'Obsessive' is one of those clinical words that changed in meaning as it became part of everyday speech. We talk of pedantic, nit-picking people as being 'obsessional', for example - or say that someone is 'obsessed' with cars, or sex, or football.
But doctors use these terms in a more limited, clinical way. 'Obsessions' are thoughts or ideas that keep coming into your mind, even when you don't want them to; compulsions are things that people feel they have to do, even though they try to resist.
OCD is an illness characterised by these unpleasant, repetitive thoughts and acts. It used to be considered a very rare condition, but in fact it probably affects two to three per cent of the general population. The World Health Organisation ranks it as the tenth cause of worldwide disability. Men and women are equally affected.
What are the symptoms?
There are (so far) no reliable clinical tests for this condition, so the diagnosis depends on accurately identifying symptoms. An interesting 'diagnostic questionnaire' is available - but, of course, the condition should only be formally diagnosed and treated by a specialist.
Cars, sex and football may be compelling - but these pleasurable interests are never part of clinical OCD. People with OCD suffer from more mundane compulsions: things like repeated and stereotyped checking, counting, ordering or cleaning. Obsessive thoughts are sometimes distressingly violent or obscene.
OCD sufferers carry out compulsive rituals to such extremes that they interfere with normal living. It's normal, for example, to double-check that the gas fire has been turned off, and the front door locked, before you go to bed. But it's not normal to have to wash your hands 20 or 30 times a day in a rigid routine. Likewise, it's not normal to clean the house so thoroughly that you wear out the wallpaper, or to start meticulously setting the table for Christmas dinner in late September.
Features of OCD
- unpleasantly repetitive thoughts, images, or impulses coming from the patient's own mind
- the thoughts are recognised as being silly or inappropriate
- the obsessions are resisted unsuccessfully (at least initially)
- the thought of carrying out the act isn't pleasurable in itself
- present on most days for at least two weeks
What causes OCD?
Freudians thought of OCD routines as a psychological defence against increased anxiety, and this is probably true in normal situations. Many of us would triple-check we had our passports before leaving on holiday, or have little mental routines we carry out before sitting exams.
But it seems that true, clinical OCD is a form of biological mental illness. It has a tendency to run in families, often occurs with other conditions such as depression and anxiety, and researchers have linked it to brain changes seen in specialised brain scans.
Treatment
Untreated OCD tends to get better over time without treatment, but most people benefit from the group of antidepressants called SSRIs. This includes drugs such as sertraline or paroxetine. As with depression, it can take two to four weeks for the drug to have effect, and improvement may continue for several weeks or months after that.
Treatment might also include cognitive behavioural therapy, carried out by a psychologist or nurse therapist.
This article was last medically reviewed by Dr Rob Hicks in May 2005.
First published in October 1997.
Obsessive Compulsive Behaviour News:
Right in the middle of a nervous breakdown; What's wrong with me? - I am so glad I found your site. After several months of attempting to effectively deal with my issues, out of sheer desperation, and as a stab-in-the-dark, I goggled "what's wrong with me" and came across another question and answer exchange on your site. I found it extremely useful and educational but it left me with some old and new concerns so I thought maybe this was my opportunity to get some answers (or at least ideas). Now I just have to try not to get my hopes up in waiting for a response! Of course I would certainly appreciate one soon, as much as any other individual that posts on your site I'm sure.I am a 28-year-old married, working female. I have always been an emotional, anxious, awkward individual, but I owned that and I never let it really affect my life in any big negative way (I didn't think). Recently, however, I've had more and more difficulty overcoming these challenges so that I am now to a point where I cry daily (sometimes multiple times daily) and have daily thoughts of anxiousness, sadness, frustration, uselessness, self-loathing, guilt (sometimes lasting all day).I now feel like I'm not heading toward a "meltdown" or "breakdown", but that I'm right in the middle of one. I've been here for months and I'm stuck. Just when I think I'm feeling better, once again I lose all feeling of control and rationality because of some often incidental event, making everything else seem to pile up. You should understand that I have always been an extremely organized, rational, well-meaning, even positive individual. And I believe I am an intelligent individual. So first of, it does not make sense to me that I can even be feeling this way. I have had no abnormal tragedy in my life, thank God. How should I be allowed to feel the selfishness of fear and vulnerability when I don't really know what those terms mean compared to some people's experiences?So I guess I'm looking for any answers, explanations, thoughts or ideas as to how I got here... and how I get out. I do feel I have attempted various methods of managing my stress levels, with varying degrees of success. (I've tried to change my mood/outlook and be more positive and selfless. I've tried to give myself time off to "recoup". I've even decided that maybe it's not the best thing to keep it all inside and have confided in a couple of people about a couple of things - but I am a very inarticulate person, at least face-to-face, and have difficulty understanding my emotions let alone expressing them.) So in the end all my methods come down to me still feeling overwhelmed, empty, or even wronged in some way ("it's unfair") - except I have no-one to blame but myself, right??There is constantly a battle being waged in my head. Scratch that, make it MULTIPLE battles. I am exhausted every day after work. I am exhausted every morning and have to fight to get out of the house (sometimes knowing I have to see and be around people is the toughest thought). I'm exhausted from the mental difficulty, from the crying, from the lack of sleep, from the pain in my back and neck. I used to be SO involved and have SO much more desire and energy! Theatre, choirs, sports, school, work, committees... While attending university it was nothing for me to have a 16 hour day, every day. Now all I can say is "I need to do less", "I want more time". Which says a lot, because part of my attempt at feeling better has been to make the very tough decision to quit some responsibilities. I really only have work and a couple of other things now.I can feel myself getting more emotional now and can see it in reading this back so I will leave it there - hopefully this gives you a good idea of what situation I find myself in. Can you help?
obsessive strange thoughts about life and existentialism - I have a very serious problem that maybe you can explain. I have been having these 'episodes' where sometimes I forget where I am at and I have these obsessive strange thoughts about life and existentialism, usually it comes out of nowhere and I think about how weird it is that our language is compiled in to the words that we use. I think about how weird that is, and then I start to panic because I don't understand what is happening to me. Like I will look at a word for example 'question' and I will obsess on how weird it looks and sounds when we communicate and read it in a sentence. I know it sounds bizarre, but it is really scaring me! I also am afraid to go to sleep at night because when I hit REM, I am half aware, and forget who I am or where I am at. I also ponder how strange life is and how it is definitely strange that we exist and are self aware. It is horrible and is freaking me out. I must say that I have been under the most stress that I have ever felt in my life for the past decade. I left the military because of this issue and after hearing stuff about the 2001 attacks that seemed like something out of a horror film. I take Prozac for depression, Xanax for anxiety (although my doctor is not nearly giving me enough) and have been on Seroquel before. (I stopped those, because I CANNOT stand the way they make me feel). If you can help it would be greatly appreciated because as we speak I am having immense trouble concentrating and am pondering why and how I came to be, and why our lives and looks are the way they are. I need to go to sleep, but I know what is coming. Please help if you can
Narcissistic Stepfather - I was bullied and physically manhandled by my stepfather over 6 months ago so i left that night and have never returned to the house where my mother still lives. My narcissistic father has constantly tried to contact me and i have changed my mobile number twice so i don't have any contact with him. I am studying at University (Children's Services and Behavioural management) i wonder why?? But have had lots of anxiety since the situation with my stepfather. I fear seeing him at the shopping centre and found myself in a cold sweat when i saw his car at the supermarket the other day. Will he ever leave me alone or do i have to get a restraining order on him which would be very hard on my mother who i love very much. What should i do and how can i stand up to this man??
Teenaged girl at risk for Eating Disorders writes, "i want to be confidant with my body" - im 15 approx 5'4 and weigh about 119 and i hate it i want to be 100-105.i have no self confidence and i want to look like i just stepped out of a magazine.i eat 24/7 and it kills me i know iff i dont stop im going to look like my mom who is a tad on the chunky side, but im scared ill look worse. i jus want to be skinny what do i do?
Im so confused...is is BPD or Bipolar? - Hello, I am 27 yrs old and have been having many symptoms that correlate almost exactly to both diagnosis of BPD and Bipolar disorder. I have mood swings, the highs and the lows, anxiety, suicidal thinking (and 2 attempts), sleep disturbance of always feeling tired to never feeling tired at all, i have always had relationship problems, i have an anger problem as well and spending problems. I did have an emotional and verbally abusive childhood as well. My mother and sister were both told they had Bipolar Disorder. But then told by someone else that they did not. My sister is currently in treatment for BPD. I'm not sure what to think, what to do, or how to control my anger, mood swings, racing thoughts,etc. I feel so out of control. please...can you give some insight on what you may think it could be? I would really appreciate it.
I can't stop jerking off! How can I stop masturbating? - Hey Doctor Dombeck. I can't stop jerking off. I am trying to stop but my cravings keep getting to me!
What is Neuroticism? - i would like to know if neuroticism is a form of personality disorder
Am i schizophrenic? - Two questions came in recently, I believe, from different people wondering if they might have Schizophrenia. Taken together they illustrate the difference between worrying over the condition, and possibly experiencing it. The first reader writes: Hi, I was just wondering if and when symptoms of schizophrenia would develop. My mother had a serious case of schizophrenia and i believe that my grandmother also suffered from the illness. I talk to myself sometimes and i do get kind of paranoid about people talking about me behind my back, however i don't hear voices and I don't hallucinate and I don't partake in drugs because I'm scared of becoming schizophrenic. I've actually spent a lot of my time researching the illness in hope to prove to myself that I don't. I'm a 19 year old male, so that means that if symptoms were to occur it would start soon. Is there anyway to prevent it from occurring if it hasn't already? The second reader has this to say: I know you probably get a thousand of these questions a day. I really don't know how to ask this so ill just tell u some of the things i CATCH myself doing that i feel aren't normal. I guess the main thing is; i feel like the universe is a conscious being and its "job" is to cause me pain through annoyance and setting me up and i can almost see it laughing at me sometimes. It seems like it catches everything and plans ahead for elaborate setups. I've caught myself crying and cursing at it...then i think omg I'm ill. but when I'm upset i forget and its real all over again. its like i know its not real but even know as im writing this i don't know for sure. i feel as if there are two parts of my mind fighting for control;one is trying to fly into the abyss of insanity and the other is holding on for dear life,thats why i use the word CATCH because ill be flying then ill say wait....this isn't normal. i use the term poking. the universe is always poking me. oh my god writing it makes it sound so crazy. I took an iq test when i was around 6 or 7 and "supposedly" scored like 136 or something sometime i feel like i was lied to because i don't feel very bright next to others, except when it comes to consciousness. it seems everyone is in a fog. (I know i jump around allot.) sometimes when I'm deep in thought i vocalize what I'm thinking without even realizing it,or hearing it really. I CATCH myself doing it. i also have extremely violent dreams most of the time it seems like a "task". but i am always somewhere where there are a set number of people normally with guns and i have to find weapons from my surroundings.(for example: i'm in an abandoned house there are like 5 or 6 guys and all i can remember is killing one of them with a metal clothes hanger i unwound. and I'm not trying to be sinister but i almost enjoy my dreams its like trying to work out a problem. i really don't know what else to mention. It would be greatly appreciated if you could give me your opinion. Thanks. See my response to these two questions below:
Cyclical Depression - Dr. Dombeck , I have been complaining of a cyclical depressed mode since childhood , (i am 25 years old now married male), every 2 or 3 years I have a an attack of depressed mode for about a year duration. I am a GP , my symptoms start insidiously and become stationary for a hole year with intolerable depressive thoughts , sometimes suicidal thoughts, and in many events i experienced hearing incomprehensible sounds buzzing in my ears (experienced more during stress). until now I do not know any aggravating or relifing factors. I am not on any medications,have no allergies, and have never smoked drinked or used drugs. I was an abused child during the period from 6 to 12 years of age. i have no surgical or medical history. i have a family history of 4 similar conditions. (my older brother and sister and 2 of my uncles). no one seeked medical advice but me -through this message- one symptom which I doubt it is relevant is having a notable difficulty in making decisions,another is having anxiety provoked diarrhea. would you guide me out this darkness ?
Frightening thoughts - fear losing control - please help! - hello, I'm a 23 year old male. For many years I have occasionally felt what i would describe as a "creepy dark cloud" over me. This feeling typically comes on only in the later evening hours before bed. I just don't feel "right" at such times, although I am able to function normally, just as if i were simply in a 'bad mood'. It is a very foreboding feeling. Back to normal when i wake up in the morning. A few months ago i had a bad day, and experienced some sort of an "attack" in which i felt like i was losing my sanity; slipping from my grip of reality briefly. I felt like i needed to speak with someone immediately - someone to ground me. I felt like i was losing control over myself. In recent months since then, I've begun to struggle with intrusive thoughts which often involve the worst things i can imagine. The idea will occur to me to kill someone I love, or a friend, or myself. I am *extremely* troubled by these dark thoughts and feelings. I feel so guilty, like a monster. I try to redirect myself, but sometimes that is of little comfort...These thoughts seem to be the product of my own mind - I've never had any auditory or visual hallucinations that I am aware of. No dreams of murderous acts or anything like that, either. i feel like whatever is wrong with me preys on my greatest fears. These thoughts represent the antithesis of what I *want to be*. I don't think I am capable of ever hurting anyone, but I am very disturbed by these intrusive ideas. I hesitate to call them compulsions, but there is an element of that, I think. in recent weeks, i have improved a bit for no apparent reason. I've finally started to feel "normal" again on most days. Please, any thoughts or educated guesses you could offer would be really appreciated. I'm so scared that I've begun to slip into some psychotic zone here. What all might be wrong with me?
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