Obsessive Compulsive Disorder (OCD)

Obsessive-compulsive disorder (OCD), is characterized repetitive thoughts and behaviors that are senseless and distressing but extremely difficult to overcome.

Obsessions involve persistent and recurrent intrusive thoughts, images or impulses that are experienced as disturbing and inappropriate.

Compulsions can involve over repetitive behavior, or more covert mental acts. This is often in response to an obsession and it is behavior that is often times rigid as to how it should be performed. The goal can be preventing or reducing distress or preventing some dreaded event or situation.

NIMH defines Obsessive Compulsive Disorder as:
"An anxiety disorder and is characterized by recurrent, unwanted thoughts (obsessions) and/or repetitive behaviors (compulsions). Repetitive behaviors such as handwashing, counting, checking, or cleaning are often performed with the hope of preventing obsessive thoughts or making them go away. Performing these so-called ?rituals,? however, provides only temporary relief, and not performing them markedly increases anxiety." http://www.nimh.nih.gov/health/topics/obsessive-compulsive-disorder-ocd/index.shtml

Some of the characteristics of OCD are as follows:

Cognitive:

Obsessions are defined as recurrent, persistent ideas, thoughts, images or impulses involuntarily coming to awareness. (Recurrent, persistent ideas, thoughts or images, impulses involuntarily coming to one's consciousness.)

Ruminations are forced preoccupation with thoughts about a particular topic, associated with brooding, doubting, and inconclusive speculation. (Several hours a day worried if a former lover will establish contact.)

Cognitive rituals are often elaborate series of mental acts that one feels compelled to complete. Termination of a ritual as contingent upon properly performing or carrying out performance of the ritual. (Elaborate mental acts that one feels compelled to complete.)

Motor:

Compulsive motor rituals can be elaborate, time-consuming activities that are often associated with common, every day activities such as eating, washing, toileting, grooming, dressing and sexual activity. (repetitive hand washing, compulsive counting or "checking" of objects.)

Compulsive avoidances involve substitute actions performed instead of appropriate anxiety causing behavior. (e.g. Distracting oneself before exams with elaborate avoidance activities, so as to avoid having to study for the test, an action with potential anxiety.)

OCD can range from mild to severe. One reference says that OCD effects 2% or persons in the US. Divorced or separated persons, or unemployed people are somewhat overrepresented. There seems to be little gender difference in OCD, markedly different than that of depression and other anxiety disorders. It is stated that 67% of those with OCD may also experience major depression at some time in their life and there can be other comorbid personality problems or disorders.

There are different schools of thought with regards to OCD and its causes. From a psychodynamic viewpoint displacement, substituting one activity for another activity can be a causal factor, a person who has thoughts of hurting a child, displaces those thoughts with other compulsive behavior. A person might be seeking forgiveness for some real or imagined transgression, and try to find that in a "formula" of compulsive behavior, in an endeavor to "undo" such thoughts or past actions.

In this aspect of OCD, helping a person past an "all or nothing" viewpoint of life, to realize that we are acceptable despite our imperfections and that perfection is not expected or demanded, can be important psychological and spiritual lessons to learn, both acknowledging such, and making it a part of one's psyche. Some religions teach a very strict view of sin, fundamentalist religions that might stress obedience through fear. Others might have been raised by overly demanding parents, or parents who were abusive, or who never gave approval. These thought patterns are not easy to erase. This type of thinking, then can contribute to the thought patterns that contribute to obsessive thoughts.

From the role of a psychologist or that of a pastor or other counselor, a person needs to be helped to realize that perfection is not expected of them, that God does not expect perfection, and also that God is forgiving, especially if a person continues to make efforts in a positive direction. Accepting mercy for oneself and realize that each one has worth can be something of value in changing the thinking that can lead to obsessive thoughts.

The Behavioral Model for OCD is said to be very helpful for many who experience such compulsions. In the therapy involved, a person would be exposed to a situation that leads to obsessive-compulsive behavior and helped through the situation. Repeated success in controlling the compulsion or overcoming unreasonable fears, helps a person gain mastery of the situation and confidence.

Though treatment for OCD today might involve pharmaceutical treatment, there is a very high rate of relapse with pharmaceuticals, 80-90%. For this reason, behavioral treatment is often preferred for OCD. (for those 10% with OCD, which seems to be intractable, neurosurgery techniques have been suggested.)

Before anyone resorts, though, to neurosurgery, in addition to behavioral and cognitive therapies, one might consider also some of the other suggestions found on this site, on the 16 Keys to good mental health, which help to overcome problems associated with OCD, in addition to whatever methods of therapy one chooses.

Behavioral and cognitive therapy are effective because the results are more enduring as new skills are learned and reinforced and new ways of thinking developed.

Thought patterns need to be changed with OCD. The compulsive way of thinking can develop in certain mental environments. Attention might be needed to the time and type of music one listens to. Excessive time with television and devotion to films as a form of recreation can have the effect of locking the mind in a passive mode, that is being constantly directed by external sources, the media. The mind can become weak and open to suggestion. Similarly, sports such as baseball and basketball, can become something of an obsession, the statistics involved with baseball lends itself well to the type of thinking that is associated with OCD. Not to say that playing sports might lead to such thinking, but the passive obsession of following teams and statistics, might lead to such thinking. Baseball is known for being amongst the sports where superstitious thinking is most common among players and coaches, as well as fans, and it is that type or pattern of thinking that for a few, might also lead to obsessions and compulsions.

Art is an excellent therapy for OCD, it calms the mind down, soothes it, helps a person disappear from the intensity of life. Reading the news rather than watching it on television can also be of benefit for some. The news for some, might contribute to fears that can lead to irrational obsessions. Reading the news is more gentle, and it requires more deliberate choice in what articles one will read. It requires more mental energy and strength to read the news rather than to watch it, and if reading becomes a way of life, it can serve the purpose of strengthening the mind. This in turn can help some to gain ground on certain types of mental health disorders.

Finding quiet time with nature, green therapy, is also of value as a therapeutic activity for OCD. Prayer is of value, attention to spiritual needs, as well as the avoidance of pornography, which can set up patterns of thinking of obsessions, compulsions and guilt.

There is much that can be done to overcome the thought processes that lead to obsessive compulsive disorder and it need not be a lifetime difficulty, neither does treatment of OCD necessitate medication.