Understanding Obsessive-Compulsive Disorder – Got Anxiety?

Nearly 90 percent of the population experience occasional unpleasant intrusive thoughts or images (obsessions) that typically revolve around themes of aggression and harm.

Examples would include thoughts or images of jumping in front of an oncoming train; killing another individual; physically or sexually abusing a child; intentionally driving one’s car into another person, etc.

When mental intrusions such as these occur “out of the blue,” most people have no problem easily dismissing them as silly or unimportant, nor do they experience negative emotions such as anxiety, guilt or disgust following the obsessive thought.

In addition, these individuals feel no need to perform extensive, time-consuming rituals for the purpose of lessening their emotional discomfort, or to prevent harm from occurring to themselves, those they love, or a perfect stranger.

However, individuals who evidence a clinical diagnosis of Obsessive-Compulsive Disorder (OCD), tend to place a great deal of over-importance on their obsessive thoughts, thus triggering a sense of extreme emotional distress — primarily anxiety.

These feelings of anxiety elicit a strong need to “neutralize” or “undo” particular thoughts and images by engaging in a repetitive, seemingly senseless, array of compulsions (rituals).

Those with OCD believe that these rituals serve the purpose of (a) temporarily lowering their anxious arousal, and (b) help to prevent the occurrence of harm to self or others, due to a sense of over-responsibility concerning the content of their mental intrusions.

The majority of ritualistic behaviors performed by individuals who have a diagnosis of Obsessive-Compulsive Disorder tend to be directly related to a specific type of obsession.

For example, someone who is fearful of contamination will typically alleviate their anxiety by performing washing and cleaning rituals.

An individual who frequently doubts whether he or she has turned off an electrical appliance before leaving home will compulsively check and re-check to ensure this task has been performed.

Someone who becomes anxious at the sight of objects that are not symmetrically arranged in the proper order may engage in compulsions related to arranging, straightening, counting, or any other ritualistic behavior directed at correcting the situation until it feels “just right” or “perfect.”

Those with OCD recognize that their ritualistic behaviors are not reasonable, yet they have a great deal of difficulty controlling them. In addition, these rituals tend to significantly interfere with daily functioning, oftentimes taking up to 4-7 hours per day to perform.

Seen below, is a brief summary regarding the prevalence, course of development, causes, and the primary co-occurring disorders typically associated with Obsessive-Compulsive Disorder.

PREVALENCE & COURSE OF DEVELOPMENT

7.5 million of the general population (1 in 40)

3rd most common psychological disorder

Slightly > half are female

Average age of onset for males is 13-15 years

Average age of onset for females is 20-24 years

Rarely develops after the age of 35 years

Intellectual abilities are typically in the high average IQ range

Onset is usually gradual, unless associated with trauma

Childhood onset seen more in males, but symptoms tend to fluctuate

Treatment is typically sought 7-10 years following symptom onset

Often the cause of serious marital problems

CO-OCCURRING DISORDERS

Depression

Tics/Tourette’s Syndrome

Body Dysmorphic Disorder (BDD)

Trichotillomania (hair-pulling)

Another anxiety disorder such as panic, social anxiety or generalized anxiety

CAUSES

Genetic predisposition

Neurochemical (insufficient serotonin levels)

Neuroanatomical (over-reactive activity of specific brain sites)

Childhood autoimmune diseases (Rheumatic fever, Sydenham’s Chorea, PANDAS)

Environmental vulnerabilities (traumatic life experiences, major life transitions, etc.)

Obsessive-Compulsive Disorder is perhaps the most complicated, as well as misunderstood anxiety disorder. As mentioned earlier, persons with OCD experience obsessions in the form of unwanted intrusive thoughts, images, or urges that create significant emotional distress — typically feelings of extreme anxiety, guilt and/or disgust.

Following the experience of these negative emotional states, the individual then makes exaggerated predictions regarding the future occurrence of some catastrophic event that he or she believes can only be prevented by engaging in a particular ritual over and over again.

The ritual may be performed in one’s mind (mentally rehearsing a phrase, visualizing a particular image) or their actions (excessive hand washing, rearranging objects in a specific manner). If the ritual is not performed correctly by following a very specific set of self-imposed rules, the person feels solely responsible should the predicted catastrophic future consequence materialize.

In part 2 of this series, we’ll detail the nature of Obsessions and Compulsions, focusing primarily on their defining features.

Barry C. Barmann, Ph.D., is a Licensed Clinical Psychologist in Nevada and California. His wife, Mary B. Barmann, MFT, is a licensed Marriage and Family Therapist in California. Barry may be reached for comment at barry@behaveanalysis.com; visit anxietytreatmentinclinevillage.com to learn more.