Read an Excerpt

OBSESSIVE-COMPULSIVE DISORDER: DEFINITIONS AND OVERVIEW

Obsessive-compulsive disorder, or OCD, is one of the most common but frequently underdiagnosed mental health problems of our time. Until very recently OCD--an anxiety disorder of overwhelming obsessions and repeated rituals that sufferers are powerless to stop--was considered rare and difficult to treat. Today we know that this disturbing and at times even incapacitating disease affects as many as one in forty people, making it the fourth most common of all psychiatric disorders. In the past ten years, we have also learned a great deal about coping with OCD, and the good news is that it is a highly treatable illness. Even though OCD will usually continue to cause some degree of distress to those afflicted with it, medication and behavior therapy can help control its symptoms and significantly improve the quality of life for OCD sufferers.

The signs of OCD are probably familiar to most of us, and you may very well have read about or seen or even met someone who suffers from this disorder. Long ago Shakespeare wrote of Lady Macbeth washing and rewashing her hands, trying in vain to remove the spot that only she could see. In the hit film As Good As It Gets, Jack Nicholson's character, obsessed with cleanliness and order, carefully steps over every crack in the sidewalk and insists on eating with his own plastic knife and fork when he visits a restaurant. And earlier this century, the reclusive multimillionaire Howard Hughes was famous for carefully sealing the doors and windows of his homes with paper towels and tissues to prevent errant germs from slipping in.

These were all rituals designed to relieve fears of contamination, a very common obsession in OCD. Yet while extreme behavior patterns such as these easily lend themselves to either tragic or humorous portrayal in literature and film, the reality is that they cause acute pain and distress to those suffering from them. People who have OCD are in fact fully aware of how bizarre and irrational their obsessions and compulsions may be, but without proper treatment they cannot control them and often go to extreme lengths to conceal them.

What is obsessive-compulsive disorder?

OCD is a common anxiety disorder characterized by upsetting and demanding thoughts and rituals that are virtually impossible to control. The unsettling thoughts or ideas are called obsessions; actions performed to reduce the distress caused by them are called compulsions. Usually both anxious thoughts and rituals are present, although in some cases it may be only one or the other. Obsessions and compulsions range in intensity from mildly interfering to extremely disabling. In contrast to those suffering from other psychiatric problems, people who have OCD are conscious of and commonly painfully embarrassed by the unusual thoughts and behavior that typify their disease.

What are obsessive thoughts like?

Thoughts grow increasingly uncomfortable and troubling to someone who has OCD. A perfectly healthy person may believe that he will catch a life-threatening illness just by touching a doorknob, or while driving down the road suddenly and without justification, he may become convinced that he has caused a terrible traffic accident. Many OCD sufferers are racked with doubt and guilt about simple things such as whether they left the stove on or the coffeemaker plugged in and might consequently cause a fire. Others have extremely disturbing thoughts of a violent, sexually inappropriate, or blasphemous nature.

What is the relationship between obsessions and compulsions?

When you have OCD, it is very difficult to get anguishing thoughts out of your mind. People may find relief from their obsessions only by engaging in compulsive, ritualistic behavior. And since that relief never lasts, they act out the rituals again and again. Sufferers eventually become locked into very rigid, absolute, and unforgiving patterns of thought and/or behavior.

There is often a direct link between obsessions and compulsions. The most common obsession by far is a fear of contamination by dirt, germs, or disease, and rituals typically used to relieve the resultant nervousness and apprehension are washing the hands until they are red and raw or showering for hours on end.

Checking is another very common type of compulsive behavior. "Checkers" are obsessed with doubt and guilt that they may harm others, and so they may repeatedly drive over the same patch of road to check that they have not caused an accident, or return home again and again to make certain that the stove and coffeemaker have been turned off.

When checking does not seem sufficient, some people also engage in "undoing" rituals, such as mentally counting or repeating a complicated string of numbers again and again to ward off some imagined disaster. Others are driven to hoard trivial objects, such as bits of string, old newspapers, and sometimes even trash. Many are preoccupied with symmetry and order, and they spend hours uselessly arranging paper clips in a drawer or shoes in the closet.

How do people with OCD feel about their disorder?

Most people with OCD suffer in silence and are slow in seeking medical treatment, since their behavior embarrasses, confuses, and frightens them. Even though they recognize that the irrational thoughts and rituals consuming their lives make no sense and at times try to resist or control them, the urges to carry them out are overwhelming.

Obsessive-Compulsive Disorder: Definitions and Overview

Obsessive-compulsive disorder, or OCD, is one of the most common but frequently underdiagnosed mental health problems of our time. Until very recently OCD--an anxiety disorder of overwhelming obsessions and repeated rituals that sufferers are powerless to stop--was considered rare and difficult to treat. Today we know that this disturbing and at times even incapacitating disease affects as many as one in forty people, making it the fourth most common of all psychiatric disorders. In the past ten years, we have also learned a great deal about coping with OCD, and the good news is that it is a highly treatable illness. Even though OCD will usually continue to cause some degree of distress to those afflicted with it, medication and behavior therapy can help control its symptoms and significantly improve the quality of life for OCD sufferers.

The signs of OCD are probably familiar to most of us, and you may very well have read about or seen or even met someone who suffers from this disorder. Long ago Shakespeare wrote of Lady Macbeth washing and rewashing her hands, trying in vain to remove the spot that only she could see. In the hit film As Good As It Gets, Jack Nicholson's character, obsessed with cleanliness and order, carefully steps over every crack in the sidewalk and insists on eating with his own plastic knife and fork when he visits a restaurant. And earlier this century, the reclusive multimillionaire Howard Hughes was famous for carefully sealing the doors and windows of his homes with paper towels and tissues to prevent errant germs from slipping in.

These were all rituals designed to relieve fears of contamination, a very common obsession in OCD. Yet while extreme behavior patterns such as these easily lend themselves to either tragic or humorous portrayal in literature and film, the reality is that they cause acute pain and distress to those suffering from them. People who have OCD are in fact fully aware of how bizarre and irrational their obsessions and compulsions may be, but without proper treatment they cannot control them and often go to extreme lengths to conceal them.

What is obsessive-compulsive disorder?

OCD is a common anxiety disorder characterized by upsetting and demanding thoughts and rituals that are virtually impossible to control. The unsettling thoughts or ideas are called obsessions; actions performed to reduce the distress caused by them are called compulsions. Usually both anxious thoughts and rituals are present, although in some cases it may be only one or the other. Obsessions and compulsions range in intensity from mildly interfering to extremely disabling. In contrast to those suffering from other psychiatric problems, people who have OCD are conscious of and commonly painfully embarrassed by the unusual thoughts and behavior that typify their disease.

What are obsessive thoughts like?

Thoughts grow increasingly uncomfortable and troubling to someone who has OCD. A perfectly healthy person may believe that he will catch a life-threatening illness just by touching a doorknob, or while driving down the road suddenly and without justification, he may become convinced that he has caused a terrible traffic accident. Many OCD sufferers are racked with doubt and guilt about simple things such as whether they left the stove on or the coffeemaker plugged in and might consequently cause a fire. Others have extremely disturbing thoughts of a violent, sexually inappropriate, or blasphemous nature.

What is the relationship between obsessions and compulsions?

When you have OCD, it is very difficult to get anguishing thoughts out of your mind. People may find relief from their obsessions only by engaging in compulsive, ritualistic behavior. And since that relief never lasts, they act out the rituals again and again. Sufferers eventually become locked into very rigid, absolute, and unforgiving patterns of thought and/or behavior.

There is often a direct link between obsessions and compulsions. The most common obsession by far is a fear of contamination by dirt, germs, or disease, and rituals typically used to relieve the resultant nervousness and apprehension are washing the hands until they are red and raw or showering for hours on end.

Checking is another very common type of compulsive behavior. "Checkers" are obsessed with doubt and guilt that they may harm others, and so they may repeatedly drive over the same patch of road to check that they have not caused an accident, or return home again and again to make certain that the stove and coffeemaker have been turned off.

When checking does not seem sufficient, some people also engage in "undoing" rituals, such as mentally counting or repeating a complicated string of numbers again and again to ward off some imagined disaster. Others are driven to hoard trivial objects, such as bits of string, old newspapers, and sometimes even trash. Many are preoccupied with symmetry and order, and they spend hours uselessly arranging paper clips in a drawer or shoes in the closet.

How do people with OCD feel about their disorder?

Most people with OCD suffer in silence and are slow in seeking medical treatment, since their behavior embarrasses, confuses, and frightens them. Even though they recognize that the irrational thoughts and rituals consuming their lives make no sense and at times try to resist or control them, the urges to carry them out are overwhelming.