We are usually given a somewhat humourous example of a neurotic person obsessed with germs and washing, who needs things to be exactly in order or who repeatedly checks to make sure the door is locked or the stove turned off. A good example of this is Jack Nicholson’s character from the movie As Good As It Gets.
Although these characters can be funny on the silver screen, the real disorder is not a laughing matter.
Obsessive compulsive disorder (OCD) affects between one and two per cent of the population and is characterized by recurrent thoughts, impulses or images that are experienced as intrusive or inappropriate and that cause anxiety or distress.
The disorder is split into obsessions and compulsions. Obsessions are anxiety inducing thoughts and compulsions are repetitive behaviours or mental acts that the person feels driven to do in response to an obsession, and in order to relieve their anxiety.
A common example is the well-known obsessive worry about dirt or germs followed by excessive washing to remove contamination. Others can include anxiety that something bad will happen as a result of a forgotten action such as locking the door, which is followed by repeated checking. Counting, repeating, hoarding and endlessly rearranging objects in an effort to keep them in precise alignment are other examples of compulsive behaviours.
Unlike other compulsive habits such as drinking or drug abuse, the person suffering from Obsessive Compulsive Disorder is not repeating compulsions to provide pleasure.
Most people with OCD are attempting to ward off harm from their obsessive thoughts by repeating their compulsive behaviours. Some do this with regimented rituals that are the same each time, while others have rituals that are complex and change frequently. These rituals may give the person some relief from their anxiety, but it is temporary.
An important distinction needs to be made when diagnosing OCD. This involves the level of disturbance the obsessions and compulsions are causing. In order to be diagnosed with the disorder, the anxiety must cause significant distress and interfere with daily activities. Usually, compulsive behaviours take up more than an hour a day and can be much more time consuming than that.
Many people can be described as ‘compulsive’ simply because they hold themselves to a high standard, are perfectionists or are very organized. This type of compulsiveness can often serve a valuable purpose in assisting the person and contributing to self esteem and work performance. If extreme enough to interfere with functioning, it can constitute an obsessive-compulsive personality disorder.
Most people who experience OCD recognize at some point that their obsessions are excessive or unreasonable. Often, the individual is ashamed of these thoughts and behaviours and attempts to hide them from others. Unfortunately, this means that it can take many years before people seek help for their disorder.
Effective treatment is available for OCD. Treatment usually involves cognitive behaviour therapy and/or medication and helps most people resume normal daily activities.
While no single cause is known for OCD, it is believed that there are genetic and biological factors involved. Selective serotonin re-uptake inhibitor medications are the most effective for this disorder.
If you are troubled by recurring disturbing thoughts and feel compelled to perform repetitive behaviours, talk to your family doctor. Help is available.
Dr. Latimer is president of Okanagan Clinical Trials and an Okanagan psychiatrist.
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