But for someone with obsessive-compulsive disorder, or OCD, these thoughts become all-consuming, interfering with the individual’s day-to-day routines and responsibilities. For example, individuals with OCD may feel compelled to return home multiple times before going to work to make sure the stove is off or be driven to wash their hands repeatedly to eliminate germs. These time-consuming rituals and intrusive thoughts can interfere with work, school, or home life, eventually leading to chronic unemployment, academic failure, or social isolation.
The compulsive behaviors associated with OCD are not just personality quirks, but symptoms of a severe mental illness. According to estimates from Stanford University, OCD occurs in 0.8-2.2 percent of the population in any given year; however, these statistics may underestimate the actual prevalence of the disorder in community settings. The International OCD Foundation estimates that there are approximately 2-3 million adults in the US living with OCD. Symptoms are most likely to appear for the first time in childhood, between 8-12 years old, or in later adolescence and young adulthood.
Although the occurrence of OCD is relatively low compared to other psychiatric disorders, this condition can cause significant disability and takes a considerable toll on the individual’s social functioning. OCD has been associated with higher than average rates of drug or alcohol addiction, which can negatively impact the outcome of the disorder. People with OCD who misuse alcohol or drugs may have more severe obsessive-compulsive symptoms. They are also more likely to display self-destructive behavior or to be hospitalized. Once OCD has been identified in an individual, it is important to intervene in the course of the condition by offering therapeutic support.
Detecting the Red Flags of OCD
OCD was once classified as an anxiety disorder, but the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders (version 5), places the condition in a separate category with other disorders involving repetitive behaviors or obsessive fears. Still, anxiety and fear play a central role in the thought processes of people with OCD.
Even if these fears are unfounded or only loosely based in reality, they intrude on the individual’s thoughts and interfere with daily activities. Some of the most common fears, images, or thoughts shared by individuals with OCD include:
- The fear of germs
- The fear of unclean substances or environments
- The fear of harming others or harming oneself
- The fear that a loved one will be harmed
- The fear of illness
- The fear of forgetting things or losing possessions
- The fear of offending a religious deity
- A preoccupation or superstition about certain numbers
- An obsession with symmetrical placement in objects
- An obsession with counting things
- An obsession with sexual images or words
- An obsessive fear of being “bad” or “evil,” or a fear of doing evil things
The ritualistic behaviors of OCD are considered to be an attempt to relieve anxiety and emotional distress; however, because these rituals are never completely effective at easing internal tension, they must be repeated over and over again. The following repetitive compulsions are frequently observed in people with OCD:
- Handwashing, showering, tooth-brushing, and other grooming activities
- Superstitiously counting objects
- Cleaning one’s living environment or office
- Sorting things in a specific order (such as by color or size)
- Checking work for mistakes
- Checking one’s body, skin, or hair for flaws
- Arranging things repeatedly in order
- Reviewing one’s actions over and over again to see if one has harmed someone else or committed a sin
- Repeating activities or movements, such as tapping one’s foot or taking steps, a certain number of times
- Hoarding or collecting items that have little or no value to anyone else
People with OCD may know that their behaviors and thoughts are irrational or unrealistic.
They may want desperately to be free of these compulsions, but they are unable to live with the anxiety that occurs when they don’t engage in these behaviors.
The most effective way to overcome the anxiety and compulsive behavior of this condition is through a combination of therapies, including behavioral modification therapy, support groups, family counseling, and psychiatric medications.
Studying the Origins of OCD
The causes of OCD are not yet known, but the disorder has been linked with imbalances in neurochemistry that block communication among certain areas of the brain. Specifically, the National Alliance on Mental Illness states that imbalances in serotonin, a neurotransmitter involved in emotional regulation, moods, metabolism, sleeping patterns, and vasopressin, a hormone that affects fluid regulation and cellular function, have been associated with the behaviors and thought processes of OCD. Structural abnormalities in the frontal lobes and basal ganglia of the brain — areas associated with cognition and movement — have also been identified in people with OCD. Some people with this condition display behaviors like repetitive tapping, blinking, or other compulsive body motions that are similar to those shown in disorders like Tourette’s syndrome.
Like many other forms of mental illness, OCD tends to run in families. Having a parent, brother, sister or other close blood relative with the disorder increases the likelihood of developing the condition. No specific genes have been tied to OCD. Other theories maintain that OCD is caused by a childhood illness or exposure to environmental toxins. As of yet, no single theory has been confirmed; it is more likely that OCD arises from a number of different factors.
The Relationship Between OCD and Addiction
Substance abuse is often used as a way to ease the anxiety and internal tension of OCD, yet alcohol and drugs can actually make the symptoms of the disorder worse.
A study published in the Journal of Anxiety Disorders found that out of 323 adults with OCD, 27 percent met the criteria for a substance use disorder. Twelve percent of the study sample qualified as alcohol dependent or alcoholic, while 11 percent were dependent on both drugs and alcohol, and 3 percent were dependent on drugs alone.
Most study participants reported that their substance abuse started after they began to experience OCD symptoms. The study found that individuals who had obsessive thoughts or compulsive behaviors for the first time in childhood or early adolescence were more likely to abuse drugs or alcohol later in life. Experiencing OCD as children or teenagers apparently isolated these individuals from their peers and caused significant psychological distress, which later led to substance abuse.
Social isolation is a common side effect of OCD, and many people with this disorder become housebound as a result of their all-consuming fears. The isolation caused by this disorder can also increase the risk of depression, which makes the individual even more vulnerable to abusing drugs or alcohol. The result is a vicious cycle in which chemical dependency increases isolation and depression, which in turn can trigger anxiety and worsen the compulsive behavior of OCD. If left untreated, both OCD and addiction are likely to progress, potentially leading to an escalation of self-destructive behavior and hospitalization.
Intervening on a Loved One’s Behalf
People with OCD often feel ashamed or guilty about their repetitive behaviors and compulsive thoughts. As a result, they may hide their disorder from their closest friends and family members, and the condition may go undiagnosed and untreated for years. Intervening on behalf of a loved one with OCD could save the person a great deal of emotional and physical suffering, especially if substance abuse is involved.
Substance abuse is always a sensitive subject, and many people are reluctant to bring up the topic for risk of offending their loved one or of making the problem worse. However, this temporary discomfort is a small price to pay for an intervention that could change the course of someone’s future for the better. Discussing OCD and addiction with a relative or friend may be easier if you keep the following points in mind:
- OCD is a disorder that causes tremendous anxiety, emotional pain, and fear. The behaviors used to relieve these feelings can lead to shame or guilt. Remember that although these behaviors may seem odd, comical, or annoying to healthy individuals, they are deeply distressing to the person who experiences them. It is important not to minimize the severity of OCD symptoms just because they seem bizarre or idiosyncratic.
- Addiction is a chronic, debilitating disease of the brain, not a moral weakness. People with OCD may already feel ridden with fear of being bad or immoral. When talking with them about substance abuse, it is crucial to be as neutral and nonjudgmental as possible.
- OCD and addiction can both lead to social withdrawal and depression. No matter how tense or emotional the conversation may become, remember that this intervention may help your loved one avoid years of loneliness and despair.
- The best approach to treating OCD and addiction is a specialized program for clients with dual diagnoses. Before you talk to your loved one, take some time to research addiction treatment programs that also offer comprehensive recovery services for clients with OCD. If you are prepared to offer a solution, your loved one will be more inclined to agree to seek help.
In spite of the persistence and severity of OCD symptoms, the disorder responds well to the right kind of treatment. One of the most effective therapeutic modalities for treating OCD is Cognitive Behavioral Therapy (CBT). CBT has been used to help resolve the repetitive, intrusive thoughts of OCD. The purpose of CBT is to empower the individual to identify and correct destructive thoughts by replacing them with more positive thought patterns and behaviors.
A form of Cognitive Behavioral Therapy called Exposure and Response Prevention (ERP) – or Exposure and Ritual Prevention – was developed in the 1960s to reduce the frequency and severity of OCD behaviors by exposing the client to the thought or situation that is feared. Clients are asked to immerse themselves in imagined scenarios in which they are not able to perform the ritual that eases the fear. Clients are then guided to the realization that the fear is unfounded and the behavior unnecessary. According to the journal Dialogues in Clinical Neuroscience, the success of ERP represents the first real breakthrough in the treatment of OCD. Before the 1960s, the disorder was considered untreatable.Stanford University Medicine states that approximately half of clients with OCD who seek treatment for the disorder can improve with behavioral therapy alone, and up to 75 percent of the patients who go through therapy continue to show improvement after six months. Medication may be prescribed for clients who do not respond to therapy alone and who need additional support for their anxiety or depressive symptoms. Medications in the SSRI category (selective serotonin reuptake inhibitors) have shown positive results in correcting the neurochemical imbalances that contribute to obsessive-compulsive behavior. These medications include popular antidepressants like paroxetine (Paxil), citalopram (Celexa), sertraline (Zoloft), and fluoxetine (Prozac).
While addressing the symptoms and causes of OCD, therapy must also address any co-occurring substance use disorders. Some clients may benefit from inpatient therapy at a residential treatment facility that specializes in treating patients with a dual diagnosis of mental illness and addiction, while others may show more improvement through an outpatient program. A complete psychiatric and medical assessment can help the treatment team determine the most appropriate level of care for the individual client, and choose the interventions that are most likely to produce improvement in obsessive fears and addictive behaviors.
OCD is not one of the most common psychiatric disorders, yet its effects can take a serious toll on those who live with this condition. At one time, OCD was considered to be so mystifying and complex that it could not be successfully treated. Today, mental health professionals and substance abuse treatment specialists have a range of resources at their disposal for dealing with both OCD and addiction. Too often, individuals with OCD live with distressing fears and compulsive behaviors for years before they receive professional help. Holding an intervention on behalf of a loved one with OCD and addiction could halt the progression of both disorders and give the individual a chance to build a more positive future.