Obsessive Compulsive Disorder

Obsessive compulsive disorder (OCD) is placed in the anxiety class of mental illness. OCD is manifested in a variety of forms, but is most commonly characterized by a subject's obsessive and repetitive distressing or intrusive thoughts and related compulsions (tasks or rituals) which attempt to neutralize the obsessions. OCD symptoms cause distress, take up a lot of time (more than an hour a day), or significantly interfere with the person's work, social life, or relationships. Unlike compulsive drinking or gambling, OCD compulsions do not give the person pleasure.

However, as you look at the symptoms of OCD, you can view them as extreme forms of ordinary personality traits that many people have to varying degrees. 2.3% of the U.S. population has OCD in a given year (twice that many have had it at some point in their lives). Many more people demonstrate obsessive compulsive traits. Under most circumstances, those traits will not interfere with a person's life the way that an obsessive compulsive disorder does, but they can be considered as risk factors for developing full-blown OCD. For example, we all differ in the degree to which we display something called thought-action fusion (a breakdown in the distinction between performing an action and just thinking about it). Probably everybody has superstitious beliefs. Can you jinx someone just by thinking of something good (or bad) happening to them? How far out of your way do you go to avoid walking under a ladder? Do you have lucky socks or a lucky color or number you repetitively wear or play? Can you leave your home without it being totally tidy? Do you crave reassurance? Do you find yourself rechecking things? Do you re-read/re-write your reports many times? These all could be symptoms of obsessive compulsive disorder.

The Facts

OCD typically begins during adolescence or early childhood; at least one-third of the cases of adult OCD began in childhood. It affects men and women equally. OCD is a medical brain disorder that causes problems in information processing which can start at any time from preschool age to adulthood (usually by age 40). On average, people with OCD see three to four doctors and spend over nine years seeking treatment before they receive a correct diagnosis. Studies have also found that it takes an average of 17 years from the time OCD begins for people to obtain appropriate treatment. Sufferers are generally of above-average intelligence, as the very nature of the disorder necessitates complicated thinking patterns.

The OCD Process

Obsessions are recurrent and persistent thoughts, impulses, or images that cause marked anxiety or distress. These thoughts, impulses, or images are not simply excessive worries about real-life problems. The person attempts to ignore or suppress such thoughts, impulses, or images, or to neutralize them with some other thought or action. Compulsions are repetitive behaviors or mental acts that the person feels driven to perform in response to an obsession, or according to rules that must be applied rigidly. The behaviors or mental acts are aimed at preventing or reducing distress or preventing some dreaded event or situation. The person recognizes that the obsessive thoughts, impulses, or images are a product of his or her own mind, and the sufferer realizes that his/her obsessions or compulsions are unreasonable or excessive. The obsessions or compulsions must be time-consuming (taking up more than one hour per day) to be considered a "disorder." The disorder causes distress or impairment in social, occupational, or school functioning.

Common Obsessions
(broken down by category)

• Contamination Obsessions: concern with
• dirt or germs
• environmental contaminants
• bodily waste or secretions
• illness/disease
• animals/insects
• pregnancy
• fear of blood
• fear of eating certain foods
• bothered by sticky substances or residues
• Symmetry, Order, Exactness and "Just Right" Obsessions: need for symmetry or exactness in
• dressing
• grooming
• item placement
• eating
• fear of saying the wrong thing or not saying it "just right"
• need to know or remember
• Safety, Harm and Violent Obsessions
• fear of harm to self or others due to carelessness or on impulse
• fear of being responsible for terrible events
• fear of blurting out obscenities or insults
• fear of doing something else embarrassing
• fear of violent or horrific images
• Hoarding/Saving Obsessions
• need to hoard or save things
• fear of losing objects, information, people, something symbolic
• Other common obsessions include
• pathological doubting or indecisiveness
• excessive concern with functioning of, or injury, to a body part
• colors/numbers with special significance
• superstitious fears
• lucky or unlucky numbers, colors, or clothing
• intrusive meaningless thoughts/images or nonsense sounds, words or music.
• Common Compulsions
  Compulsive thoughts or behaviors are carried out to reduce the anxiety of the person's obsessions. Common compulsions include:
• excessive grooming/cleaning
• counting objects or up to a certain number over and over again
• saving, collecting or hoarding
• touching, tapping or rubbing certain objects repeatedly
• repetition of special words or images mentally
• special prayers
• mental counting
• list making and reviewing
• blinking or staring rituals
• excessive checking of drawers, door locks and appliances to be sure they are shut, locked or turned off
• repetition of normal activities, such as going in and out of a door, sitting down and getting up from a chair
• ordering and arranging items in certain ways
• seeking constant reassurance and approval
• excessive list making
• needing to confess
• excessive rereading or rewriting
• superstitious behaviors
• ritualized eating behaviors
• excessive checking oneself for signs of a catastrophic disease

Some people with the disorder still maintain successful careers and relationships as many find ways to hide or suppress their obsessive-compulsive behavior related to feelings of shame/embarrassment. The list of celebrities with this disorder is impressive: Ludwig von Beethoven, Jose Conseco, Winston Churchill, Francis Ford Coppola, Carrie Fisher, Margot Kidder, J.P. Morgan, Axl Rose, Cole Porter, Roseanne Barr, Michelangelo, Stanley Kubrick, Harrison Ford, Billy Bob Thornton, Warren Zevon, Kathie Lee Gifford, Howard Stern, Cameron Diaz, Albert Einstein, Charlie Sheen and Michael Jackson. Donald Trump is terrified of germs. He refuses to touch the ground floor button of a lift and avoids shaking hands with people--especially teachers. He is quoted as saying, "I'm going to do everything in my power not to shake hands with teachers. They have 17,000 germs per square inch on their desk. That's ten times the germ rate of those in other professions. Howie Mandel's germ obsession led him to build a second "sterile" house where he can retreat if he fears catching germs from anyone, including his family. The last half of Howard Hughes' life was spent in almost total isolation due an irrational fear of infection. By the end he refused to have any physical contact with any human being.

Treatment

Treatment for OCD involves a combination of psychopharmacology and behavioral therapy. A type of behavioral therapy known as "exposure and response prevention" has been proven very effective in treating OCD. In this approach, a person is deliberately and voluntarily exposed to whatever triggers the obsessive thoughts and then is taught techniques to avoid performing the compulsive rituals and to deal with the anxiety. Medication treatments include selective serotonin reuptake inhibitors (SSRIs), such as Paxil, Aropax, Prozac and Luvox, as well as tricyclic antidepressants.

Tips for Law Enforcement Officers on Scene

• Make contact face to face
• Use a soft, gentle approach.
• Treat the sufferer with respect and dignity.
• Remain calm and factual but caring and supportive.
• Show patience. OCD has phases. It gets better at some times and worse at others. You may have another call about the subject.
• Evaluate the situation for safety: person and dependents
• Evaluate the need for paramedic response, especially in elderly hoarders.
• Refer the subject to his/her primary practitioner for a mental health evaluation.
• Go slowly and expect gradual changes.
• Reassure the person that others will try to help and work with him/her.
• Attempt to involve family.
• Work with other agencies to maximize resources.
• Provide Hotline Referral Numbers
• OCD Hotline: 1-800-639-7462
• Anxiety Hotline: 1-888-ANXIETY (1-888-269-4389)

• I have upsetting thoughts or images enter my mind again and again.
• I feel like I can't stop these thoughts or images, even though I want to.
• I have things I have to do excessively or thoughts I must think repeatedly to feel comfortable
• I have a hard time stopping myself from doing things again and again, (counting, checking on things).
• I wash myself or things around me excessively.
• I repeat things many times to make sure they are done properly.
• I rearrange objects excessively, things have to be in a certain order.
• I feel like my home, car, wardrobe has to have symmetry.
• I redo things often until it feels right.
• I avoid situations or people because I am worried about hurting them by word or actions.
• I keep useless items because I feel I can't throw them away
• I am excessively afraid of losing important objects.
• I make excessive mental or written lists.
• I am excessively concerned about germs and diseases.
• I check myself frequently for evidence of illness.
• I worry a lot about terrible things that could happen if I'm not careful.
• I have unwanted urges to hurt someone but know I never would.
• I often feel like I have jelly legs.
• I often have unexplained shortness of breath.
• Certain numbers, colors, clothes are extremely important to me related to luck or unluckiness.
• I have rituals about eating, dressing, cleaning, eye contact.
• I have superstitious beliefs that I must act on.
• I need constant reassurance.
• I experience intrusive music, sounds, nonsense words.
• I repeat activities like going in and out of a door numerous times.
• I have an excessive fear that blood or other human secretions, animals or insects will contaminate me.
• I always feel like I have to get things off my chest, confess.

Do any of these apply to you? More than one? How many? Sorry, there is no magical scoring. These are the signs and symptoms of OCD. The question is: how do the obsessive thoughts and compulsive responses affect your ability to function professionally, socially, or in a relationship? If you worry you may have OCD, you at least have the traits. If the OCD process takes more than an hour of your day, is embarrassing or uncomfortable to do, or negatively affects aspects of your life remember that treatment is available, and that you are not alone.