Sharing her story in the Apple TV+ documentary series, The Me You Can’t See, Ginny particularly struggles with fears around contamination and cross-contamination, which materializes as several “washing” rituals carried out every day. As an Olympic athlete who participates in a contact-heavy sport, she’s successfully worked through her condition with the help of therapy. Her therapist, clinical psychologist Dr. Angela Smith, PhD., explains that the emotion most often associated with OCD is anxiety, adding, “Some individuals describe feeling disgust, guilt, or a ‘not right’ feeling.” But what is OCD exactly? Is there a chance that you may have it, or that someone you love deals with the disorder? Learn all about this mental health condition from insights shared by Smith alongside Dr. Neil Leibowitz, Chief Medical Officer of Beacon Health Options, and Dr. Roseann Capanna-Hodge, integrative and pediatric mental health expert and member of the International OCD Foundation (IOCDF) and the Anxiety & Depression Association of America (ADAA).
What is OCD?
According to Dr. Leibowitz, OCD is “a cycle of obsession that includes a pattern of unwanted thoughts, images, or urges that leads to compulsions or repetitive behaviors that are an attempt to neutralize these obsessive thoughts.” Even though these compulsions can provide a degree of temporary relief from anxiety and distress, the feelings can be easily triggered again, causing the cycle to repeat itself. “In order to have OCD, the degree or level of impairment must cause significant distress and interfere with a person’s daily activities and life,” Dr. Leibowitz adds. Dr. Capanna-Hodge explains it like this: “It is sort of like feeding a barking dog in that every time you feed into the intrusive thoughts, you accidentally allow them to take hold—then they are more likely to occur. Someone with OCD isn’t doing these behaviors on purpose.” The ADAA reports that OCD affects 1% of the U.S. population, and it’s equally common among men and women.
Are people born with OCD?
People aren’t necessarily “born” with OCD. Smith details that OCD most commonly develops in adolescence but can also develop in early childhood or adulthood. Challenging occurrences can bring about OCD. “Traumatic events can be precursors to many adverse experiences, including the development of OCD,” she says. “Studies show wide-ranging rates of co-occurring OCD and Post-Traumatic Stress Disorder (PTSD), but the trauma and development of PTSD may also occur after OCD has been diagnosed.”
Is OCD hereditary?
Smith says, “Like other anxiety-based disorders, OCD does run in families, and it is in fact more likely to run in families than panic disorder, social anxiety disorder, and generalized anxiety. However, having an immediate family member does not necessarily mean that someone will develop OCD. Similarly, some with OCD do not have a family member with the disorder.”
What’s taking place in the brain?
Like other mental health disorders, the activity that takes place in the brain of someone with OCD is quite the tangled web. “There is increased activity occurring in circuits or loops among certain areas of the brain, such as the cortex, the striatum, and the thalamus,” Dr. Leibowitz says. “This leads to the development of obsessions and the compulsion is the reaction that provides temporary relief. But the relief is only temporary, and the compulsive behaviors actually serve to reinforce the circuit, creating this loop of obsessions and compulsions.” The brain chemical serotonin is an important player in this process. “We know this at least in part because the main medications we use to treat OCD act on serotonin,” Dr. Leibowitz says.
What are the different types of OCD?
OCD isn’t a one-size-fits-all mental health disorder. It appears in many forms. Smith shares that there are “several common presentations” of OCD, which she says include:
Contamination obsessions (e.g., fear of becoming ill and associated hand-washing, showering, and avoidance of things considered contaminated)Harm obsessions (e.g., fear of unintentionally harming oneself or others and associated checking and avoidance)Unacceptable thoughts (e.g., thoughts with a sexual, violent, or blasphemous theme)“Not just right” experiences, which is associated with a feeling of things feeling “not right” and urges to remedy the feeling by doing a behavior to make it feel right
What difficulties do those with OCD face?
“Intrusive thoughts and compulsive behaviors hijack a person’s brain and make the day-to-day very difficult,” Dr. Capanna-Hodge says. “When your brain is constantly in a state of fright, it is hard to be connected, focused, and do even simple tasks if those intrusive thoughts and compulsions are intense. Many people with OCD are highly functional and go through periods of waxing and waning when the thoughts and compulsions might be less or more intense.” OCD is a complex disorder, something that can make diagnosed individuals feel isolated and “different.” In fact, it’s more complex than many realize. “The first issue with OCD is that it is underdiagnosed,” Dr. Leibowitz says. “This is often due to misdiagnosis. People may be diagnosed with Attention-Deficit Hyperactivity Disorder (ADHD), depression, anxiety, or other disorders when in fact they are suffering from OCD.” And although there are treatment options, Dr. Leibowitz believes that it’s difficult to treat, saying, “There are limited medication options for people with OCD, and many people do not reach full remission.”
How does someone receive an OCD diagnosis?
“A diagnosis of OCD can be made by a mental health professional, such as a psychologist or psychiatrist, and is based on the presentation and severity of symptoms, time spent engaged in obsessions and compulsions, the amount of distress and interference from symptoms, and with consideration of other potential disorders,” Smith says.
What are the treatment options?
Our experts share several treatment options available to those with OCD. They include:
Exposure and Response Prevention (ERP) Therapy, considered the “gold standard” treatment that combines Exposure Therapy and Cognitive-Behavioral Therapy (CBT), gradually exposing a person to their triggers so they can learn to be uncomfortable to the point where they can tolerate and ignore their triggersMedications called selective serotonin re-uptake inhibitors (SSRIs) include Paxil, Prozac, and LexaproTranscranial Magnetic Stimulation (TMS), a more recent treatment approach to OCD that’s a non-invasive form of brain stimulation that relies upon a magnetic field to deliver electric currents to certain areas of the brainNeurofeedback, a type of biofeedback administered by a mental health professional that offers live feedback of brain activity and reinforces positive behaviorsAlternative approaches like mindfulness, yoga, meditation, and anything else that calms the nervous system
Smith says that 7 out of 10 people with OCD benefit from ERP or medication.
Is OCD curable?
Like other mental health disorders, OCD isn’t “curable,” although, as Dr. Leibowitz explains, “it can remit to the point where it does not bother the person.” He adds that it can wax and wane over time, saying, “A key goal is to get the person to cope with the disorder.” Smith summarizes the incurability of OCD but offers hope: “It becomes clear that the experiences of an individual with OCD will never fully go away, because thoughts, feelings, and urges are an enduring part of the human experience. If the question becomes, ‘Must one’s suffering be unending?’ The answer is absolutely not. There is substantial research support for both psychological approaches and pharmacological approaches to help reduce the suffering that results from unwanted thoughts, uncomfortable feelings, and the cycle maintained by compulsive behavior.” Next up, discover 30 of the best mental health apps.
Sources
Angela Smith, Ph.D., a clinical psychologist with Anxiety Specialists of Houston.Dr. Neil Leibowitz, Chief Medical Officer of Beacon Health Options.Dr. Roseann Capanna-Hodge, an integrative and pediatric mental health expert.Anxiety & Depression Association of America. “Facts & Statistics”
