Everyone has rituals, habits, and routines, such as knocking on wood three times or carrying around a token of good luck. Often, these examples are harmless and done jokingly. For those with Obsessive-Compulsive Disorder (OCD); however, it is not simply a ritual done for fun. It is an obsession that creates a repetitive pattern of fears and thoughts, leading to a strong desire to perform repetitive behavior. Examples include being afraid of germs which leads to compulsively washing hands, or repetitively locking and unlocking the door before leaving and returning home.
These obsessions and compulsions interfere with daily activities and cause significant distress. OCD sufferers fixate on their obsessions, feeling driven to perform compulsive acts to alleviate stress and anxiety. The OCD cycle includes repetitive thoughts or urges, causing one to create rituals and behaviors to stop the obsessive thinking. If you have a loved one with OCD, it’s important to understand the illness, how it impacts them, what to expect, and how you can help.
For someone with OCD, their compulsions are not carried out at will or performed for pleasure. Completing them is essential. Many with OCD suffer from obsessions and compulsions, and there are symptoms for each.
Obsession symptoms include:
- Fear of dirt, germs, or contamination: An example is being afraid - to the point of avoidance - of touching something that someone else has touched.
- Feelings of doubt and an inability to handle uncertainty: This includes things such as stressing all day, every day, about whether or not the door is locked.
- Harmful or aggressive thoughts: Unwanted images and thoughts around violence toward oneself or others.
- The desire for things to be even and in order: Examples include needing every book to be lined up similarly on a bookshelf, or everything in a room needs to face the same way.
- Thoughts around themes such as aggression, sex, or religion: Unpleasant images around these themes are stuck in one's head.
These obsessions can often lead to compulsions, which are repetitive thoughts and behaviors that someone with OCD feels required to complete. The compulsions are in the form of rules or habits, and while they may bring temporary relief to someone with OCD, they are typically time-consuming and not practical to complete daily.
OCD compulsions and examples include:
- Washing and cleaning: Excessively washing one's hands.
- Checking: Turning a lock constantly to ensure it's locked, or checking to make sure the stove is off.
- Counting: Repeating a pattern of numbers, or the desire to perform a task a certain number of times.
- Orderliness: Scrubbing the bathroom every day, sometimes multiple times a day, or the inability to cope with anything being out of place.
- Following a strict routine: Keeping the same routine every day with an inability to deviate from it.
- Demanding reassurance: Saying a word or phrase repetitively to try and ease anxieties or calm down.
What to expect
If you have a loved one with OCD, you may notice their behaviors begin to change your daily life. Some of these behaviors may result in:
- Avoiding activities. Your loved one may avoid going out or doing things to decrease the risk of potentially triggering obsessions or compulsions.
- Avoiding social settings. Individuals suffering from thoughts of causing harm to others might socially isolate themselves for fear they will act on them.
- Less freedom. Your loved one’s compulsions, such as fear of germs or touching things, may impact your ability to have people over or go out as often as you used to.
- Strict schedules and routines. Avoidance behaviors often become pervasive, restricting daily functioning, both for the individual suffering from OCD and those close to them. These behaviors, especially the isolating ones, can be dangerous, as research has shown they can suffer from suicidal thoughts.
It is important to understand that many individuals with OCD have dysfunctional beliefs, such as:
- An overwhelming sense of responsibility
- An inflated assessment of a threat
- Intolerance of uncertainty
- Overvalued importance of thoughts, like the belief that a thought is as bad as acting on it
- An increased need to control one's thoughts
Depending on the individual and their course of illness, the awareness of these beliefs might differ.
Supporting someone with OCD
It can be hard to help a loved one suffering from OCD, but there are a few ways you can provide support, including:
- If someone close to you is suffering from OCD, discuss their specific obsessions and compulsions. It may help you better understand their behaviors and decisions to avoid particular people, situations, and places.
- Remain calm when a loved one is anxious or upset. OCD sufferers typically experience feelings of anxiety, disgust, or a sense of incompleteness around their obsessions. The compulsion then must be performed until things look, sound, or feel just right. If they aren't able to achieve this, it can often solicit feelings of anxiety or panic. Stay calm and grounded, suggest practicing controlled breathing, and remove them from the triggering situation.
- Be patient. Don't get frustrated with their rituals, or the anxiety their obsessions bring. Remember, they are not in control of these feelings.
- Suggest they seek help from a doctor. A practitioner or a mental health professional can help your loved one. It is their decision whether to see someone, but you can offer support and encouragement around doing so.
Help and treatment
Unfortunately, if not treated, OCD becomes chronic and has a low remission rate, making it vital to seek help from a clinician. The dedicated professional will ask questions about the presence of intrusive thoughts, images, urges, repetitive behaviors, and mental rituals.
Being honest with the clinician is important since the nature of the intrusive thoughts, frequency, and severity of compulsive behavior allows for the correct diagnosis. It helps distinguish it from occasional intrusive thoughts and compulsive behavior that everyone experiences, such as checking if the stove is off before leaving home.
Additionally, a doctor will determine the nature of the obsessions and compulsions and whether it is OCD-specific or linked to other anxiety-related disorders, including anorexia nervosa (AN), where symptoms include intrusive thoughts and compensatory behaviors.
The practitioner will assess the severity of OCD and the degree of awareness of the condition. Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) is the most commonly used severity assessment scale for OCD. It usually is done for baseline assessment and throughout the illness to monitor a patient's response to treatment.
The awareness of the illness is broadly categorized into 3 degrees:
- Good/fair: The individual maintains that the beliefs that he or she holds are false, likely false, or potentially false.
- Poor: The individual thinks that their compulsive beliefs are probably true.
- Absent/delusional: The individual is certain that the upheld beliefs are true.
Research suggests that better OCD awareness can lead to improved treatment outcomes. Awareness can decrease over time if OCD goes untreated, making it crucial to seek help early.
Mayo Clinic. Obsessive-compulsive disorder.
National Alliance on Mental Health. Obsessive-compulsive disorder.
Simpson, H. B., Stein, M. B., & Hermann, R. (2018). Obsessive-compulsive disorder in adults: Epidemiology, pathogenesis, clinical manifestations, course, and diagnosis.
Stein, D. J., Costa, D. L., Lochner, C., Miguel, E. C., Reddy, Y. C., Shavitt, R. G., ... & Simpson, H. B. (2019). Obsessive–compulsive disorder. Nature reviews Disease primers, 5(1), 1-21.