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How to Distinguish Between OCD, Developmental Disorders, and Basic Personality Public education and media have provided an increased awareness about OCD, although this has not been without some problems. One example, is that people now talk about being “so OCD,” to describe feeling “obsessed” with order and cleanliness, or to explain why they like to be in control or do things a certain way. This, however, is not OCD. Rather the term “obsessed” when used in this way really means being preoccupied with an idea, or having a strong preference for something. People with OCD are plagued with unwanted thoughts and ideas, not preoccupied or preferring to think about something of interest. There is a big difference. Another important distinction between those with and without OCD, is that when people without OCD engage in specific repetitive behaviours (e.g. cleaning or ordering), it is by choice, and they typically gain some pleasure or a sense of productivity from their actions. Whereas individuals with OCD feel forced into engaging in rituals, and find the repetitive and time intensive actions upsetting and exhausting. These factors provide an important distinction in understanding the role of ritualistic behaviour that might be part of the developmental or intellectual disorder, and that which might be part of OCD. For individuals diagnosed with a developmental disorder and/or an intellectual disability, ritualistic behaviours that co-occur, such as in Autism, are generally by choice and provide some pleasure or satisfaction. Finally, for individuals struggling with OCD, the obsessions and/or compulsions are time consuming, typically lasting an hour or more daily, sometimes as much as almost every waking moment in more severe cases. This, not surprisingly, causes significant impairment in major areas of life functioning such as school or work, friendships, family life, recreation, and even healthcare. Facts • OCD can begin early, starting between ages seven and 12. In fact, up to half of all adults with OCD say their symptoms started when they were children. • OCD is more common in boys than girls in childhood, but into adulthood, women are affected at a slightly higher rate than men. • OCD symptoms can change over time. For example, when OCD first appears it might begin with excessive washing compulsions, but over time this can shift to excessive checking compulsions while compulsive washing disappears. • OCD occurs in 2-3% of children and adults during their lifetime • Seeking reassurance from others that things will be okay or a ritual was completed “correctly” is common in people with OCD. This can include asking parents and staff to do rituals as well. What Are the Most Effective Treatments for OCD? The most effective treatments for OCD are Cognitive Behavior Therapy (CBT), which includes Exposure and Response Prevention and Cognitive Therapy, and medication using a class of medications called serotonin reuptake inhibitors, or SRIs. Exposure and Response Prevention is the most widely known and researched psychotherapy treatment for OCD. It involves having the individual learn to face their feared obsession, such as “I’ll become contaminated and ill from touching anything outside my home,” by actually coming into Katherine Martinez, Psy.D., R.Psych will present at DSRF’s 20th Anniversary conference, “From Good to Great,” on the topic of Understanding OCD and Other Anxiety Disorders in individuals with Down Syndrome: Learn How to Identify and Intervene. For more information or to register, visit DSRF.org/GoodtoGreat. Hand in Hand Fall 2015, Vol. 19 Issue 3
contact with feared items (e.g. seat at the bank or doorknob), and not engaging in a preventative measure (e.g. washing hands). As time elapses the individuals fear or discomfort will naturally rise, but as new and corrective information is obtained (e.g. “I’m not getting ill from sitting at the bank”), the fear and discomfort decrease and fade. The individual learns that rituals are irrelevant to reducing the fear and discomfort. Over time with enough repeat exposures to these types of experiences, the strength of the individual’s obsessions, and frequency of compulsions, also decrease and fade. Cognitive Therapy uses similar, but more cognitivebased, techniques to help the individual identify, examine, and correct, misappraisals and erroneous beliefs that are understood to be central in maintaining the OCD. Finally, for some individuals, their symptoms are so severe and/or they are reluctant to try CBT, that medication is a preferred treatment option. Medications are prescribed by a physician or psychiatrist, and are generally best provided by someone with expertise in the treatment of OCD. How can I help my loved one? You are not alone if you are struggling to know how to best help your loved one. For many families, friends, and employers of individuals with OCD, it can take time to even recognize that the person is struggling with OCD. In fact, the average length of time to get a correct diagnosis is 7-12 years! Some common warning signs that your loved one may be struggling with OCD include: • Missing time- E.g. Your loved one cannot explain how they spent the three hours in the bedroom. • Excessive time- E.g. Showers taking an hour, or other activities taking unusually long periods. • Routine rituals gone awry- E. g. Leaving the home used to involve a quick visual light switch check, and double doorknob twist, to ensure the home is secure. Now exiting involves a manual light switch check, and window and door lock check in every room, 5-minute front door lock check, and more. • Getting stuck- E.g. Being unable to shift from one activity to another such as washing hands over and over, and being unable to move smoothly to the next bathroom task. • Reassurance seeking- E.g. Asking for reassurance that things are right, nothing bad will happen, etc. • Checking in unusual/excessive ways- E.g. Checking with the waitress that a soda is free from contaminants when the bottle is clearly new/sealed. • Poor attention and focus- E.g. Individuals may loose focus or have trouble attending due to engaging in mental rituals For those whose loved one has already been diagnosed, there are several things you can do to help: • Don’t say, “Stop it!”- Recognizing that OCD is a neuro-bio-behavioural disorder and not simply willful misbehavior is critical. As a result, it is not helpful to tell the person to “just stop it!” They would if they could. • Don’t engage in, or do rituals, for your loved one- Participating in the person’s rituals keeps the OCD alive. It might make it easier in the short-term to help your loved one complete a ritual, but it will make it harder in the long-term to release your loved one from the grip of OCD. • Do be supportive- Providing your loved one with accurate information about OCD, taking them to appointments, telling them you love and care about them, not stocking up on supplies that encourage the rituals, and other actions, confirms your support. • Do provide corrective information – But don’t fall into reassurance provision. There is a key difference between letting your loved one know that a reasonable time to shower is between 5-10 minutes when they don’t have this information, versus telling them showers take 10 minutes many times, every day, when your child/client clearly has this information. In the latter example you are feeding the ritual. In Conclusion OCD is a highly debilitating disorder that affects approximately 2-3% of the population, often beginning in late childhood or early adolescence. The most common obsessions include themes of contamination, losing control, and harm, although there are other themes that frequently present as obsessions. The most common compulsions are washing and cleaning, checking, and repeating, although like obsessive themes, there is a range of compulsive behaviours that an individual with OCD may exhibit. Getting help for your loved one is critical and there are several well supported treatments that can provide relief. Speaking with a professional is the most important first step you can take for your loved one, as this will allow him/her to begin the journey towards an improved quality of life. Information generously provided by the following resources: www.iocdf.org www.anxietybc.com Hand in Hand Fall 2015, Vol. 19 Issue 3
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