Obsessive-Compulsive Disorder (OCD): When Does it Cross the Line?


Healthy Living – May 9, 2017
David Prescott, PhD – Acadia Hospital

dr-prescott.jpgWhat Are Obsessions and Compulsions?  Symptoms of Obsessive-Compulsive Disorder have been the target of more than a few jokes.  Movies and television shows such as “What About Bob” or “The Big Bang Theory” have built characters around obsessive thinking and compulsive behaviors. While many of us roll our eyes at our own silly rituals or irrational thoughts, obsessive-compulsive disorder can significantly interfere with even the simplest of activities, like preparing a meal or leaving the house for school.
An obsession is a thought or visual image that occurs repeatedly.  Most people do not want the thought to occur in the first place, find it distressing, and feel that they cannot control the thought or image.  Examples of obsessions include the thought that you may try to injure or hurt someone, the image of you doing something impulsive like jumping out of a window, or the thought that you are contaminated by germs. 
Compulsions are behaviors, usually ritualistic acts, that are performed repeatedly even though the person knows that they are not necessary.  In the short run, a compulsive behavior reduces anxiety, although over the long run they become more and more disruptive and interfere with getting things done.  Examples of compulsions include frequent hand washing, checking (for example checking the stove, checking that doors are locked) or counting.  In severe cases, compulsive rituals can take several hours. 
When Does Obsessive-Compulsive Disorder Cross the Line?  It is estimated that in any given year, about 2.2 million Americans (1% of the population) meet criteria for a diagnosis of obsessive-compulsive disorder.  The typical age of first diagnosis is in the late teens or early twenties.  About half of the people who meet diagnostic criteria for obsessive compulsive disorder appear to have “severe” symptoms. 
The line between having obsessive-compulsive traits in our personality and having a disorder that requires treatment is not always entirely clear.  However, some signs that the problem may be getting out of hand include that a person:
  • Can't control his or her thoughts or behaviors, even when those thoughts or behaviors are recognized as excessive
  • Spends at least 1 hour a day on these thoughts or behaviors
  • Doesn’t get pleasure when performing the behaviors or rituals, but may feel brief relief from the anxiety the thoughts cause
  • Experiences significant problems in their daily life due to these thoughts or behaviors
Treatment of Obsessive-Compulsive Disorder:  Can’t people just stop it?  While it sounds simple at first, giving up compulsive behaviors in OCD takes time and support.  Psychotherapy, or talk therapy, is usually very helpful. 
Cognitive based therapies help identify thoughts which trigger a compulsive ritual.  Or, behavioral therapies may focus on preventing a person from engaging in compulsive behavior, like hand washing (called response prevention).  As you may have found if you ever tried to help a friend, in the short run preventing someone from performing a ritual initially causes anxiety and anger.  However, in the long run, it can break unwanted patterns. 
Medications used to treat obsessive-compulsive disorder are usually a class of medications called serotonin selective reuptake inhibitors, or SSRI’s.  Research suggests that a combination of psychotherapy and medications is the best treatment approach for obsessive-compulsive disorder.
For more information:
National Institute of Mental Health: https://www.nimh.nih.gov/health/topics/obsessive-compulsive-disorder-ocd/
American Psychological Association Help Centerhttp://www.apa.org/helpcenter