OBSESSIVE-COMPULSIVE DISORDER

Obsessive-Compulsive Disorder (OCD) is a type of psychological disorder that is characterized by having obsessive thoughts and/or exhibiting compulsive behaviours. These thoughts and behaviours often create emotional distress and can greatly interfere with one’s ability to function on a daily basis. For example, the act of repetitive hand washing or checking can make someone late for work. Oftentimes, there is a secretive element to OCD. Ritualistic behaviours can seem embarrassing and a person may isolate him/herself and avoid treatment as a way to hide his/her shame.1

Obsessions are:

  • Persistent and recurrent thoughts, impulses, or images that are disruptive and cause anxiety and/or stress. Obsessions are NOT worries about real-life problems.1

Compulsions are:

  • Repetitive behaviours or mental acts that one feels they must perform in response to obsessive thoughts.1

In order to be diagnosed with OCD, a person must meet the following criteria:

  • The person must attempt to ignore or suppress obsessive thoughts and/or impulses.1
  • The person is aware that the obsessions are not delusional in nature. Rather, the obsessions are products of his/her own mind.1
  • The compulsive actions are directed towards preventing stress or reducing stress of a dreaded event/situation.1
  • The symptoms of OCD are not caused by a different psychiatric disorder, medical condition, or substance abuse.1

Canadian Statistics

  • Approximately 1% to 2% of the population will have an episode of OCD during their lives.[1]
  • A report from 2015 estimated that the lifetime prevalence of OCD is about 2%.[2]
  • It takes approximately 10 years between the onset of OCD symptoms and when a person first seeks help for the disorder.3
  • Over 90% of people with OCD have both obsessive and compulsive symptoms.2
  • Thirty percent of people with OCD refuse Behavioural Therapy or quit treatment early.2
  • Women are slightly more susceptible to experiencing OCD than men.2

Behaviours associated with OCD:

  • Repeatedly checking the door to make sure it is locked.
  • Spending the majority of the day, nearly every day, cleaning the house.
  • Touching a certain point on the railing every time before going up the stairs.
  • Checking every email for hours to ensure that there are no mistakes.
  • Counting to 25 every time you pass a certain car color.
  • Picking up items off the curb to take home, regardless of what they are.

Feelings associated with OCD:

  • Embarrassment
  • Anxiety
  • Worry
  • Guilt
  • Shame
  • Uncertainty

Thoughts associated with OCD:

  • “If I don’t tie my shoes in this particular way, something bad will happen to my family.”
  • “I forgot to count to ten after brushing my hair, I’m terrified of how my day will go!”
  • “If things on my desk aren’t organized, I won’t be able to think clearly and then I’ll get fired.”
  • “I can’t visit my grandparents in the hospital; there are too many germs there and I’ll surely get a disease.”

OCD and the Body:

The physical symptoms of OCD are similar to those experienced by sufferers of Anxiety Disorders, including:

  • Irritable Bowel Syndrome.[3]
  • Racing Heart[4]
  • Muscle Tension[5]
  • Migraine Headaches[6]

OCD and the Brain:

Studies examining the neuroscience of OCD have consistently reported that the disorder stems from disfunctional communication between three areas of the brain: the Cortex, Striatum, and the Thalamus. The pathway between these brain areas, called the Cortico-Striatal-Thalamo-Cortical (CSTC) pathway, is hyperactive in people with OCD.[7] There is also increasing evidence that Glutamate disregulation is connected to the symptoms of OCD.7 Glutamate is a neurotransmitter that acts as an excitatory influence in the brain. Studies of mice have shown that overactivation of the CSTC can result in abnormally frequent grooming in mice.[8] The indication of these studies on mice is that the human brain operates in a similar way, and over-activation of the CSTC in humans may be responsible for overactive behaviours (compulsions).

Does Psychology Work?

  • Cognitive Behavioural Therapy (CBT): CBT is one of the most commonly used psychological treatments for OCD. The goal of CBT is to help the afflicted person change their thoughts and modify their behaviours to improve their mental health. In the context of OCD, learning to identify and modify obsessive thoughts and compulsive behaviours can be greatly beneficial. Research has shown that CBT is an effective treatment for OCD, with substantial reductions in OCD symptoms occurring after treatment.[9] Other studies have shown that CBT is an effective long-term treatment of OCD.8 In addition, CBT does not have to be conducted in person order to be effective. Studies have found that remote CBT, such as through phone calls or video chats, is as effective as in-person treatment for OCD.[10]
  • Exposure and Response Prevention (ERP): ERP is a type of CBT treatment that teaches people with OCD how to overcome their desire to engage in obsessions and compulsions. Research has shown that ERP is an effective treatment for OCD and that the positive results are still present after 3 years.[11] ERP has also proven to be effective at treating hoarding, which is one of the more difficult symptoms to overcome in OCD treatment.[12]Additionally, ERP has been effectively used to treat people experiencing “unacceptable thoughts” as a symptom of OCD.12

Tips to Manage OCD!

  • Prepare for Stress: Symptoms of OCD are often triggered or worsened by stress. Stress is inevitable, but you can learn how to better respond to potential stressors. Although it takes practice, reducing stress can be as simple as planning ahead and finding time for relaxation. For example, if heavy traffic triggers your OCD, bringing a relaxation CD to listen to in the car could be a way to reduce stress.
  • Create a “Fear Ladder:” Creating a fear ladder is an exposure technique that can help people with OCD gradually face anxiety-provoking situations without engaging in OCD thoughts and/or behaviours. To do this exercise, make a list of fears from the least frightening to the most frightening. Practice exposing yourself to the least feared item, such as imagining (but not doing) yourself touching the garbage can without gloves, and see if you can delay or avoid OCD behaviours. Once you are able to successfully engage in a feared situation without responding to urges, attempt to move on to the next fear. This strategy can help you gain confidence in your ability to resist the urges of OCD.
  • Know Your Triggers: Tracking thoughts and situations that trigger OCD can be a helpful strategy for managing the disorder. Developing an awareness of your triggers can help you create strategies for responding more productively the next time you encounter the same trigger. It can be helpful to write down a triggering situation and a strategy for reducing OCD compulsions and obsessions. An example of a strategy is mindfully paying attention to your surroundings instead of getting caught in a loop of obsessive thoughts.

Living with OCD can be exhausting and diminish your quality of life. If you are experiencing OCD, know that there are ways to reduce or get rid of your symptoms. Even if your symptoms are different than those listed on this page, a diagnosis of OCD is still possible. OCD can sometimes occur at the same time as other mental health challenges, such as Depression. At Hopewell Psychological, we are experienced in treating co-occurring disorders and offer a variety of treatment options to address all of your concerns. We offer individual treatment as well as couples, family, and group therapies for improving interpersonal relationships. Hopewell only uses psychological therapies that are research tested and has helped hundreds of people find a more peaceful way of living.

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*Psychologists are covered under Insurance Companies in Canada. You will need to check with your insurance company about the specific details regarding your coverage.

References

[1] ‘Psychology Works’ Fact Sheet: Obsessive Compulsive Disorder.” Canadian Psychological Association. 2014. Web. 9 May 2017.

[2] “Section B–Anxiety Disorders.” Statistics Canada. 27 Nov 2015. Web. 10 May 2017.

[3] Gros, D. F., et al. “Frequency and severity of the symptoms of irritable bowel syndrome across the anxiety disorders and depression.” Journal of Anxiety Disorders 23 (2009): 290-296.

[4] Sayed, S., et al. “Current Treatments for Anxiety and Obsessive Compulsive Disorders.” Current Treatment Options in Psychiatry 1.3 (2014): 248-262.

[5] Lazarov, A., et al. “Obsessive-compulsive tendencies may be associated with attenuated access to internal states: Evidence from a biofeedback-aided muscle tensing task.” Consciousness and Cognition 21 (2012): 1401-1409.

[6] Cupini, L. M., et al. “Obsessive-Compulsive Disorder and Migraine with Medication-Overuse Headache.” The Journal of Head and Face Pain 49.7 (2009): 1005-1013.

[7] Pittenger, C., et al. “Glutamate Abnormalities in Obsessive Compulsive Disorder: Neurobiology, Pathophysiology, and Treatment.” Pharmacology & Therapeutics 132.3 (2011): 314-332.

[8] Ahmari, S. E., et al. “Repeated Cortico-Striatal Stimulation Generates Persistent OCD-like Behavior.” Science 340.6137 (2013): 1234-1239.

[9] Butler, A. C., et al. “The empirical status of Cognitive-Behavioral Therapy: A review of meta-analyses.” Clinical Psychology Review 26 (2006): 17-31.

[10] Wootton, B. M. “Remote Cognitive-behavior therapy for Obsessive-Compulsive Disorder: A meta-analysis.” Clinical Psychology Review 43 (2016): 103-113.

[11] Rosa-Alcazar, A. I., et al. “Psychological treatment of Obsessive-Compulsive Disorder: A meta-analysis.” Clinical Psychology Review 28 (2008): 1310-1325.

[12] Abramowitz, J. S., et al. “Symptom presentation and outcome of Cognitive-Behavioral Therapy for Obsessive-Compulsive Disorder.” Journal of Consulting and Clinical Psychology 71.6 (2003): 1049-1067.

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