Understanding OCD: A Comprehensive Guide to Symptoms, Causes, and Treatment Options

What is Obsessive Compulsive Disorder (OCD) Subjectively, or Generally?

OCD is an acronym for Obsessive-compulsive disorder. The above quote represents the experience well. OCD is a name for a plaguing, lived experience that, for those who battle it, is burdensome, constant and unrelenting. This name represents the experience of hyperfocus on certain, usually irrational thoughts that are only relieved with certain behaviors, sometimes bizarre. But the behaviors only briefly relieve anxiety before the flood of obsessive thoughts returns. It can be like an irrational fear on steroids coupled with a maladaptive coping skill on steroids, and the worst part is that they feed each other, making the cycle vicious and quickly out of one’s control. I have heard other therapists refer to OCD as “sticky brain,” because your mind sticks to an idea and will not let it go. Moreover, what it sticks to gets thrown into hyperdrive and feels like fast thoughts and strong urges for relief.

What is OCD Objectively, or Clinically?

A Clinician would describe OCD like the International OCD Foundation does: thought-life “characterized by a cycle of obsessions, intrusive thoughts, or images that leave the patient with uncontrollable worry, anxiety, and doubt. Persons with OCD habitually engage in compulsions or rituals in an attempt to reduce anxiety related to obsessions.” The DSM (mental health disorder handbook) explains that these obsessions, intrusions and compulsive behaviors are beyond appropriate in duration, and they consume at least one hour or more of one’s wakeful time per day. Yale school of medicine explains this further by highlighting that “there are functional abnormalities in the brains of people with OCD, within the cortex-basal ganglia circuitry,” and this is evident in brain imaging. See below, and notice that “the warmer colors – reds and yellows – correspond to brain regions with higher activity; the cooler ones – blues and greens – are brain areas with less activity.” The healthy brain is pictured on top, and the OCD brain is pictured on the bottom.

In short, the OCD brain is much more active, even at rest, than the healthy brain, evidenced by more red and yellow on the bottom pictured brain. This can be explained, in part, by a malfunction in serotonin reuptake and a constant search for relief that is only minimally satisfied in the OCD brain. The healthy brain can rest, in part, because of the serotonin reuptake functioning properly, while the OCD brain cannot due to the structural difference and serotonin reuptake malfunction. This depicts that OCD has a significant genetic component. While OCD can be exacerbated or even onset via traumatic experience, trauma is not necessarily part of it. Moreover, there seems to be hormonal influence on OCD, as it can appear for the first time in women during the perinatal period.

What is Perinatal OCD?

Perinatal OCD is OCD that manifests during the perinatal period, or for a woman in pregnancy. Symptoms can persist after delivery, as well. Something worth noting here is that intrusive thoughts and images in OCD are not representative of the mother’s intent. They are intrusive and inconsistent with her character. For example, a mother with perinatal OCD may have a persistent irrational fear that she will hurt or kill her child, but her intent is the exact opposite. Fear does not indicate urge. This makes perinatal OCD extra haunting for mothers, because there can be endless shame wrapped up in the concern, “Am I a murderer because of these thoughts?” Many mothers with perinatal OCD are concerned they are experiencing psychosis, which they usually are not. It’s a living hell.

In the book I cited in the resources below, perinatal OCD is described as thoughts of suffocation (SIDS), thoughts of accidents, ideas of intentional harm, thoughts of losing the baby, illness, unacceptable sexual thoughts and contamination. Compulsions may include checking, washing and cleaning. Sometimes, counting and checking may indicate that OCD existed before motherhood. Again, these concerns dominate a mothers’ thinking more than one hour per day to classify as diagnosable OCD. In other words, some of these thoughts are appropriate when they are not constant. For the mother suffering perinatal OCD, it seems like they are all she can think about.

Can OCD Manifest In Children?

Some behaviors in children can appear as OCD, such as preoccupation with symmetry and order. Many of these behaviors are developmentally appropriate, but it is worth noting here that OCD behaviors can manifest in children, especially children with a family history of OCD. There is a diagnosis called PANDAS which stands for Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections. Essentially this looks like OCD with symptoms beginning to show after a significant strep infection. If this is a concern, the best thing to do is ask your Pediatrician about PANDAS.

So How Can I Assess for OCD?

The Yale-Brown Obsessive Compulsive Scale is the leading assessment to diagnosis OCD, and there are sub-clinical, mild, moderate, severe, and extreme ranges. There is also a symptom checklist that can be very helpful that elucidates what obsessive thoughts may sound like. These include categories of aggression, contamination, sexual, religious, hoarding, symmetric and somatic obsessive thoughts and compulsions. Reviewing the symptoms can really help with developing insight. Insight is important too, because prognosis, or the hopes of OCD responding to treatment, is significantly influenced by patient insight. Can you recognize thoughts as obsessive and irrational? If there is any part of you that can, this part is worth developing, because it is this part that will succor treatment best. Without insight, the prognosis is poor. That said, you are off to a good start considering you are exploring with this blog. Your insight is there. Keep nurturing it if this blog is speaking to you.

What Treatment At Home Can I Try for OCD?

There are treatments you can try at home, and there are professional interventions that can help. Based on what we know about serotonin’s role in OCD, adjusting diet and light intake can help. Serotonin is directly impacted by sunlight. So, get outside significantly more. And,fatty acids directly correlate with serotonin. So, increase fatty acid intake. Another consideration for at home strategies is this: avoidance reinforces maladaptive behavior. So, if you are avoiding people or places due to triggering obsessive thoughts, then slow, gradual, exposure to triggers will help to desensitize the severity of the trigger. You can try this with a trusted friend, too, for support.

What Professional Interventions Are There For OCD?

There are well established pharmacological and therapeutic treatment interventions for OCD. A high dose of an SSRI can help tremendously, and for some people this is enough. For many people, this medical approach bolsters therapy. That is, medication and therapy together are the best treatment for most people battling OCD.

The most effective therapeutic treatment for OCD is exposure and response prevention (ERP) therapy which is often coupled with cognitive behavioral therapy (CBT). This means exposing the OCD brain to whatever triggers the obsessive thinking, and through frequent exposure adjusting the response over time. This is a behavioral treatment, and many clinicians will couple cognitive behavioral therapy with it to help manage the out-of-control thinking.

Can EMDR Help with OCD?

Yes. EMDR can help with OCD if there is a trauma history, and EMDR can help even if there is not a trauma component. EMDR is among the leading treatments for Post Traumatic Stress Disorder (PTSD). So, relieving PTSD symptoms can relieve OCD symptoms, as well, especially if the OCD symptoms developed in response to traumatically influenced fears. That said, EMDR can also act as an exposure therapy, only the exposure is mental rather than physical. We still have much to learn, but one thing we know about EMDR is that it activates the nervous system and draws one directly into a memory, or into a perceived threat, as in OCD. So, with EMDR we can flood the nervous with a worst-case scenario, desensitize the obsession, and reprocess fears. Ultimately, this leads to a decrease and sometimes eradication of obsessive thoughts which reduces the urge for compulsions. This is also safe to practice in pregnancy.

Can You Give Me An OCD Example?

OCD can manifest in different ways. In my clinical experience I have witnessed this materialize in the following way. I knew a young lady struggling with perinatal OCD who was terribly afraid that she would accidentally, sexually assault her child or that someone else may. This fear was accompanied by horrific, vivid images of the potential assault and nightmares. This woman would not leave her children with anyone, even trusted family, and she was hypervigilant when anyone else was around her children. This made diaper changing, bathing, and trusting anyone else with childcare very difficult. This also made it challenging for her to be present with her child. She was ashamed of her difficulty to be present, and she was scared this made her monster. With the help of EMDR, she no longer has to manage these concerns because the fears are gone. She can also recognize OCD thoughts sooner and incorporate support and apply coping skills before the obsessions get out of control. Motherhood is still challenging, but she is in it now, rather than living in constant fear. She described this to me as realizing one day, “I have not had one of those thoughts… I can’t even remember,” with tears and a smile.

Takeaway

If you are reading this because you are struggling, you are already on the right track. Keep going. Try some home remedies. If those do not work, reach out to us or any practicing clinician, really, can get you to information and support you need if they do not have it already. You do not have to live with this extra mental load that can be so incapacitating. You can live more free.

OCD is a deeply challenging condition, but with the right tools and support, individuals can manage and reduce its impact on their lives. Whether through home remedies, professional therapy, or a combination of both, it is possible to live a more free and fulfilling life despite the presence of OCD.

Schedule an appointment with therapist and author of this blog, Hope Stanley

Authored by Hope Stanley

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