by Dr. Axe
While the phrase, “don’t be so OCD,” gets thrown around in everyday conversation, many forget that it’s a serious disorder that affects many more than one would think. Approximately 2–3 percent of the adult population in the U.S has obsessive compulsive disorder (OCD), an anxiety disorder that is characterized by unwanted fears, obsessions and beliefs that drive compulsive behaviors. (1)
What sets apart OCD from having normal “habits” or rituals? Generally a loss of control and obsessiveness, which leads to repeated, irrational behaviors (calledcompulsions). OCD is a common disorder that affects both adults and children/adolescents, usually being diagnosed around the age of 19 and lasting for years if left untreated.
Estimates show that less than 10 percent of those suffering from OCD are currently in treatment — and many will go decades without telling anyone about their symptoms, hiding it from family and friends. Many people with OCD experience reoccurring, unwanted thoughts, mental images and “voices inside their head” telling them they must act out of certain compulsions, otherwise something bad is going to happen.
People with OCD are often fearful, and despite continuing to hold up certain behaviors over and over again, these behaviors usually bring little happiness. In fact, people suffering from OCD are much more likely to have depression and general anxiety, addictions and other types of mental problems.
A compulsion is considered a type of ritual that is driven by any sort of obsession — for example, the compulsion to continuously check things around the home, complete tasks in a certain order, or uphold a certain level of unnecessary cleanliness. The underlying reason that compulsions are performed is because they provide a temporary sense of relief and feel reassuring in the face of anxiety. This is the same reason that most healthy adults and children establish routines and have habits in general: They are predictable and, therefore, feel safe. (2)
Research shows that a high percentage of people with OCD experiences significant problems in their daily life, including feeling isolated and cut off from relationships (a real problem considering relationships are a major contributor of what makes us happy). Many also have a hard time holding a steady job and even lose control over motor skills (such as repeatedly blinking, speaking or grunting, and moving body parts like the face, neck or shoulders). Fortunately, natural treatment approaches like CBT therapy, a meditation practice, and various lifestyle changes can make a huge impact.
The Most Common OCD Symptoms
OCD is found in all age groups, all ethnic groups, and in both men and women. In children, OCD seems to be prevalent in boys more and is usually diagnosed earlier in life than in girls (average age of onset is typically reported as 6–15 for males and 20–29 for females). Research shows that up to one-half of all sufferers will find that their OCD has its roots in childhood, many even before their pre-school years. Most people with OCD start to show warning signs and symptoms as a teenager or in early adulthood, and the disorder is almost always diagnosed before the age of 40.
According to the Anxiety And Depression Association of America, obsessive compulsive disorder symptoms commonly include: (3)
- obsessive thinking, also called “ruminating”: this usually involves having repeated thoughts and urges that are very hard to stop or ignore
- a loss of control over behaviors and thoughts, especially in unfamiliar situations
- extreme anxiety when rituals/compulsions are not performed or are interfered with
- having repeated mental images that cause anxiety
- irrational fears about germs, illnesses and contamination
- feelings of aggression, fear and loss of control
- strong aversions or feelings against “taboos” like sex, religion, violence
- needing to have things in a certain order, place, pattern or quantity
- the drive for excessive cleaning and/or handwashing
- needing to repeatedly keep checking on anything that seems threatening (for example, if things are unplugged, locked or clean)
Different types of OCD symptoms can be subdivided in two groups: the obsessions (such as the thoughts and fears listed above) and the compulsions which they drive. Obsessions and compulsions interact since compulsive behavior is a way to counteract the anxiety caused by the obsession.
Carrying out compulsions doesn’t usually lead to happiness like you might think. The International OCD Foundation explains that compulsions are different from ordinary habits or rituals in a few key ways: (4)
- they feel very out of control and are not always done “by choice”
- the person might recognize that their own thoughts or behaviors are irrational but keep doing them anyway
- usually at least one hour per day is spent on compulsive behaviors
- while having a routine can be productive, enjoyable and beneficial, compulsions usually don’t bring any source of pleasure; instead, they lower anxiety temporarily, but long-term contribute to reoccurring fears and obsessions
Some researchers categorize people with OCD into different subgroups based on their recurring compulsions:
- Washers: usually fear contamination, germs and becoming dirty or sick
- Hoarders: find it very hard to discard of things, throw things out and pass on uncessary items
- Doubters: strongly fear being wrong, rejected, blamed or ridiculed by others
- Checkers: fear being harmed from perceived dangers, such as from fires, robbers, animals, etc.
- Counters: tend to fixate on numbers and need to count things over and over again
- Arrangers: fixate on order, patterns, symmetry and balance
What Causes Obsessive Compulsive Disorder?
Like other psychological disorders such as depression or anxiety, obsessive compulsive disorder is believed to be caused by a combination of factors related to both “nature and nurturing.” In other words, a person with OCD most likely has some degree of a genetic predisposition to abnormal thinking patterns and brain structure, but their disorder is also likely being triggered by their upbringing and environment.
Although the exact cause of OCD is not agreed upon, most researchers believe that a chemical/hormonal imbalance in the brain plays a part in the development of OCD, although it’s still not clear which comes first: the disorder itself, or the chemical imbalance. When people suffering from OCD are given medications to alter certain aspects of their brain chemistry — particularly levels of two neurotransmitters calledserotonin and vaopressin — some are able to find relief from symptoms. This suggests that serotonin and vasopressin play an important role in mood and behavior regulation, and that hormonal imbalances can trigger anxiety.
It’s generally accepted that OCD is caused by a combination of genetics, abnormal brain structure/functioning and life experiences/environment: (5)
- Genetics: OCD seems to run in families. Although having a relative with OCD doesn’t necessarily mean you will develop the disorder itself, many family studies have shown that people with first-degree relatives (such as a parent, sibling or child) have a higher risk for developing OCD than those without a family history. However, it’s always hard for researchers to separate someone’s upbringing from their genetic predisposition.
- Brain Structure and Functioning: Researchers from Yale University explain that very recently new ways of using MRI brain scans to measure how different parts of the brain are functionally connected to one another have revealed patterns of abnormality in the OCD brain. (6) Within the brain, there are two parts most related to fear-based beliefs called the basal ganglia and the thalamus. A connection/circuit runs from the front part of the brain to the basal ganglia, then to the thalamus, and then back to the front again. Healthy adults have a built-in mechanism that takes place during this brain circuit which acts like an internal “filter,” helping to decipher unharmful events/ thoughts from real, rational fears. In people with OCD, this filter seems to be malfunctioning, so they are much more effected by perceived threats or fearful thoughts and have a harder time telling the difference.Why does this break in normal brain circuits develop? Some researchers speculate that a combination of genetics, inflammation within the brain, and anxiety-provoking experiences (especially at a young age) contribute to abnormal brain processing that leads to OCD. Therapeutic techniques that interrupt fear-based thoughts, shed light on compulsions and reduce anxiety help to restore the normal brain circuit described above and, therefore, lower the need for compulsions. Rarely, another factor that also influences brain functioning/structure is a history of infections, especially during childhood (such as Pediatric Autoimmune Neuropsychiatric Disorders and Streptococcal infections).
- Experiences/Environment: People who have a history of trauma and difficult childhood experiences (like divorce, abuse, neglect or family deaths) are at an increased risk for developing OCD compared to those who don’t. These events seem to alter brain patterns and can even shape the physical structure of the brain thanks to “neuroplasticity,” which means reoccuring thoughts wind up forming physical brain changes that make these thoughts more likely to happen again in the future.
OCD Treatment and Prevention Plan
Obsessive compulsive disorder is treated with a combination of: psychological support, in some cases medication use, helpful strategies to reduce anxiety, and ongoing social/family support. The goal is to help someone learn about their own thought patterns, begin to recognize when fears are irrational, and then to gradually stop compulsive behaviors that form rituals/habits that only further drive up anxiety.
Many OCD patients tend to rely on medication alone to control symptoms, but studies have shown that medication usually doesn’t solve the underlying problems associated with OCD, especially when it’s not combined with therapy and lifestyle changes.Psychotropic medication use often leads to recurrence of symptoms and can also cause complications (like depression, trouble sleeping, changes in appetite/body weight and poor digestive functioning).
Some studies have found that around 90 percent of all people with OCD who exclusively rely on pharmacotherapy (taking medications) have a complete return of their OCD symptoms once they stop taking their prescriptions. In contrast, certain therapy techniques used in combination with lifestyle changes can offer long-term relief for OCD symptoms, with no side effects and usually benefits beyond just gaining control over compulsions.
Studies show that therapeutic interventions and social support, without any medications at all, even positively change the physical structure of the brain in people with OCD.One study published in the Journal of The American Medical Association found that after 10 weeks of structured exposure and response prevention behavioral and cognitive treatments, the majority of OCD patients showed significant improvements in certain brain processes (bilateral decreases in caudate glucose metabolic rates) and better control over OCD thoughts and compulsions. (7)
Below are some of the most well-researched and beneficial treatment approaches for OCD:
1. Cognitive Behavioral Therapy (CBT)
CBT is one of the leading therapeutic techniques used to treat OCD. Cognitive-Behavioral Therapy is now used in place of traditional psychoanalysis and many other forms of therapy because researchers have learned over the past 15 years that other techniques usually have little impact on the underlying causes of the disorder (ruminating thoughts and fears) and its symptoms. Many studies have found that CBT is highly beneficial for people with OCD even without the need for medication, and it can make a dramatic impact on someone’s quality of life within a relatively short period of time. (8)
In traditional psychotherapy, the client’s problems and past are usually discussed, especially their early family life and relationships, but in CBT treatments both the client and the therapist take active roles in uncovering the underlying beliefs that are being experienced in the present moment. CBT is less concerned about the past and more interested in looking at the “here and now,” shining a powerful light on the actual ruminating thoughts the patient is dealing with on a day-to-day basis. The idea is that a patient first must learn about their own internal dialog, beliefs and what’s driving their compulsions (whether it’s fear over rejection, illness or harm) in order to manage their behaviors.
One of the primary tools used in CBT is called Exposure and Response Prevention (ERP), also sometimes called “exposure therapy,” which gradually exposes the patient to their fears with support from their therapist. Another practice is “imaginal exposure,” which involves the client’s imaging to come into contact with their fears and avoid compulsions (such as not checking, arranging or counting something) so they can practice how to handle the situation in the future and prepare for feelings that will arise. Many CBT programs also assign “homework” so the client can continue to challenge symptoms on their own in various situations between the therapy sessions.
2. Reducing Anxiety
General anxiety, and the fear over consequences that will result from not acting out compulsions, is at the root of OCD, so reducing stress and anxiety is key. Certain lifestyle habits are known to either promote or lower anxiety, especially those related to someone’s diet, sleep, level of physical activity, ability to handle stress and their relationships.
- A Healthy Diet: An unhealthy diet can contribute to anxiety by raising inflammation, which alters brain structures and neurotransmitter functions. A poor diet can also increase moodiness and fatigue, lead to weight gain that impacts someone’s body image, and lead to poorly managed blood sugar levels that cause feelings of jitteriness/nervousness. Anti-inflammatory foods, healthy fats, unrefined carbs and proteins are important for neurotransmitter synthesizing and balancing someone’s mood and stress response.Some of the best foods for beating anxiety include: foods high in B vitamins (such as grass-fed beef, wild-caught fish, poultry, brewer’s yeast and green leafy vegetables), high-antioxidant foods (like fresh veggies and fruit), raw dairy products, foods with omega-3 fats (especially wild-caught fish like salmon), anti-inflammatory fats like coconut and olive oil, and foods high in magnesium (such as leafy greens, nuts, avocados and sea vegetables). Foods that can contribute to anxiety include: added sugars, refined carbohydrates, alcohol and caffeine, refined fats such as most vegetable oils and trans-fats, and processed/packaged snacks that are high in artificial additives. Taking supplements like adaptogen herbs to lower cortisol can also be helpful.
- Exercise: Regular exercise helps train the brain to manage stress and fear in a healthier way. Exercise is a great way to boost confidence and self-esteem, is totally free, available to everyone and benefits the entire body/mind. It’s also a good way to improve sleep quality, lower inflammation, have a rewarding goal to work towards, and can be done with other people or family members, which offers a sense of your connection. (09)People with OCD and other forms of anxiety can also benefit from exercises that promote relaxation, such as yoga or tai chi (which tie the mind and body mind), deep breathing techniques and other forms of stress management that lower muscle tension and help control ruminating thoughts.
- Getting Enough Rest/Sleep: According to research done by University of Berkeley,sleep deprivation increases “anticipatory anxiety” and is linked to higher rates of anxiety disorders. (10) A lack of sleep increases stress hormones like cortisol and adrenaline, which can negatively effect someone’s mood and interfere with normal brain chemistry. It also ramps up the brain regions that contribute to excessive worrying and ruminating. Seven to nine hours of sleep per night is needed by most adults to help manage stress, balance hormones, prevent fatigue and control their moods.
- Meditation: A 2008 study that was published in the Journal of Mental And Nervous Diseases found that meditation and mindfulness practices helped significantly improve OCD symptoms completely naturally within a short time frame. The controlled pilot study tested the effects of a mindfulness intervention on obsessive compulsive disorder (OCD) symptoms and tested the psychological processes possibly mediating such effects, including a reduction in ruminating thoughts and improvements in “letting go” of impulses. Participants with OCD symptoms received either mindfulness training or were put on a waiting list. The meditation group attended eight group meetings teaching meditative breathing, body scan, and mindful daily living tips. The results found that mindfulness intervention reduced OCD symptoms in the majority of participants and can serve as an effective, safe and low-cost alternative therapy for OCD. (11)Other meditation/mindfulness practices, including “Mindfulness-based cognitive therapy” (an eight-week group therapy program) have demonstrated effectiveness in various anxiety and mental disorders including OCD. Studies show that participants value this type of treatment program as helpful for dealing with their unpleasant emotions, allowing fears to surface and then pass, and for help with living more consciously in the present with less symptoms/compulsions emerging and controlling their behaviors. (12)
3. Ongoing Social Support
Ongoing social support from family, friends or a professional therapist all seem to play a big role in helping someone to overcome OCD and prevent recurrences, since relationships and connections function as natural stress relievers. (13) Many people with OCD feel isolated, alone, embarrassed or angry about their condition, so learning about the underlying causes of OCD and finding support are key to reducing feelings of helplessness and isolation (such as”why me?”).
If you think you might have OCD learn about OCD causes, risk factors, early warning signs and treatment plans. Consider joining a local support group or connecting with people online. Find people you can reach out to when facing challenges, which makes long-term recovery more manageable. And invest your energy and attention into other rewarding things like hobbies, your relationships, your career path or faith.