Are your Thoughts and Behaviors Limiting You?
When you are literally pulling your hair out, finding yourself constantly and compulsively checking if your front door is locked, or perseverating endlessly on an experience, it may be time to explore if OCD (Obsessive-Compulsive Disorder) is at the root of these behaviors.
Definition of Obsessive-Compulsive Disorder:
The International OCD Foundation defines Obsessive-Compulsive as a mental disorder in which people have unwanted and repeated thoughts, feelings, ideas, sensations (obsessions), and behaviors that drive them to do something over and over (compulsions). Often the person carries out the behaviors to get rid of the obsessive thoughts.
Characteristics/Symptoms of Obsessive Compulsive Disorder:
• Repeated unwanted ideas, thoughts, or imagery
• Fear of contamination
• Aggressive impulses
• Persistent sexual thoughts
• Thoughts that you might be harmed or cause someone else harm
• Religious and moral fears
• Extreme need for symmetry or exactness
Prevalence of OCD in the United States:
• 1 in 40 adults
• 1 in 100 children
Concurrent Conditions associated with OCD:
• Anxiety Disorders
• Major Depressive Disorder
• Bi-Polar Disorder
• Attention Deficit /
• Hyperactivity Disorder
• Tic Disorders / Tourette Syndrome (TS)
• Body Dysmorphic Disorder
• Hoarding Disorder
• Autism Spectrum Disorder
• Excoriation (skin picking) Disorder
• Trichotillomania (hair pulling) Disorder
• Feeding / Eating Disorders
Benefits of testing for OCD:
While testing isn’t always necessary, a clinical psychologist may conduct psychological testing to determine the impact the OCD symptoms are having on the individual’s ability to function. A comprehensive psychological assessment provides feedback on the strengths and limitations of the individual. Psychological testing can help lead to a diagnosis and addressing the underlying factors of a problem. Following testing, accurately tailored treatments and interventions can be recommended.
Additional assessment factors to consider:
Since there can be a genetic component, a family mental health history should be gathered along with identifying what medications have and have not been useful to treat the family members’ OCD. Further exploring the family stressors that may exacerbate the OCD symptoms can be very beneficial.
A medical health history should be conducted for someone with OCD, especially in children and adolescents. Something that is quite different from Pediatric OCD is the appearance of Pediatric Autoimmune Neuropsychiatric Disorders (PANDAS/PANS) in this situation, OCD symptoms often emerge as a result of an infection, such as strep. Rather than developing gradually, this relatively rare sub-type of OCD manifests as a sudden appearance of OCD symptoms in children following an infection.
FVI DIGEST: OCD CASE STUDY
Dana is a 10 year old, white, 4th grade female. She lives at home with her mother, father, twin brothers, age 5, and her 12 year old sister. She noted experiencing a lot of unwanted ideation about symmetry and germs. She also has rigid nighttime rituals that are time consuming and impact her family. She’s a good student, who’s highly motivated, but her worries about germs have contributed to her not wanting to attend school. She attempts to minimize the anxiety about germs by washing her hands after she touches what she believes to be a contaminated object. She will wash her hands up to four times repeatedly which has led to red chapped skin. At school reading and writing have become time intensive because the OCD is demanding she balance her gaze by looking at one side of a book, and then the other for equal time. She gets mentally distracted by adding up the number of letters in words and reorganizing the words based on an even/odd pattern. Teachers describe her as having attention deficit. During her bedtime routine, she includes many rigid rituals like having to say good night in both a certain way and number of times, applying lotion in a particular fashion that includes pumping the lotion bottle two times, and organizing the blankets in a certain manner. She refuses to go to sleep if her parents are not home, thus her parents miss out on social events. Prior to her parents having an explanation of OCD for Dana’s behaviors, her parents viewed her behavior as defiant and disrespectful. OCD sends out a loud message for symmetry, so if her parents kiss her on one side of her face they need to balance it with a kiss on the other side of her face. If a person touches one of Dana’s arms, Dana will then need to touch the other arm in the same place. Dana has also experienced physical complications like teeth grinding at night, stomach pain, constipation, headaches, and irritated skin.
Dana has learned to view her OCD as a brain hiccup and to not feel guilt for her quirky behaviors. She named her OCD, “stupid thoughts” and she began to boss these “stupid thoughts” back, telling the thoughts she won’t respond to them or allow them to control her behavior. Dana learned diffusion techniques to externalize thoughts and to see the thoughts come and go, like leaves on a stream, allowing her a visual image to encourage flexibility and acceptance. Another technique that assisted Dana was learning to be “in the moment” and use her senses of smell, taste, touch, hearing, and sight to let go of being the “thinking self” and learn to be the “observing self”. Virtual Reality Therapy was beneficial in assisting with Exposure and Response Prevention. Dana visualizes someone touching something that to her was “contaminated” and then the person would proceed to go to lunch without washing their hands. To help her stay calm through the visualization exercise, Dana was taught deep breathing and progressive muscle relaxation. Dana was then able to utilize these calming strategies in her day to day activities. Eventually, she was able to practice Exposure and Response Prevention on her own. She is now able to touch a “contaminated” surface and not have to run immediately to the sink to wash her hands. Ultimately, Dana was able to go to school and not feel she had to respond to her obsessive thinking. Since her parents were seeing improvements in Dana they trusted she can regulate some of the distressful thoughts, which allowed Dana’s parents to feel more comfortable having date nights and trusting things would be ok.
Treatment for OCD:
Cognitive Behavioral Therapy (CBT) is the treatment modality which is the form of treatment recommended by National Institute of Mental Health, Mayo Clinic, and Harvard Medical School. CBT involves techniques related to Exposure and Response Prevention Therapy (ERP) and Cognitive Therapy. When you recognize that your behaviors may be becoming problematic and disruptive, a critical first step is reaching out to a qualified therapist, psychologist, or psychiatrist. They are here to help you. Break the stigma surrounding mental health by becoming more cognizant of these conditions. Once awareness exists, you can help yourself or support others in seeking out services.