NAMI Mercer County

Families Meeting the Challenge of Mental Illness

obsessivecompulsivedisorder

Observing OCD

By

Angelina Villalva, NAMI Intern

Have you ever entered a space and felt something was off? Perhaps it’s a slightly off-centered painting in a living room. Or some books haphazardly placed on a shelf without order. Sometimes it’s not even a space, but a thing, looking in the mirror and seeing that you have one hoodie string that is ever so-slightly longer than the other. 

While small, almost imperceptible to anyone else, to you these details scream out that something is markedly incorrect, and needs to be fixed immediately. To other people, these things may not matter, but for someone who strives for absolute perfection, it is imperative to have things the right way. As my mother liked to tell me growing up, “a place for everything and everything in its place.” 

Some may call it obnoxious, while others may call it obsessive. Most will say it is a clear sign of OCD, a Type A person who needs to have their whole life orderly and refined, all the way down to the laces on their shoes. 

The truth is, OCD is not as simple as needing to organize and keep things clean. It is distressing, and takes control over people’s lives in a way that causes them extreme anxiety and in some cases, physical harm. 

While exaggerated, it is true to some extent that individuals diagnosed with OCD may have issues with cleanliness and organization. However, this is not just due to a simple need to have things perfectionistic, but from feelings and thoughts referred to as obsessions and compulsions (which of course come together to an Obsessive Compulsive Disorder). 

Obsessions consist of lasting and unwanted thoughts that keep recurring. These unwanted thoughts are similar to intrusive thoughts, often relating to fears and horrible imaginations that can completely take over your headspace. Some common themes of obsessions include: 

  • Fear of contamination or dirt
  • Having a hard time dealing with uncertainty
  • Needing things to be orderly or balanced
  • aggressive/horrific thoughts about harming yourself/others
  • Unwanted thoughts including aggression, sexual, or religious subjects

These obsessions then lead into compulsions, repetitive behaviors that are meant to reduce anxiety related to the obsessions. Compulsions are sometimes referred to as rituals, as individuals who have these compulsions often partake in them at specific times and must be completed in a specific way. While meant to reduce the anxiety of obsessions, compulsions often result in no pleasure and provide limited relief from the obsessions. Common themes of compulsions may be: 

  • Washing and cleaning
  • Checking
  • Counting
  • Ordering
  • Following strict routine
  • Demanding reassurance

Compared to obsessions, compulsions can result in physical harm. For example, obsessions revolving around cleanliness and contamination of germs can result in having compulsions of hand-washing until skin becomes raw. If an individual with OCD does not complete these compulsions, they will fear something bad may happen to themselves or the people around them (friends/family). 

Currently 1-2% of people in the US are affected by OCD. Anyone can be affected, although the average age onset is around 19 years. Causes of OCD can occur due to childhood trauma, genetics (family heredity), brain changes (damage to frontal cortex and subcortical structures) and PANDAS syndrome. 

Treatments for OCD include several types of therapy and medication. The three types of therapy treatments include cognitive behavioral therapy (CBT), exposure and response prevention (ERP), and acceptance and commitment therapy (ACT).

  • CBT → helps to examine and understand thoughts/emotions
  • ERP → helps to expose individuals to feared situations 
  • ACT → helps to learn to accept obsessive thoughts as just thoughts and take power away from them

Current medication for OCD are SSRIs (selective serotonin reuptake inhibitors). There are several types of SSRIs, and it is important to consult with a doctor to determine which one may be the right treatment for you or someone you know. When taking medication for OCD, it often takes 6-12 weeks to see improvement, so it’s important to allow for time for the medication to work. 

OCD is a lifelong condition. Similar to most other mental health conditions, ensuring that you take care of both your physical health and mental health will allow for the most influential positive change. Participation and support of others in treatment such as friends and family may improve the likelihood of treatment success. 

For anyone who is living with OCD, always remember that your struggles are not small. Your fears are not silly.  It is okay to receive help and support. And you will be able to take back control of your life. QOTD by Ralph Waldo Emerson, “Do the thing you fear and the death of fear is certain.” 

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