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Anxiety Disorders - Obsessive Compulsive Disorder (OCD)

Definition

Everyone experiences anxiety at some point in their life. Sometimes when we’re stressed or overwhelmed, we can fixate on thoughts or feelings, even when we want to move on and feel or think of something else. This is fairly normal. Many people become fixated with thoughts or activities, and it does not significantly interfere with their relationships or quality of life.

If these intrusive thoughts become an ongoing problem and start interfering with life, it might be a form of Anxiety Disorder called Obsessive Compulsive Disorder (OCD). The obsessive thoughts people with OCD experience are often disturbing or frightening, and can cause a great deal of anxiety. Many people with OCD feel like they must accompany these thoughts with a compulsive action or ritual, to make the thought go away.

To understand Obsessive Compulsive Disorder, it might be helpful to understand what “obsessions” and “compulsions” are:

Obsessions: Unwanted and intrusive thoughts, images, or urges that are persistent and cause a great deal of anxiety or distress. These obsessions are often not rooted in fact, or the fear is out of proportion to the threat.

Compulsions: Repetitive behaviours (e.g. washing, checking, ordering, etc.) or mental acts (e.g. praying, counting, repeating phrases, etc.) that are carried out to reduce the anxiety caused by the obsessions.

OCD can be extremely distressing and debilitating. When someone has Obsessive Compulsive Disorder (OCD), they cycle between having intrusive thoughts and performing compulsive acts or rituals. The compulsions might help to temporarily calm the obsessive thoughts, but then the cycle starts over again. Although obsessions are illogical, unwanted and unrealistic, they are difficult to stop or ignore. People with OCD can spend a lot of time every day worrying about obsessions or carrying out rituals; this can disrupt one’s life and relationships.

Obsessive Compulsive Disorder is different for different people. For some, symptoms can begin in childhood and for others it may develop later. Some common intrusive thoughts/obsessions revolve around cleanliness or contamination (e.g. germs, dirt, etc.), exact order, or thoughts of harming self or others. However, obsessive thoughts are not always about these subjects. Obsessive thoughts can be about nearly anything.

An important thing to remember is that someone with obsessive thoughts of harming themselves or others is extremely unlikely to actually carry out the thoughts. They are no more dangerous than someone without the condition.

Some common compulsions might include repetitive hand washing, checking and re-checking things, performing certain tasks in an exact and repetitive manner, cleaning and arranging compulsively or repetitive counting/chanting. These are common, but do not describe everyone’s experience with OCD. Some people have different kinds of compulsions. In some cases, an individual with OCD may have obsessive thoughts without clear or easy-to-identify compulsions that follow.

OCD is not:

  • The result of any actions or personal failures of the individual.
  • A sign or result of low intelligence or weakness.
  • A funny or weird personality trait or “quirk”.
  • The same as being a perfectionist or really tidy.
Causes

Like all mental health issues, Obsessive Compulsive Disorder (OCD) is complicated. The causes and risk factors can include a number of things working in combination, like genetics, biology, personality environmental or life experiences.

Some possible causes or triggers for OCD could include:

  • Family history – anxiety disorders, including OCD, can run in families.
  • Learned behaviour – behaviours can be learned over time starting as early as childhood.
  • Genetics/biology – it is believed that OCD has a neurological basis.
Signs and Symptoms

Below is a list of signs and symptoms for Obsessive Compulsive Disorder (OCD). The following list should not be used to diagnose yourself or someone else. It is only intended to provide general information. If you think you might be experiencing a mental illness, you should see your doctor.

These symptoms might not be present all the time, and may get worse with stress. You might notice that many of these signs or symptoms could be explained by any number of issues, not just OCD. Also, remember that every person is different. These symptoms might not describe every person's experience with OCD.

Examples of some common obsessions:

  • Contamination by dirt, germs, or other diseases (e.g. by shaking someone’s hand, door handles, etc.).
  • Forgetting to do something that could cause harm (e.g. turning off the stove, locking the door, etc.).
  • Things not being "just right"; distress when things are shifted or touched.
  • Extreme and often irrational focus on exactness and order.
  • Having blasphemous thoughts (e.g. against God, against religion, thoughts that feel “unholy”, etc.); preoccupation with religious images and thoughts.
  • Thoughts of harming oneself (e.g. while eating with a knife or a fork).
  • Thoughts of harming others (e.g. harming babies, pushing someone in front of a train, etc.).
  • Forbidden or unwanted sexual thoughts, images or urges (e.g. recurrent pornographic images).
  • Thoughts that cause the individual significant distress and that feel like they can’t be stopped.

Examples of some common compulsions:

  • Rules and rituals; performing the same action repeatedly.
  • Avoidance of situations that can trigger obsessions, such as avoiding touching things someone else has touched.
  • Washing, such as washing one’s hands or face excessively.
  • Cleaning excessively.
  • Checking things multiple times (e.g. making sure you turned your lights off many times; driving home to double check, etc.).
  • Arranging things such as arranging your canned goods to face the same way.
  • Counting everything or counting in a certain pattern, such as counting footsteps as you walk.
  • All compulsions are excessive, are performed to get rid of obsessions temporarily, and interfere with the person’s ability to live their life.

Other thoughts, feelings, behaviours:

  • Excessive worrying.
  • Feeling apprehensive.
  • Feeling irritable.
  • Difficulty concentrating.
  • Feeling powerless.
  • Sense of impending danger, panic or doom.

When someone is experiencing anxiety because of their obsessive thoughts, they can have physical symptoms like:

  • Upset stomach, nausea or diarrhea.
  • Experiencing muscle tension.
  • Feeling restless or wound up.
  • Having sleep difficulties.
  • Feeling weak or tired.
  • Trembling.
  • Rapid heart rate.
  • Rapid breathing.
  • Excessive sweating or sweaty palms.
Help

Obsessive Compulsive Disorder (OCD) is treatable. For OCD or any other mental health concern, if signs or symptoms are interfering with your life in any way, it’s time to seek help. You don’t have to wait for things to get really “bad” before seeking help.

If OCD is causing situations where your obsessions and compulsions are interfering with your work, school, relationships or other parts of your life, it’s probably time to talk to someone. That someone could be a friend you trust, a teacher, your family doctor, a crisis line, or counsellor.

If it is a friend you are concerned about, they may resist help or not even recognize that they need it. Obsessive thoughts are hard to let go of, and people experiencing obsessions and compulsions can feel trapped and powerless to stop. They might need you to make the first step.

As always, if you feel like you or your friend might hurt him/herself or someone else, it’s time to call emergency services.

Visit the Help Section to find out how to get help for yourself or a friend.

Treatment

Like other mental health issues, Obsessive Compulsive Disorder (OCD) and how it is experienced will differ from person to person. Because each case is unique, the treatment will likely be unique for each individual.

OCD can be treated with specific types of therapy, like Cognitive Behavioural Therapy (where you learn coping strategies and ways to deal with troubling thoughts, feelings and behaviours) and support groups (where you can connect with others going through similar situations and support one another).

Counselling to learn coping skills and relaxation techniques and ways to disrupt compulsive behaviours may also help a person deal with OCD.

Family members of someone who has OCD may participate in therapy, support groups or benefit from learning about it and ways to support their loved one at home.

Medication can also be helpful to help stabilize someone enough to get the most out of therapy, counselling and living life. Every person is different, so if medication is used, it may take a while to find the medication that works best for you.

Sometimes spending time in a treatment clinic or hospital is necessary, while for others, outpatient (getting help for a professional without having to actually “stay over” in a hospital) is better.

If you have to wait to get an appointment, there are many places that offer support while you wait. Find out where to call in your area.

Along with treatment from your doctor or therapist, there are things you can do to help and support your own recovery.

Every story is different, and sometimes people need to try different types of supports before they find the right plan for them. Be patient, and don’t give up.

A person living with OCD, like any other person, will benefit from maintaining wellness and having good supports in their life. 

Myths

Sometimes when we see a character or situation in the media that portrays OCD it is inaccurate or trivializes the illness as something funny or unflattering. Here are some other common myths and misconceptions about OCD:

Myth: “I really love keeping things neat and organized. I’m so OCD!”

Fact: Many people throw around the term “OCD” to describe people who like organization or control. Saying “I’m so OCD” because you like your home clean or your notes organized contributes to the idea that OCD is not a real illness and trivializes what is a very distressing and debilitating illness for some. OCD is not a funny or quirky character trait. It’s an illness that many people live with and require treatment for. It is anxiety provoking, and interferes with a person’s ability to live a full life.

Myth: OCD is all about being neat and clean.

Fact: Although keeping things clean is a common compulsion, it is not necessarily a symptom shared by everyone with OCD. There are many other compulsions someone might have. Conversely, not everyone who is neat and clean has OCD. Once again, OCD is only diagnosed if the compulsion is distressing or debilitating, and caused by obsessive thought.

Myth: Everyone with OCD has anxiety about germs.

Fact: Again, this is only one possible symptom. Although it is common, everyone experiences the illness differently.

Myth: OCD isn’t treatable, people just need to deal with the symptoms.

Fact: OCD is treatable through medications and psychotherapy. While OCD cannot typically be cured, proper treatment can lead to increased control of the illness and increased quality of life.

Myth: OCD is an excuse for people that are picky and controlling. They should just stop it!

Fact: People are not diagnosed with an anxiety disorder unless it's much more overwhelming and impairing than the typical anxiety people feel. People with OCD need treatment to manage their thoughts and compulsions. Having a disorder has nothing to do with a person’s “strength”. It is a combination of genetics, psychological, and environmental factors that lead to the illness. Telling someone who has an anxiety disorder like OCD to “just stop it” is like telling someone who needs glasses to “just see better”. It just doesn’t work that way.

Myth: OCD is caused by poor upbringing, family dysfunction or low self-esteem.

Fact: The causes of OCD are not entirely understood. It seems to be triggered by any number of factors including upbringing, biological/genetic factors or learned behaviours. Many people who come from caring, supportive families can still be at risk of developing an anxiety disorder like OCD.

Myth: OCD is just a quirky or funny part of someone’s personality.

Fact: While some personality types may be more predisposed to developing Obsessive Compulsive Disorder, it is not a character trait. It’s an illness that can be extremely frustrating and debilitating. OCD is treatable and not necessarily part of who someone is permanently.

Support

Supporting someone with any type of serious illness can be challenging. Ways to help and support a friend or loved one who is living with Obsessive Compulsive Disorder:

  • Know the signs and symptoms of OCD and other anxiety disorders.
  • The anxious worries, obsessions and compulsions someone has when they have OCD may not make any sense to you, but they feel very urgent to the person dealing with them. Instead of trying to apply logic or explain the fears away, try thinking of a time when you were really worried and try to empathize with how your friend is feeling.
  • You may want to help your friend or make their life easier by assisting them with their rituals. This may not be helpful for someone who is in treatment and trying to learn to cope with thoughts and behaviours on their own.
  • Try to avoid being critical. Someone who has OCD is likely already really critical of themselves and knows that their thoughts and behaviours are irrational. They probably need someone around who is non-judgemental.
  • Treatment is a process. Medications and therapy can take time to help. Be aware of this and try to be supportive as your friend adjusts.
  • Be a sounding board. Listening without judgement and without trying to “fix” their problems can be incredibly helpful.
  • Ask your friend how else you can help. It may be as easy as just providing a distraction, or asking them to do simple, relaxing things with you (like hanging out, watching a movie etc.).
  • If your friend is in the hospital, go and visit them if you are able. The hospital may be scary and overwhelming for them and a friendly face can help. Make sure to ask about visitor rules first.
  • Encourage professional help for your friend when needed (see Help Section)
  • Set some boundaries for yourself, and take care. You can’t help someone if you’re feeling overwhelmed yourself.

 

See the Help Section for more info about helping a friend and self care. 

More on mindyourmind.ca

A poem submitted by a young person about their experience with Obsessive Compulsive Disorder.

Andy’s Story, a video featuring a young person talking about his experience with OCD.

Resources

The information on this page is a simple overview of a complicated health issue. The content has been taken from CAMHCMHA, and the Anxiety Disorders Association of Canada. For more in-depth information, please visit these sources or speak to a medical professional.

Ontario – call ConnexOntario to find out where there are mental health supports in your community.

Crisis – in any situation where someone is at risk of hurting themselves or others, call 911 or a local crisis line.

Please see the Help Section for more information and resources. 

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