What is obsessive compulsive disorder (OCD)?

// News / Ask Dr. Pat

By Patrick J. McGrath, OC, PhD, FRSC

Question:

Can you tell me more about OCD? I am afraid my daughter may be suffering from this problem.

Dr. Pat responds:

Obsessive Compulsive Disorder or OCD has two aspects. Obsessions are repeated, unwanted thoughts that interfere with ordinary life. We all have had occasional thoughts such as "I might get sick," or "Did I lock the door when I left the house?" These thoughts might repeat a few times and bother us for a short period of time. However, people with obsessions are plagued by these thoughts. These thoughts interfere with normal life.

Obsessive thoughts might be about:

germs, getting sick, or being contaminated by dirt
worrying that something was forgotten (i.e., to turn off stove)
harming someone (i.e., with a knife)
having a specific disease
being kidnapped

or almost anything else.

Sometimes people with other problems have obsessions. People with anorexia often have obsessions with being fat. People with phobias often obsess about what they are afraid of. This is a different type of problem.

The more one tries not to think about something, the more the thoughts come. The more you try not to think of a pink cow, the more you will think of pink cows.

Compulsions are recurrent behaviours that interfere with ordinary life and are unwanted. Sometimes obsessions and compulsions go together but other times the connection is not clear.

A person with obsessions about germs might wash their hands so much that they become raw.
A child who worries about forgetting to lock the door might check over and over again when they leave the house.
A teen with anxiety about things being messy might spend hours insuring their hair is combed right (but not every teen preening in the mirror has OCD).
A child may want all his toys lined up and feel very uncomfortable if they are not.

Compulsions can be any repeated behaviour. When the person tries to resist the compulsion, they become anxious. When the compulsion is performed, anxiety drops for a short time.

Most adults with OCD began having the problem when they were children or teenagers. Adults with OCD recognize that the thoughts and behaviours don't make sense. They often hide their obsessions and compulsions.

Psychological treatments for obsessions and compulsions are called exposure and response prevention. Exposure involves stopping avoidance of obsessions and its triggers. If a child was afraid of hitting someone every time he thought anything about baseball or saw a baseball bat, he might practice thinking about baseball instead of trying to avoid it. He might wear a baseball cap and handle a baseball bat.

Response prevention involves having the person with compulsions prevent themselves from doing the compulsive behaviour. So, a child who has to tap a glass 3 times before picking it up might practice picking up a glass without tapping on it. A child who felt she must count to 7 and put her finger to her mouth every time she saw a person before she said anything to them might practice saying hello to people she met without doing the rituals.

In the short run, exposure and response prevention both cause some anxiety but they reduce the long-term anxiety. They are often very successful. They sound easy but are quite difficult to do successfully. A psychologist who is trained in these methods can be very helpful. Other types of psychological therapy are not effective.

Drug treatment is usually one of the SSRI antidepressants or a tricyclic antidepressant, clomipramine. There is emerging evidence from adult studies that using both medication and behaviour therapy together may be more effective than either one alone.

Treatment often takes months and progress may be slow. The results are usually positive. Treatment may be even more effective when OCD is caught early.

Patrick J. McGrath OC, PhD, FRSC is a clinical psychologist and a researcher. He is Professor of Psychology, Pediatrics, and Psychiatry at Dalhousie University and Vice President - Research at IWK Health Centre in Halifax. He is also the CEO of the Strongest Families Institute, which provides mental health care to families across Canada.