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You check three times to make sure the door is locked before you leave the front porch. You never touch the handrail on an escalator. You line up your pens parallel to your keyboard on your desk at the office.
Everyone has exhibited a little obsessive or compulsive behavior from time to time. You want to confirm the door is locked before you leave. You know how many ‘germy’ hands touch that escalator handrail every minute of every day. And you like to have your pens right there, easy to grab if you need to write something down. These actions make sense.
However, it is estimated that 1.2% of U.S. adults suffer from obsessive-compulsive disorder (OCD). They aren’t people who demonstrate a few persnickety behaviors from time to time. They are roughly 2.5 million adults whose daily lives and their ability to function are hampered by a mental illness that keeps them trapped in an often vicious cycle of thoughts and actions they cannot escape.
OCD is a treatable disorder, but can antidepressants be used to manage its symptoms? Let’s find out more about the disorder and treatment options.
What Is Obsessive-Compulsive Disorder (OCD)?
To understand what OCD is, you first need to know what obsessions and compulsions are. Obsessions are intrusive thoughts or images that constantly preoccupy someone. They aren’t like a song that gets stuck in your head. These thoughts or images seem inescapable and, as such, cause a tremendous amount of anxiety. The obsessive thoughts completely distract the sufferer from thinking about anything else.
There are categories of common obsessions. These include those involving violence, sex, contamination, religion and morality, death, relationships, perfection, self-identity, responsibility, and real or imagined past experiences.
Compulsions are responses to obsessions. They are typically repetitive thoughts, actions, or behaviors employed to make the obsessive thoughts go away or to quell associated anxiety. Common compulsions include strict and consistent routines, orderliness, counting, checking things, and hand washing or cleaning.
OCD is, therefore, a chronic mental health disorder characterized by uncontrollable and recurring thoughts and associated repetitive behaviors.
What Are the Symptoms of OCD?
Those with OCD spend an hour or more a day focused on such thoughts and compulsions. Without treatment, this situation can become uncontrollable, even if OCD sufferers know that their thoughts and their reactions to them are disproportionate or even illogical. And although their compulsions provide temporary relief from the obsessive thoughts, they don’t provide any resolution.
OCD is sometimes accompanied by a tic disorder, characterized by sudden, repetitive movements or sounds. Examples include excessive blinking or eye movement, head jerking, and grunts or sniffing.
OCD takes a major toll on the ability of people with the disorder to function in their daily life, education, and employment. It can strain relationships to the breaking point. Those with contamination obsessions can develop contact dermatitis or infections from frequent hand or body washing. And individuals with OCD may also suffer from depression and can even have suicidal ideations.
What Are the Causes of or Risks for Developing OCD?
Although no specific cause has been identified for OCD, three theories involve genetics, changes in brain chemistry and function, and learned behavior.
Risks include family history, encompassing both the role of genetics and learned behavior from a parent or other relative with OCD.
Trauma is also a risk factor, based on the theory that someone who has experienced a traumatic event may develop OCD as a way to cope with it.
There appears to be a link between OCD and other mental health conditions, especially anxiety disorders and mood disorders, including depression. OCD also shares obsessive and compulsive behaviors with other disorders, including autism, Parkinson’s Disease, Tourette’s syndrome, body dysmorphic disorder, and eating disorders.
Moreover, there is some evidence that people with OCD or on the threshold of meeting the criteria for a diagnosis of OCD have a higher incidence of some physical health issues, including migraine headaches, respiratory ailments, allergies, and thyroid problems.
How Is OCD Diagnosed?
There is no lab or imaging test that can diagnose OCD. A healthcare provider or therapist will conduct a psychological evaluation by asking questions about thoughts, ideas, and compulsive behaviors and their frequency. Patients are asked how such behaviors are affecting their lives and relationships. The provider may seek permission to talk to family, friends, or others about their behavior. There are also scientifically validated surveys which can help diagnose OCD and determine the severity of the disorder.
The provider compares the information gathered with the criteria for OCD as described in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5) to determine whether the patient’s symptoms match the criteria. In addition, because obsessive and compulsive behaviors are symptoms of other mental health and neurological issues, a doctor may perform a physical exam to rule out any other conditions before diagnosing OCD.
How Is OCD Treated?
There is no cure for OCD. The goal of treatment is to help control the symptoms so those with OCD can function more normally in their daily lives. Psychotherapy, medications, targeted brain stimulation, and lifestyle changes are used to varying degrees, based on the severity of symptoms. The more intense the symptoms are, the more intense the therapies may be. Individuals with OCD will likely use a combination of treatment methods to control their symptoms.
A type of cognitive behavioral therapy, called exposure and response prevention (ERP), has become the most used and most effective therapy for the treatment of OCD. In ERP therapy, patients practice facing the thoughts, images, or situations that cause their obsessions. Then they learn how to prevent the compulsive behaviors they normally use to reduce the anxiety raised by their obsessive thoughts.
Patients do these exercises under the guidance and in the presence of a therapist in safe surroundings. The concept is to retrain the brain over time, until the patient no longer perceives the obsession as a threat.
Of course, intentionally calling out the obsession will create a tremendous amount of anxiety in the beginning. In time, patients learn their thoughts can’t hurt them. That way, they can begin to stop fighting obsessions with compulsive behaviors and discover their thoughts are unlikely to come true. Once patients reach this point, they can better manage their OCD on their own.
Those who suffer from severe OCD may need more intensive therapy, often in a residential or inpatient hospital setting.
Just as ERP is the go-to cognitive behavioral therapy for OCD, selective serotonin reuptake inhibitors (SSRIs) are the go-to medication. The American Psychiatric Association recommends using a combination of both as the first-line treatment for OCD.
SSRIs are a class of antidepressants. They work by keeping serotonin active for a longer period of time among brain cells. Serotonin is the brain chemical often called “the feel-good hormone.” Adequate and steady production of it is necessary to balance mood. These medications have proven to be effective treatment for depression and anxiety disorders.
While OCD is not a form of depression, many people with OCD suffer from depression. And as discussed, OCD causes anxiety. The use of SSRIs by those with OCD helps control both depression and anxiety, which, in turn, helps these individuals manage their obsessive-compulsive disorder.
Although SSRIs are the most common antidepressants prescribed for OCD, doctors may prescribe other antidepressants. Regardless of what medications a doctor recommends, patients should consider multiple factors when discussing them, starting with potential side effects. Although no medication is without side effects, some are more serious than others. Benzodiazepines, for example, are often prescribed to treat anxiety – however their role in treating OCD is very limited. However, unlike SSRIs, “benzos” are controlled substances with the potential to cause addiction. In fact, patients who stop taking them after even one month can experience withdrawal symptoms.
Drug interactions must also be taken into account. Other medications, vitamins, herbal supplements, and even foods and beverages can render a medication ineffective or cause life-threatening interactions.
Since 2004, the U.S. Food and Drug Administration has required that a “black box warning” accompany all antidepressants, disclosing the potential for increased risk of suicide, particularly among children and young adults. There is strong evidence that contradicts that purported risk, but patients should consider all potential risks when agreeing to take medication. No matter what medications are taken, they should not be discontinued without prior consultation with a qualified medical provider.
In the more severe cases of OCD, if cognitive behavioral therapy and medication are not working adequately, there are other procedures which can be introduced.. These may help, although they lack the strength of evidence and established track record of psychotherapy and medication. Two of these therapies are deep brain stimulation (DBS) and transcranial magnetic stimulation (TMS).
Deep brain stimulation is a common treatment for those suffering from Parkinson’s Disease, and it has been approved for treatment of severe OCD. Electrodes are implanted in certain areas of the brain and stimulated to balance the production and activity of brain hormones. DBS requires surgery, opening the skull to place the electrodes and running wires under the skin to an implanted neurostimulator.
In contrast, transcranial magnetic stimulation is not invasive. TMS uses a device with a wire coil that is pressed to the outside of the head. When an electric current runs through the coil, it creates a magnetic field that penetrates into the brain and alters brain activity.
Again, these therapies are usually only tried after more traditional treatments have been exhausted. It is very important to consult with a clinician with experience and expertise in these modalties, should one wish to explore them.
Lifestyle Changes and Coping Mechanisms
Certain lifestyle changes may also help patients manage the anxiety caused by OCD. In particular, exercising regularly, getting enough high-quality sleep, and avoiding alcohol and nicotine are proven ways to reduce anxiety.
There are also coping mechanisms recommended for OCD. This can sound ironic since the compulsive behaviors used to quell obsessive thoughts are OCD’s inherent coping mechanism. However, there are healthier coping mechanisms that can aid sufferers of the disorder.
ERP therapy is essentially used as a coping mechanism, but if you suffer from OCD, here are three others you can employ:
- Keep your stress level low, since stress exacerbates OCD. Make time during your day to unplug and de-stress, perhaps by doing some deep breathing. Walk away from stressful situations, such as if someone begins to argue with you.
- Keep a journal in which you write down circumstances that triggered your OCD, how you responded to them, and what you could have done differently. Not only will this help you avoid triggers, but the information you document will help your therapist address your OCD.
- When you first get a sense of an episode coming on, try to focus your attention on something other than the obsessive thought. Start singing a song, take a walk, pet your dog, or do anything that will switch your mind to a different thought.
What Questions Should I Ask My Doctor If I Think I Have OCD?
If you suspect you have OCD, it is also quite likely that you have beenhiding your obsessions and compulsions from others, even your closest loved ones. Just don’t hide them from your doctor. You should have an honest and open discussion with your healthcare provider about obsessive thoughts you may be having, the compulsive behaviors you’re using to respond to them, and what you think may be triggering the cycle.
Writing down your questions before you see your provider is always a sound strategy. Your first question should be, “Do you treat patients with OCD?” If they don’t, ask for recommendations of healthcare professionals who do.
You should ask your doctor if they have ruled out any other possible diagnoses, such as autism or Parkinson’s Disease. If the provider diagnoses OCD, ask for a review of the DSM-5 criteria and their explanation for how you meet it.
Finally, ask your doctor about recommended treatments and sources of information you can use to learn more about OCD.
Get Started Today
The earlier you seek treatment for your OCD, the sooner you can begin managing the disorder. Managing it will help you get back to a more normal way of life and stop OCD from taking over.
Get started today by confronting your OCD. The road ahead won’t be easy, but by facing up to the disorder, you’ll be taking the first step on the journey to reclaim your life.