Once thought to be rare, OCD is now recognized as a fairly common disorder, with a lifetime prevalence of 2% to 3%. OCD is a typically a chronic disease, and is associated with significant suffering and functional impairment. Because of its prevalence, chronicity, and disabling nature, OCD was identified by the World Health Organization as one of the world’s top ten causes of illness-related disability.
OCD Symptoms, Onset, and Course
OCD is characterized by intrusive, unwanted, distressing thoughts, urges, or images (i.e., obsessions) and by repetitive behaviors or mental acts that the patient feels driven to perform in response to an obsession (i.e., compulsions). The repetitive behaviors or mental acts are aimed at preventing or reducing distress or preventing some dreaded event or situation; however, these behaviors or mental acts either are not connected in a realistic way with what they are designed to neutralize or prevent, or are clearly excessive. A diagnosis of OCD also requires that the obsessions or compulsions cause marked distress, are time consuming (take more than one hour per day), or significantly interfere with the person’s normal routine, occupational or academic functioning, or usual social activities or relationships.
OCD usually begins in adolescence or adulthood, although it can start in childhood. Onset after age 50 is rare. There is no gender difference in prevalence of OCD, but onset is typically earlier in males than females.
Most OCD patients have a chronic waxing and waning course, but some have a deteriorating course and others have an episodic course (they have periods of wellness between OCD episodes).
Examples of different types of obsessions and compulsions in patients with OCD:
A patient with contamination obsessions feared contracting a fatal illness when she touched anything that was not sterile; this led to elaborate hand washing rituals (e.g., handwashing with antibacterial soap for more than 2 hours per day until her hands were red and raw, cleaning items bought in the grocery store with bleach) and avoidance of public places (e.g., bathrooms, restaurants, swimming pools).
A patient with symmetry obsessions felt extreme discomfort if things were not in the right place or if things were not done properly; this led to ordering and arranging rituals (e.g., spending hours aligning objects in his home) and to repeating rituals (e.g., re-reading the same passage in a book for hours, rewriting letters if a dot over an “I” was not perfectly centered.)
A patient with hoarding obsessions and compulsions could not bear objects going to waste to the point that she couldn’t even walk past a public trash can without finding some object to bring home; unable to discard any of her accumulated objects, she rented increasing amounts of storage space once her own home was full, eventually becoming bankrupt in the process.
A patient with sexual obsessions had near constant intrusive images of having sex with his mother and grandmother; in response to these intrusions, he performed different mental compulsions, including repeating special prayers in a set manner and mentally repeating certain words and images.
A patient with aggressive obsessions had intrusive fears that he would harm others; this led him to avoid potentially hazardous situations whenever possible (e.g., driving) and to perform checking rituals to try to reassure himself that he had not already caused harm (e.g., mentally reviewing conversations for misinformation he might have given, listening hourly to the news for accidents he might have inadvertently caused).
Obsessive Compulsive Disorder Treatment Options:
There are several effective treatments for OCD, typically used in combination with psychotherapy. Dr. Fairweather will formulate a specific treatment plan based on your unique set of symptoms.