Obsessive Compulsive Disorder Symptoms, Diagnosis and Treatment

Obsessive Compulsive Disorder Symptoms

The Diagnostic and Statistical Manual of Mental Disorders Version 5 describes obsessions as recurrent and persistent thoughts, impulses or images that are experienced, at least at some time during the illness, as intrusive and unwanted and in most people cause marked anxiety or distress. People try to ignore, suppress or neutralize these with some kind of thought or action (compulsion). Compulsions are defined as repetitive behaviors (hand washing, checking) or mental acts (praying, counting, repeating words silently) that the person feels driven to perform in response to an obsession or according to rules that must be followed rigidly. These behaviors are aimed at preventing some dreaded event or situation that is not realistically connected or clearly excessive to this process. These Obsessive Compulsive Disorder symptoms are time consuming, taking at least an hour a day, causing significant distress, and impairment of social, occupational or other areas of functioning.

What Causes Obsessive Compulsive Disorder?

There seems to be a genetic component in twin studies and seems to run higher in families with Tourett’s Disorder (a disorder in children and teens of chronic motor and vocal tics). It occurs in 1-2% of the population, and is more frequent in boys when it expresses in childhood but is equally common in males and females. It begins typically between the ages of 6-15 in boys and 20-29 in young women. Onset is usually gradual with a waxing and waning course throughout life. About 15% show progressive deterioration and about 5 % have no symptoms between episodes.

Are there Specific Tests for Obsessive Compulsive Disorder?

Given wide individual variability, these changes are not yet distinct enough to detect and accurately allow a diagnose. Scanning is used to help determine the likely success of certain high risk procedures. Psychological screens for OCD like the Yale-Brown Obsessive Compulsive Scale (YBOC) are helpful for initial screening, and initial assessments and are used as a baseline to help follow the progress of a person’s ongoing efforts.

An initial evaluation usually consists of screening tests, a careful review of family, personal and medical history, bloodwork, along with a review of present symptoms, stresses, supports and life function. Having a friend or family member attend the evaluation can provide ‘the rest of the story’ as discussing one’s obsessions and compulsions can be extremely shame inducing and are often not mentioned or minimized. The time spent on rituals is frequently underestimated. The effect on personal relationships is often not accurately perceived. Often, there exists a resentful feeling that their family members don’t understand…and they are right, family members don’t usually understand.

How is Obsessive Compulsive Disorder a Family Illness?

As you might imagine, when a member of a family finds themselves involved in the rituals described above, others will likely notice. There are times when the person is able to cover their symptoms and decide to never tell anyone about them. However, over time, like a cancer, the rituals grow and become more difficult to hide. As the person’s mind becomes consumed with the rituals there is less time spent thinking or caring about anything else. This illness affects relationships in all aspects of a person’s life, at school, work, in the family and in their social life. As the obsessions increase, the person’s attention to important relationships in life wanes apart from meeting the needs of the illness. Of course, milder forms of the illness exist that may only cause relatively minor inconvenience.

How do You Treat Obsessive Compulsive Disorder?

Cognitive Behavior Therapy is a major treatment option. This can be used with and without a medication. The SSRI’s are the most frequent choice of medication. At times a second medication is chosen to augment the effectiveness. Unlike depression, however, seldom does one attain complete resolution of their symptoms. About one half of those treated experience significant relief. If even thirty percent of the push for time spent in obsessions or compulsions can be alleviated, a person feels significantly better. Therapies that promote self-esteem, relationship therapy and family therapy can all be helpful, particularly once the obsessions and compulsions are lessened.

Where can I find Help?

  • Many online sites can be helpful like the National Institute of Mental Health, NIMH
  • Books are another available resource:
    The Boy Who Couldn’t Stop Washing by Judith J. Rappaport, MD
    Obsessive-Compulsive Disorders: A Complete Guide to Getting Well and Staying Well by Fred Penzel, Ph.D.
    The OCD Workbook: Your Guide to Breaking Free from Obsessive-Compulsive Disorder by Bruce M. Hyman, Ph. D.
  • Support Groups like National Alliance on Mental Illness, NAMI, have web sites (NAMI.org) and local support groups.
  • Friends who have successfully dealt with OCD themselves or with a family member may have information about local resources.
  • Many churches and communities have resources or know of local resources.
  • Your family doctor can review any medical issues and likely has suggestions about local resources.
  • Local therapists, psychologists or psychiatrists who specialize in OCD can provide assessments and help you develop a plan of action. OCD requires a rather specialized form of therapy and this kind of therapy is best performed by someone who specializes in OCD.
  • When needed, you can go to a nationally recognized center for treatment or a second opinion.
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