Struggling with any mental illness is challenging, and obsessive-compulsive disorder is no exception. Complicating matters is that many OCD symptoms may not initially appear to be severe; however these symptoms can escalate to the point where a person needs to seek help.

“OCD is an anxiety-based disorder consisting of the presence of obsessions, compulsions or both,” Dr. Misty Tu, M.D., medical director and psychiatrist at Seattle Anxiety Specialists, says.

These obsessions are “recurrent or persistent thoughts, urges or images that are often intrusive and unwanted” leading to distress or anxiety, she adds. Because these thoughts are unsettling “people try to suppress or neutralize these thoughts with some other thought or action, which are often compulsions.”

These types of repetitive behaviors are different from people having other consistent and repetitive behaviors like only eating meat on the weekend or always doing laundry on a Sunday evening. When someone experiences OCD, their “repetitive behaviors or thoughts are usually excessive and not entirely realistic. Someone being afraid that something bad is going to happen to their family could be an example of an obsessive thought. Having to flick the light switch eight times could be a compulsion in response to that, but most people would not connect that action with keeping themselves or their family safe,” Tu says.

Jennifer Yeh, a psychotherapist at Seattle Anxiety Specialists, says that OCD negatively impacts an individual’s capacity to function, and that while the U.S. diagnostic manual for mental disorders notes that individuals may experience obsessions without compulsions — or vice versa — “most patients present with both obsessions and compulsions.” She says OCD has been referred to as the “doubting disease” because people with the condition often have obsessions or compulsions centered on doubts about their internal or external experiences.

OCD is also not as common a mental health issue as other mental health illnesses, like depression, are. The American Psychiatric Association says in the U.S., “OCD affects 2%-3% of people” while the National Institutes of Mental Health says that 8.4% of Americans experience depression.

With OCD, the APA says that “slightly more women than men are affected.” They also report that OCD frequently surfaces in “childhood, adolescence, or early adulthood; the average age symptoms appear is 19 years old.”

Diagnosing OCD

OCD can lead to elevated levels of distress or social dysfunction. It’s best to seek help as soon as you think you may need it. Yeh says while it can be difficult in some parts of the country to find an available OCD specialist, a useful resource is the International OCD Foundation’s online help finder search tool.  Another path to care is through a primary care physician who might prescribe medication when appropriate or refer to a specialized provider to do so.

Diagnosing OCD is also complicated and can be very frightening to someone experiencing it, Tu adds.

“They [the thoughts the individual has] can be entirely disconnected from the type of person they really are. For example, they could have a dog they love, but have obsessive thoughts that they’re going to hurt the dog. Some thoughts are even worse, and these can cause a lot of guilt and shame. It’s hard to talk about this with other people and there is a lot of fear [people] won’t understand that they don’t want to do any of these things, but these thoughts keep coming into their head.”

Yeh says if you think you might have OCD, a “starting place to consider is: Does your experience indicate extreme discomfort with uncertainty?” She says that OCD may take the form of widely known compulsions such as excessive hand washing or constant door lock checking, but may also include indicators less commonly associated with OCD, such as perpetually seeking ‘second opinions’ from medical providers, or spending inordinate amounts of time on things like Google searches or scrutinizing online reviews.

“It’s important to clarify how functional behavior is differentiated from OCD behavior,” Yeh says. While online searching is innocuous in most situations, what people with OCD experience isn’t “pleasant and motivated by curiosity – but instead is a desperate, frustrating and uncontrollable hunt for resolution from plaguing doubt.”  In addition, compulsions can also take the form of thoughts, such as exhaustively mentally reviewing a past conversation.  The covert nature of these mental compulsions adds a layer of “invisibility” to OCD, potentially complicating accurate diagnosis.

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While most individuals with OCD believe or suspect their obsessions are not based in reality, “there is a subset of sufferers with limited insight, or where insight is absent.” In those instances, it is typically the people impacted by a person’s OCD who see the issue, Yeh says.

Mental health professionals, particularly those with specialty OCD training, will be able to assess whether a person has OCD and should also consider any other possibilities that could contribute to similar symptoms.

“Some [illegal and recreational] drugs can cause individuals to become obsessive,” Tu says. “General anxiety, depression and even psychosis can have some similar symptoms, so it’s important to seek help and have a thorough clinical evaluation for diagnosis.”

Another thing that can complicate diagnosis of OCD is that there generally are not specific triggers that act as a precursor to OCD, Tu says. “Occasionally it’s seen after a traumatic event and, very rarely, it’s been associated with a quick onset after an infection — it’s believed it could be triggered by an unusual autoimmune response.”

Treating OCD

Treatment plans for OCD vary according to the severity of symptoms and can include interventions such as exposure and response prevention, which is a specific form of cognitive behavioral therapy; medication; and even (in the most severe cases) neurosurgical treatments.

Yeh says exposure therapy can be delivered in a range of intensities depending on client need, from weekly outpatient visits to partial hospitalization or even residential programs.  In some situations exposure therapy can take place in settings — like a grocery store, parking lot or playground — pertinent to the client’s specific obsessional triggers, Yeh says. 

Tu adds that therapeutic approaches targeted to OCD symptoms have been proven to be effective. Antidepressants have been successful in alleviating a lot of symptoms and “there are several augmentation agents that can also be added if antidepressants alone do not provide remission of symptoms. Outside of medications, transmagnetic stimulation has also been proven to treat OCD,” she says.

While there are multiple ways to treat OCD, like any other chronic illness there isn’t a cure but rather a path to managing it.

“The goals for treatment of any mental illness should be remission of symptoms with no significant side effects,” Tu says. “OCD can lead to anxiety, depression and time-consuming behaviors. The goal is to free individuals from as many of these symptoms as possible so that they can lead full and happy lives.”

Seattle Anxiety Specialists, PLLC is a private psychiatry and psychotherapy practice in downtown Seattle, providing evidence-based treatments and in-depth self-exploration for anxiety and conditions that create anxiety including phobias, depression, GAD, OCD, PTSD, ADHD, OCPD and bipolar.