What is OCD?
The following is a story about a fictional client named Eric, written to help educate readers about OCD. I’ve done my best to make his story an accurate representation of OCD.
“It’s hard to describe, but it’s like a picture in my head that I can’t get rid of. I’ve tried meditating, praying, running, but nothing works,” Eric said. “I feel like I’m going crazy.”
“I don’t think you’re going crazy, but it would help me to learn more about this picture in your head,” I responded. “Could you tell me what the picture is?”
Eric shifted in his chair. “It’s pretty weird…I feel dumb even mentioning it. But I keep seeing a picture of me running over someone with my car. It’s not something I like thinking about, and I’m not going to run over someone on purpose. I know that it probably won’t happen, either. But every time I drive it’s all I can think about. It even happens when I’m not driving sometimes.”
“Okay, that’s helpful. Anything else related to driving?”
“Well, I guess sometimes I question if I want to hit someone with my car. I know I don’t really want to, but I question if I actually do want to. Does that make sense?”
I nod. “Yeah, that makes perfect sense. I’ve heard stories like this before. You said you pray or meditate to try to make these go away?”
“Yeah, I’ll ask God to take the picture out of my head or I’ll try to resist the picture from showing up. Like I’ll try to push it out of my head. It feels like it makes it worse sometimes.”
Eric and I talked a while longer. During our discussion, I learned that Eric also felt uncomfortable about germs sticking to his hands. He’d wash his hands repeatedly until it “felt like all the germs were gone.”
“There’s no logic behind it,” Eric explained. “I just get the urge to wash my hands until it feels like all the germs are gone.”
Near the end of our session, I was able to give Eric a diagnosis.
“It’s pretty clear from your symptoms that you are struggling with OCD.” I told him. “The good news is, it’s very treatable, and I’m optimistic that you’ll feel better soon.”
What is OCD?
We’ll hear more about Eric’s journey with OCD in the next blog post, but for now, let’s take a break from his story to learn more about OCD.
Obsessive-compulsive disorder (OCD) is a common mental health disorder characterized by the presence of obsessions and compulsions.
According to the DSM-5 (the book mental health providers use to make diagnoses), obsessions are repeated and unwanted thoughts, images, or urges that occur in someone’s mind. Because they’re unwanted, they’re often described as “intrusive.” Two of Eric’s obsessions were worrying about hitting someone with his car (intrusive thought) and seeing pictures of hitting someone in his mind’s eye (intrusive image). Additionally, he also felt uncomfortable about germs “sticking” to his hands, giving him the urge to “wash them off” (intrusive urge).
People can have different levels of insight into their obsessions, meaning they may or may not be able to recognize how irrational they are. A person’s level of insight is often a predictor of how willing they are to engage in treatment, with people who have high levels of insight generally being more willing to participate.
Let’s use Eric as an example. Eric’s obsessions regarding running someone over every time he drove was fairly illogical – the chances of him hitting someone every time he operated a vehicle is slim to none. He displayed a high level of insight into this obsession by saying that he knew “it probably wouldn’t happen.” He also displayed good insight into his germ obsession by saying that “there’s no logic behind” washing his hands repeatedly.
Because obsessions can be so scary or uncomfortable, people often use compulsions to stop them. Compulsions are mental or physical acts used to “neutralize” obsessions. To get rid of his driving obsessions, Eric would pray or try to “push” the image out of his head. He would also wash his hands excessively to “get rid of the germs on his hands.”
To meet the full criteria for OCD, these obsessions and compulsions must be time-consuming or cause enough distress to interfere with daily life.
As with Eric’s case, it’s important to note that OCD can have a serious negative impact. Even though pop culture likes to make light of it, people who have OCD may find it difficult to work, have meaningful relationships, or engage in enjoyable activities.
OCD can also have different themes, meaning the content of one’s obsessions can vary drastically. I’ve written another post about common OCD themes here.
How Common is OCD?
According to the International OCD Foundation, obsessive-compulsive disorder is a common mental health disorder that affects about 1 out of every 100 people.
Although it isn’t technically defined this way, I think of OCD as existing on a spectrum. Full-blown OCD exists on one end of the spectrum, while someone without any obsessions or compulsions is on the other end. In my experience, most people fall somewhere in the middle, occasionally having an obsessive thought but without much negative impact.
Take, for example, a recent trip I took to Utah. After hiking several miles, a friend and I stood a few feet from the edge of a cliff, soaking up the amazing views. After a few moments, he broke the silence with an unexpected question.
“Do you ever worry you’re going to accidentally jump off?”
I couldn’t help but laugh. The way he asked was so abrupt that I had to pause for a second to think.
In the brief silence, my friend hurried to explain himself.
“I’m not going to do it or anything. Sometimes my brain just makes me worry that I might.”
My friend was far from meeting the full criteria for OCD, but as this example illustrates, he was experiencing an intrusive thought. Just like most people, his brain lived somewhere in the middle of the OCD spectrum.
Because they’re so common, it’s worth exploring how obsessions form in the brain.
What Causes OCD?
The human brain is an amazingly complex organ, silently maintaining our body’s most basic functions while simultaneously giving us the ability to love, think, and reason.
Unfortunately, just like the rest of our bodies, our brains sometimes don’t operate the way they’re supposed to. Although it isn’t fully understood, research suggests that several parts of the brain are responsible for causing OCD.
I don’t pretend to be a neuroscientist, but I’ll provide the best explanation that I can (or you can click here to watch a solid summary video).
First, a part of our brain called the “orbitofrontal cortex” (OFC) creates an obsessive thought.
The OFC then shoots a message to a region of the brain called the “basal ganglia,” warning it about this distressing thought.
Normally, the basal ganglia is able to “turn off” the message the OFC sends. However, in a person with OCD, the OFC is overactive, making it difficult for the basal ganglia to turn off this message and direct a person’s attention elsewhere.
This loop makes it almost impossible to ignore obsessive thoughts. It also makes it difficult to stop engaging in compulsions once you’ve started, leading to the debilitating symptoms of OCD.
Although it can begin at any age, the International OCD Foundation reports that OCD most likely begins in childhood (between ages 8-12), or in adolescence/early adulthood. The late teens and early 20s are a time when people are vulnerable to lots of other mental health disorders, so it’s not surprising that OCD sometimes appears around then as well.
Nature or Nurture?
Clients will often ask me why they have OCD. Research suggests that genetics are a large contributor to someone having OCD, while some environmental factors and different life experiences also contribute. One meta-analysis (a research study that examines multiple research studies at once) suggested that 40% of the variance in twins with OCD was determined by their genetics.
Unfortunately, there isn’t one “OCD gene.” Rather, it’s a combination of genes that contribute to OCD, making it difficult to fully pinpoint which ones are responsible.
Some Good News
One of the reasons I enjoy working with people who have OCD is because it is very treatable. Unlike some other mental health disorders, there are clear guidelines about what helps with OCD and what doesn’t. Currently, a form of cognitive behavioral therapy called “exposure and response prevention” (ERP) is the gold standard for treating OCD. Research also shows that medication can help alleviate symptoms. I’ve written an entire blog post about treating OCD here.
As you’re reading this, perhaps you’ve realized that OCD is ruling your life. If so, you can click here to contact me about taking the first step toward conquering your OCD.
