts and would help you let go of these compulsions. In the case of OCD, these areas function differently, which might explain the behavior.

Environment

The environment can be a big factor in why certain people get OCD. The following elements are noticed in literature studies.

 

Parents with poorer mental health or fewer coping mechanisms have a higher chance of having children with OCD. 

 

Patients themselves report something similar. They feel like they are raised more by parents who are either overprotected or emotionally neglected. Some believe there was a lack of parental warmth.

 

Women with OCD also report more childhood sexual abuse, than women without OCD.

 

The last environmental risk factor is perinatal. Women with prolonged labor or edema during pregnancy might have higher chances of having a child with OCD. 

Prevention

We can’t prevent OCD. The only thing we can do is detect it early. This is important as untreated OCD tends to worsen. The symptoms can also change into other obsessions and compulsions. Treatment is available and can help you cope with the triggers.

OCD Types

OCD subtypes usually are based on overt symptoms. Research is still ongoing on whether these are the only subtypes, and whether we can call these types. At this point we can agree that the following themes are rather reoccuring for people with OCD. Multiple themes can also occur at the same time in the same person.

 

  1. Contamination/washing: contamination obsessions with cleaning compulsions.
  2. Doubt about harm/ checking: afraid of hurting themselves or others and checking compulsions.
  3. Hoarding: deep fear of letting go of objects or accumulating them. Sometimes this is driven by the intrusive thoughts that this couls harm another.
  4. Symmetry/ordering: repeating, counting compulsions, ordering, and symmetry obsessions.
  5. Unacceptable thoughts/ rituals: sexual, aggressive, or religious obsessions and compulsions related to those.

Comorbid Mental Disorders

People with OCD tend to show co-occurring disorders. The probability is high to have (one of) the following comorbid disorders:

 

  • anxiety disorder (panic disorder, social anxiety disorder, generalized anxiety disorder, or specific phobia)
  • depressive or bipolar disorder
  • obsessive-compulsive personality disorder
  • tic disorder
  • attention/deficit-hyperactivity disorder
  • other obsessive-compulsive related disorders (trichotillomania /hair -pulling disorder, excoriation /skin picking disorder)
  • oppositional defiant disorder.

OCD Diagnosis

Only a mental health provider can diagnose your OCD. 

 

To diagnose your OCD they will use the guidelines set up by the American Psychiatric Association. They will compare your mental health concerns with the common symptoms of OCD. The Diagnostic and Statistical Manual describes these.

 

Your mental health professional will most likely also perform a psychological evaluation. They might investigate if you show the associated thoughts, feelings, and behavior. Your doctor or therapist might compare this to what your direct environment reports on your behavior (f.e. Family or friends). They will want to exclude other mental health conditions to be sure to treat you properly.

 

Lastly, a doctor will perform a physical exam. Your doctor might want to exclude other medical problems that could cause this symptom pattern. 

Treatments and Therapies

OCD can look different for different people. There is no one-size-fits-all cure, however there are a number of options to try out. A mental health provider can set up a treatment plan. They probably will recommend a combination of psychological therapy and psychopharmacology. 

Medication

 

Some people with OCD struggle to contain their urges. Medication might be a solution or a way to contain the symptoms.

 

Research shows that serotonergic medications can work for those with OCD. The following medication can balance the chemicals associated with OCD

 

  • tricyclic antidepressant
  • selective serotonin reuptake inhibitors (SSRIs).

 

If you notice that this medication is not working for you, then a medical provider can take another look at your medication. 

Psychotherapy

 

There are multiple forms of psychotherapy well known to treat OCD. 

 

Probably the most well known therapy form is “Exposure therapy”. Instead of avoiding the feared thought or activity, the patient gets “exposed” to what they fear. This is done in a safe environment, under guidance of a psychologist or a trained mental health professional.

 

A form of talk therapy that might help OCD is Cognitive Behavioral Therapy (CBT). Cognitive behavioral therapy is focused on adapting faulty or unhelpful ways of thinking. Your mental health professional can treat the underlying health issue with therapy. 

 

The above kinds of therapy are also useful for panic attacks or other anxiety symptoms.

Other Treatment Options

Some people are treatment-resistant. In that case you can consider under advice of your doctor if the following are options.

 

  • When your daily life is deeply disturbed, you can consider commitment. There are residential treatment programs available for OCD. If commitment scares you there are also  intensive outpatient programs. These can provide intensive care and give you and your family the needed break.
  • Another treatment solution that is more intense is Deep brain stimulation (DBS). The FDA approved this treatment for adults with OCD who are not responsive. The Maya clinic reports that implanting these electrodes could regulate abnormal impulses in OCD.
  • A last form of treatment could be transcranial magnetic stimulation (TMS). In this kind of treatment an electromagnet coil delivers a magnetic pulse to stimulate your nerve cells. This is supposed to improve OCD symptoms according to the FDA and Mayo Clinic.

 

The Bottom Line

Did you know that 1 in 40 people have OCD? That number is staggering. It’s important to understand why so many of us are afflicted with this disorder. In short, OCD is a mental illness recognized by obsessional thoughts or urges, and compulsions. Usually people show these compulsive actions to get rid of the fear caused by the obsessions. It can look like someone who is checking, cleaning or repeating other actions to prevent something from happening. 

 

OCD is not the same as obsessive-compulsive personality disorder. This is a personality disorder that can be recognized by a deep perfectionism and extremely high expectations. Treatment is available for both. It usually consists of therapy and medication. 

 

We hope this article will help you better understand the condition. You can find more resources or more information on our website. You can also join the community if any of these topics resonate with you personally.

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