Obsessive Compulsive Disorder: Children and Adults

Obsessive-compulsive disorder (OCD), formerly considered a type of anxiety disorder, is now regarded as unique condition. It’s a potentially disabling illness that traps people in endless cycles of repetitive thoughts and behaviors. People with OCD are plagued by a recurring and distressing thoughts, fears, or images (obsessions) they cannot control. The anxiety (nervousness) produced by these thoughts leads to an urgent need to perform certain rituals or routines (compulsions). The compulsive rituals are usually performed in an attempt to prevent the obsessive thoughts or make them go away.  

Although the ritual may temporarily alleviate anxiety, the person must perform the ritual one more time when the obsessive thoughts come back. This OCD cycle progresses to the point of taking up hours of the person’s day and significantly interfering with normal activities. People with OCD may aware that their obsessions and compulsions are senseless or unrealistic, but they can’t stop them.

 

Obsessions are involuntary, seemingly uncontrollable thoughts, images, or impulses that occur repeatedly on your mind. You do not want to have these ideas but you can’t stop them. It’s unfortunate that these obsessive thoughts are often disturbing and distracting.  

Compulsions are behaviors or rituals that you feel driven to act out repeatedly. Usually, compulsions are performed in an attempt to make obsessions to go away. For example, if you are afraid of contamination, you might develop an elaborate cleaning rituals. However, the relief won’t lasts. In fact, the obsessive thoughts usually come back stronger. And the compulsive behaviors are often end up causing anxiety themselves as they become more demanding and time-consuming.  

Most people with OCD falls into one of the following categories:

• Washers are afraid of contamination. They usually have a cleaning or hand-washing compulsions. 
• Checkers repeatedly check on things like (oven turned off, door is locked, etc.) that they associate with harm or danger.
• Sinners and doubters are afraid that if everything isn’t perfect or done just right something terrible will happen or they will be punished.
• Counters and arrangers are obsessed with order and symmetry. They may have a superstitions about certain numbers, colors, and arrangements.
• Hoarders fear that something bad will happen if they throw away anything. They compulsively hoard things that they don’t need or use.

Causes of Obsessive Compulsive Disorder:

OCD sometimes runs in families, but no one knows for sure why some people have it while others don’t. Researchers found that the several parts of the brain are involved in fear and anxiety. To learn more about fear and anxiety in the brain, scientists may be able to create the better treatments. Researchers are also looking for ways in which stress and environmental factors may play a role. 

What Are the Symptoms of Obsessive Compulsive Disorder:?

The symptoms of OCD, which are the obsessions and compulsions, may vary. Common obsessions includes:

• Fear of dirt or contamination by germs
• Fear of causing harm to another
• Fear of making a mistake
• Fear of being embarrassed or behaves in a socially unacceptable manner
• Fear of thinking a sinful or evil thoughts
• Need for order, symmetry, or exactness
• Excessive doubt and the need for a constant reassurance
• Common compulsions include:
• Repeatedly bathing, showering, or washing hands
• Refusing to shake hands or touch on doorknobs
• Repeatedly checking things, such as locks or stoves
• Constant counting, mentally or aloud, while performing a routine tasks
• Constantly arranging the things in a certain way
• Eating foods in a specific order
• Being stuck on words, thoughts or images, usually disturbing, that won’t go away and can interfere with sleep
• Repeating specific phrases, words, prayers
• Needing to perform tasks in a certain number of times
• Collecting or hoarding items that has no value

Treatments of Obsessive Compulsive Disorder:

OCD is generally treated with a medication, psychotherapy, or both.  

• Psychotherapy. A type of psychotherapy called cognitive behavior therapy is especially useful for treating OCD. It teaches a person in different ways of thinking, behaving, and reacting to the situations that help him or her feel less anxious or fearful without having obsessive thoughts or acting compulsively. One type of therapy that called exposure and response prevention is especially helpful in reducing compulsive behaviors in OCD. 

• Medication. Doctors also may prescribe medication to help treat OCD. Most commonly prescribed medications for OCD are antidepressants and anti-anxiety medications. 

Antidepressants are used to treat depression, but they’re also particularly helpful for OCD, probably more so than the anti-anxiety medications. They may take on several weeks 10 to 12 weeks for some to start working. Some of these medications may cause an side effects such as headache, nausea, or sleeping difficulty. The side effects are usually not a problem for most people, especially if a dose starts off low and slowly increased over time. Talk to your doctor about any side effects you may have.

Anti-anxiety medications are powerful and there are different types. Many types begins working right away, but they generally shouldn’t be taken for long periods.  

It’s important to know that although antidepressants can be safe and effective for many people, they may be risky for some, especially for children, teens, and young adults. A “black box”—the most serious type of warning that a prescription drug can have has been added to the labels of antidepressant medications. These labels will warn people that antidepressants may cause some people to have suicidal thoughts or attempting a suicide. Anyone taking antidepressants should be monitored closely, especially when they first start the treatment with medications.  

Some people with OCD do better with cognitive behavior therapy, especially in exposure and response prevention. Others will do better with medication. While others do best with a combination of the two. Talk to your doctor about the best treatment for you.  

OCD usually responds well to treatment with certain medications and/or exposure-based psychotherapy, in which people face the situations that causes fear or anxiety and become less sensitive (desensitized) to them. NIMH is a supporting research into new treatment approaches for people whose OCD does not respond well to the usual therapies. These approaches includes combination and augmentation (add-on) treatments, as well as modern techniques, such as a deep brain stimulation.  

What happens if Obsessive Compulsive Disorder is not treated? 

Without treatment, the symptoms of OCD can progress to the point that the sufferer’s life becomes consumed, inhibiting their ability to attend the school, keeping a job, and/or maintain important relationships. Many people with OCD have thoughts about killing themselves, and about 1% complete suicide. 

In terms of the prognosis for the specific symptoms, it’s rare for any to progress to a physically debilitating level. However, problems like a compulsive hand washing can eventually cause complications like the skin becoming dry and even breaking down. Repeated trichotillomania results in unsightly scabs on the person’s scalp. 

Self-help tip 1: Challenge OCD

Refocus your attention

When you’re experiencing OCD thoughts and urges, try shifting your attention to something else.

• You could exercise, jog, walk, listen to music, read, surf the web, play a video game, make a phone call, or knit. The important thing is to do something you enjoy for at least 15 minutes, in order to delay your response to the obsessive thought or compulsion.

At the end of the delaying period, reassess the urge. In many cases, the urge will no longer be quite as intense. Try delaying for a longer period. The longer you can delay the urge, the more it will likely change. 

Write down your obsessive thoughts or worries

Keep a pad and pencil on you, or type on a laptop, smartphone, or tablet. When you begin to obsess, write down all your thoughts or compulsions.

• Keep writing as the OCD urges continue, aiming to record exactly what you’re thinking, even if you’re repeating the same phrases or the same urges over and over.
• Writing it all down will help you see just how repetitive your obsessions are.
• Writing down the same phrase or urge hundreds of times will help it lose its power.
• Writing thoughts down is much harder work than simply thinking them, so your obsessive thoughts are likely to disappear sooner.

Anticipate OCD urges

By anticipating your compulsive urges before they arise, you can help to ease them. For example, if your compulsive behavior involves checking that doors are locked, windows closed, or appliances turned off, try to lock the door or turn off the appliance with extra attention the first time.

• Create a solid mental picture and then make a mental note. Tell yourself, “The window is now closed,” or “I can see that the oven is turned off.”
• When the urge to check arises later, you will find it easier to relabel it as “just an obsessive thought.”

Create an OCD worry period

Rather than trying to suppress obsessions or compulsions, develop the habit of rescheduling them.

• Choose one or two 10 minute “worry periods” each day, time you can devote to obsessing. Choose a set time and place (e.g. in the living room from 8:00 to 8:10 a.m. and 5:00 to 5:10 p.m.) that’s early enough it won’t make you anxious before bedtime.
• During your worry period, focus only on negative thoughts or urges. Don’t try to correct them. At the end of the worry period, take a few calming breaths, let the obsessive thoughts or urges go, and return to your normal activities. The rest of the day, however, is to be designated free of obsessions and compulsions.
• When thoughts or urges come into your head during the day, write them down and “postpone” them to your worry period. Save it for later and continue to go about your day.

Go over your “worry list” during the worry period. Reflect on the thoughts or urges you wrote down during the day. If the thoughts are still bothering you, allow yourself to obsess about them, but only for the amount of time you’ve allotted for your worry period. 

Create a tape of your OCD obsessions

Focus on one specific worry or obsession and record it to a tape recorder, laptop, or smartphone.

• Recount the obsessive phrase, sentence, or story exactly as it comes into your mind.
• Play the tape back to yourself, over and over for a 45-minute period each day, until listening to the obsession no longer causes you to feel highly distressed.

By continuously confronting your worry or obsession you will gradually become less anxious. You can then repeat the exercise for a different obsession. 

Self-help for OCD tip 2: Take care of yourself

Practice relaxation techniques

While stress doesn’t cause OCD, a stressful event can trigger the onset of obsessive and compulsive behavior, and stress can often make obsessive-compulsive behavior worse.

• Mindful meditation, yoga, deep breathing, and other stress-relief techniques may help reduce the symptoms of anxiety brought on by OCD.
• Try to practice a relaxation technique for at least 30 minutes a day.

Adopt healthy eating habits

Start the day right with breakfast, and continue with frequent small meals throughout the day. Going too long without eating leads to low blood sugar, which can make you feel more anxious.

• Eat plenty of complex carbohydrates such as whole grains, fruits, and vegetables. Not only do complex carbs stabilize blood sugar, they also boost serotonin, a neurotransmitter with calming effects.
• Exercise regularly
• Exercise is a natural and effective anti-anxiety treatment that helps to control OCD symptoms by refocusing your mind when obsessive thoughts and compulsions arise.
• For maximum benefit, try to get 30 minutes or more of aerobic activity on most days. Aerobic exercise relieves tension and stress, boosts physical and mental energy, and enhances well-being through the release of endorphins, the brain’s feel-good chemicals.

Avoid alcohol and nicotine

Alcohol temporarily reduces anxiety and worry, but it actually causes anxiety symptoms as it wears off. Similarly, while it may seem that cigarettes are calming, nicotine is actually a powerful stimulant. Smoking leads to higher, not lower, levels of anxiety and OCD symptoms. 

Get enough sleep

Not only can anxiety and worry cause insomnia, but a lack of sleep can also exacerbate anxious thoughts and feelings. When you’re well rested, it’s much easier to keep your emotional balance, a key factor in coping with anxiety disorders such as OCD. 

Self-help for OCD tip 3: Reach out for support

Obsessive-compulsive behavior (OCD) can get worse when you feel powerless and alone, so it’s important to build a strong support system. The more connected you are to other people, the less vulnerable you’ll feel. Just talking about your worries and urges can make them seem less threatening. 

Stay connected to family and friends

Obsessions and compulsions can consume your life to the point of social isolation. In turn, social isolation can aggravate your OCD symptoms. It’s important to have a network of family and friends you can turn to for help and support. Involving others in your treatment can help guard against setbacks and keep you motivated. 

Join an OCD support group

You’re not alone in your struggle with OCD, and participating in a support group can be an effective reminder of that. OCD support groups enable you to both share your own experiences and learn from others who are facing the same problems.  

Helping a loved one with obsessive-compulsive disorder (OCD)

If a friend or family member has OCD, your most important job is to educate yourself about the disorder. Share what you’ve learned with your loved one and let them know that there is help available. Simply knowing that OCD is treatable can sometimes provide enough motivation for your loved one to seek help. 

Tips for helping a family member or friend with OCD

The way you react to a loved one’s OCD symptoms can have a big impact.

• Criticism or negative comments can make OCD worse, while a calm, supportive environment can help improve the outcome of treatment. Focus on the sufferer’s positive qualities and avoid making personal criticisms.
• Don’t scold someone with OCD or tell the person to stop performing rituals. They can’t comply, and the pressure to stop will only make the behaviors worse. Remember, your loved one’s OCD behaviors are symptoms, not character flaws.
• Be as kind and patient as possible. Each sufferer needs to overcome problems at their own pace. Praise any successful attempt to resist OCD, and focus attention on positive elements in the person’s life.
• Do not play along with your loved one’s OCD rituals. Helping the sufferer with rituals will only reinforce the behavior. Support the person, not their rituals.
• Create a pact to not allow OCD to take over family life. Sit down as a family and decide how you will work together to tackle your loved one’s OCD symptoms. Try to keep family life as normal as possible and the home a low-stress environment.
• Communicate positively, directly and clearly. Communication is important so you can find a balance between standing up to the OCD and not further distressing your loved one.
• Find the humor. Seeing the humor and absurdity in some OCD symptoms can help the sufferer become more detached from the disorder. Of course, a situation is only humorous if the sufferer finds it funny, too.