Is OCD a Mental Illness?

It’s not unusual for a person to occasionally have obsessive thoughts or compulsive behaviors. Most people have double- or even triple-checked to make sure they locked the door, turned off the oven, or have their keys. They may also compulsively walk back to the door or put their hands in their pockets to check. But when someone has obsessive-compulsive disorder (OCD), obsessive thoughts and compulsive behaviors become intrusive, uncontrollable, last more than an hour each day, and interfere with daily life.

Obsessive-compulsive disorder (OCD) is generally defined as having excessive, unwanted, recurrent thoughts accompanied by urges to repeat certain acts or behaviors. The compulsions are usually repetitive actions or rituals designed to reduce anxiety caused by the obsessive thoughts.

In other words, a person suffering from OCD may have obsessive thoughts about becoming contaminated with dirt and germs. He or she might then engage in excessive hand washing to relieve the anxiety over being contaminated with dirt and germs. People with obsessive-compulsive disorder usually are aware that their thoughts and behaviors are unwarranted, but they don’t know how to stop them.

What Causes Obsessive-Compulsive Disorder?

Over two million Americans suffer from OCD. On average, the disorder appears around the age of 19 and affects both men and women equally. It is unclear what causes OCD, but several factors can influence development of the disorder.

  • Genetics play a role in the development of obsessive-compulsive disorder. People with a close blood relative who also suffers from OCD are more at risk of developing it themselves.
  • Brain function, specifically how serotonin interacts with the brain, has been linked to impulsivity and other symptoms of OCD. The exact connection is still unclear, but research indicates that controlling serotonin levels and production can help reduce symptoms of OCD.
  • Environmental influences can also have an effect on the development of obsessive-compulsive disorder. People who have suffered trauma or abuse as a child may be more at risk for developing OCD than others.

Diagnosing OCD

Prior to the release of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), obsessive-compulsive disorder was classified as a subset of another mental illness and considered a sort of nonspecific anxiety disorder. The description left many asking, “Is OCD a mental illness?”

Although more than two million people were suffering from obsessive-compulsive disorder, without a separate classification the previous definition could be considered confusing. Thus, with the development of the DSM-5, OCD was given its own designation and category, along with the repetitive thought and behavior disorders, such as body dysmorphic disorder (BDD), excoriation (skin picking), hoarding, trichotillomania (hair pulling), and substance/medication-induced obsessive-compulsive and related disorder. These disorders share common biological markers, symptoms, and courses of treatment. Removing OCD from the umbrella of other anxiety disorders firmly identified it as a distinct mental illness.

The DSM-5 now requires the following specific elements for an OCD diagnosis:

  • Obsession. Recurring, unwanted, intrusive and uncontrollable thoughts. Some examples of obsessive thoughts include fear of contamination, fear of shouting something inappropriate, fear of losing control and harming oneself or others, and illicit or unpleasant sexual or violent images.
  • Compulsion. Urges to repeat certain acts or behaviors. Some examples of compulsions include hand wringing, compulsive counting, excessively checking on something, repetitive vocalizations, excessive hand washing or cleaning, compulsive ordering or arranging items in a specific way.
  • Protraction. Symptoms must be time-consuming, lasting more than an hour each day, and cause significant impairment in life functioning.
  • Independence. Symptoms must not be related to another mental illness or the physiological effects of substance abuse.

Although obsessive-compulsive disorder is a distinct mental illness, it does often co-occur with other disorders, most commonly anxiety and depression.

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OCD and Anxiety

There is a high rate of co-occurrence between OCD and anxiety. In fact, about 76 percent of people who suffer from OCD also suffer from an anxiety disorder. Prior to the DSM-5, obsessive-compulsive disorder was even classified of a subset of anxiety disorders due to the overlap of certain symptoms.

Even though OCD and anxiety are distinct mental illnesses, it would appear they are inextricably linked. People with both OCD and anxiety experience excessive worry and distress even when there is no actual threat or danger present. With obsessive-compulsive disorder, obsessive thoughts generally produce anxiety, and compulsions are created to reduce or eliminate that anxiety. Both activities center around anxiety.

Treatment for OCD and anxiety are similar. Both use psychotherapy and medications—primarily antidepressants and anti-anxiety medications—to help alleviate symptoms and eliminate disruptions in life activities.

OCD and Depression

OCD and depression also frequently co-occur. About 41 percent of people with OCD also have major depressive disorder. Initially, in the 1980s, obsessive-compulsive disorder was considered a sub-dimension of depression. But currently, some mental health professionals feel co-occurring depression is a result of long-term chronic or severe OCD. The idea is that continual distress and interruption in life functions caused by chronic obsession and compulsion results in the development of depression. For instance, loss of interest in activities that were once enjoyable could occur if rituals and compulsions interfere with completing the activity. The disruption in function could equate to a decreased desire to participate.

Other symptoms of both OCD and depression appear to overlap as well. For example, fear and hopelessness that potentially drive obsessions are also essential components of depression. Researchers and mental health professionals have observed that the signs and symptoms of depression tend to appear after OCD has begun.

People with both OCD and depression are at greater risk for suicide. In one study, 63 percent of people with OCD had had suicidal thoughts, and 26 percent had attempted suicide. It is important that people with obsessive-compulsive disorder seek professional help to ensure symptoms do not get worse and lead to other disorders, like depression. Treatment for OCD and depression includes psychotherapy and prescription antidepressants.

Treatment for OCD

Like many mental illnesses, treatment for obsessive-compulsive disorder includes psychotherapy, medication, or a combination of both. Cognitive behavioral therapy (CBT) is used to help people with OCD develop new ways to deal with anxiety that do not involve elaborate time-consuming rituals. It also can help diminish feelings of anxiety by better understanding and managing triggers. CBT is designed to help people better function within their environment by changing unhelpful patterns of thinking, controlling emotions about negative experiences and stress, and adjusting behavior to more helpful ways of dealing with life’s complications.

Often, antidepressants and antianxiety medications can be helpful to reduce symptoms associated with OCD. Antidepressants, such as Serotonin Reuptake Inhibitors (SRIs) and Selective Serotonin Reuptake Inhibitors (SSRIs) target chemicals in the brain to reduce the symptoms of obsessive-compulsive disorder. These medications work on the brain to increase serotonin levels to help maintain mental balance, and include:

  • Fluoxetine (Prozac, Sarafem)
  • Sertraline (Zoloft)
  • Fluvoxamine (Luvox)

SRIs can also be effective but often require a higher dosage when treating OCD than when used for depression. They also can take up to eight to 12 weeks to begin working, but once they do people often see a faster improvement of symptoms.

Anti-anxiety medications, benzodiazepines, reduce the symptoms of anxiety by decreasing abnormal electrical brain activity. Benzodiazepines tend to be extremely effective in treating anxiety and work faster than antidepressants, but they can be highly addictive. Common anti-anxiety medications used to treat OCD include:

  • Lorazepam (Ativan)
  • Clonazepam (Klonopin)
  • Alprazolam (Xanax, Niravam)

Anti-anxiety medications also have serious side effects when combined with other medications, alcohol, or street drugs. It is important that doctors are aware of all medications that a patient is taking, to avoid potentially life-threatening side effects.

In addition to medication and talk therapy, residential treatment can be a very helpful option for people with obsessive-compulsive disorder. Because OCD is chronic and can severely impair life functions, self-management can be difficult. In residential care, people with OCD can receive help in a safe, therapeutic, home-like setting, away from triggers and with 24-hour access to mental health professionals.

Effective therapies generally take considerable time to become truly useful. It took a great deal of time to develop unhelpful behaviors, and it tends to take time to change those behaviors. Residential treatment can provide a stable environment for short- or long-term, intensive, individualized programs, and allow people suffering from obsessive-compulsive disorder to work on mastering new skills before returning to home, where situations are less uncontrolled.