Department of Psychiatry
Penn Behavioral Health

Center for the Treatment and Study of Anxiety

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OCD: Some Facts



Symptoms

It is estimated that six million people in the USA have obsessive-compulsive disorder (OCD). Men and women develop OCD at similar rates and it has been observed in all age groups, from school-aged children to older adults. OCD typically begins in adolescence, but may start in early adulthood or childhood. The onset of OCD is typically gradual, but in some cases it may start suddenly. Symptoms fluctuate in severity from time to time, and this fluctuation may be related to the occurrence of stressful events. Because symptoms usually worsen with age, people may have difficulty remembering when OCD began, but can sometimes recall when they first noticed that the symptoms were disrupting their lives.

As you may already know, the symptoms of OCD include the following:

  • Unwanted or upsetting doubts
  • Thoughts about harm, contamination, sex, religious themes, or health
  • Rituals like excessive washing, checking, praying, repeating routine activities
  • Special thoughts designed to counteract negative thoughts

In addition, you may be aware of certain situations, places, or objects that trigger the distressing thoughts and urges to ritualize. You may find yourself avoiding these situations, places, and objects.

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What causes OCD?

The reasons why some people develop obsessions and compulsions while others don't are unknown. Researchers have considered different types of explanations. Some experts have suggested that some specific "thinking mistakes" about harm occur in OCD. Examples of such thinking mistakes are:

  • Thinking about an action is the same as doing it, or wanting to do it
  • People should control their thoughts
  • If I don’t try to prevent harm, it’s the same as causing harm
  • A person is responsible for harm, regardless of the circumstances

While this theory explains the types of thinking mistakes made by people with OCD, it does not explain why some people develop OCD and others do not.

Many researchers also feel that people with OCD have abnormal brain chemistry involving serotonin, a chemical that is important for brain functioning. Unusual serotonin chemistry has been observed in people with OCD and medications that relieve OCD symptoms also change serotonin levels. However, it is not known whether serotonin chemistry is truly a key factor in the development of OCD. Research results are inconclusive at this point.

There is also evidence that OCD is more prevalent in some families than others. It is difficult to know how much of this is a result of what children learn from their family while growing up, and how much is hereditary.

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Why do you have OCD?

Many people would like to know what causes this disorder or how they developed it. There are a number of guesses, but there is as yet no satisfactory theory of its development. Most likely, there is a combination of factors (such as biological/genetic and environmental aspects) that contribute to the development of OCD. It is tempting to be overly concerned with the lack of information about how OCD develops. Fortunately, despite our lack of knowledge, there are effective treatments available that do not require an explanation for why or how a person developed OCD.

Scientists do understand a great deal about the symptoms of OCD and this is very important for the treatment of the disorder. In fact, your learning more about your OCD symptoms will help you get more improvement from this treatment. OCD is a set of habits that, as you know, involves intrusive, unwanted, and upsetting thoughts, ideas, images, or impulses (obsessions). Along with these thoughts, you have unwanted feelings of extreme discomfort or anxiety and string urges to do something to reduce the distress. Because of this, people get into the habit of using various special thoughts or actions to try to get rid of the anxiety (compulsive rituals). These habits of thinking, feeling and acting are extremely unpleasant, wasteful, and difficult to get rid of on your own.

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The two important associations in OCD

Two types of associations are a very important part of OCD and understanding both of them will help with your therapy. Therapy is designed to break both types of associations. First is the association between certain objects, thoughts, or situations and anxiety/discomfort. For example, think about a situation, thought, or object that you try to avoid or that you endure with suffering because if makes you feel distressed or uncomfortable. It is likely that you have an association between this situation and anxiety or distress.

The second type of association is an association between carrying out rituals and decreasing the distress. In other words, after you carry out your rituals you temporarily feel less distress. Therefore, you continue to engage in this behavior frequently to achieve more relief. Try to identify the situations that increase discomfort (association #1) and then the behaviors or thoughts that you perform to neutralize the discomfort (association #2). Doing this will help you in your treatment.

Unfortunately, doing rituals to reduce distress doesn’t work all that well. Your distress goes down for a short time and comes back again. Often, you find yourself doing more and more ritualizing to try to get rid of the anxiety. Even then, the rituals do not reduce the distress, and before long, you are putting so much time and energy into rituals that other areas of your life get seriously disrupted.

In order to treat OCD, the associations described above must be weakened or broken. Your therapy is designed to do this and your therapist knows exercises that will be helpful in achieving this goal. These exercises are called exposure and ritual prevention and you will learn more about them from your treatment provider.

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