Obsessive Compulsive Disorder (OCD) is a serious psychiatric condition that affects about 1% of the US population.1 When OCD co-occurs with a Substance Use Disorder (SUD), the outcomes can cause significant harm to the individual and can even be fatal. One major characteristic of OCD is the compulsion to engage in avoidance behaviors to attain relief from disturbing thoughts. If an avoidance behavior takes the form of substance use, this can quickly become substance abuse and lead to an addiction. Greater attempts at suppressing distressing thoughts could lead to overdose.
As the name suggests, Obsessive Compulsive Disorder (OCD) is characterized by:
Many of us obsess over thoughts and carry out repetitive behaviors from time to time, but OCD is a serious disorder. Many people jokingly or light-heartedly diagnose themselves with OCD, but for people suffering, the condition is no joke.
OCD can be a source of significant challenges and distress and can affect anyone, regardless of age, gender, culture, or level of education.
Obsessions are considered to be “intrusive thoughts, images, or impulses that are experienced as repetitive and unwanted.”2 These can be significantly disturbing for the individual.
When a person suffering experiences an obsession, they also usually experience co-occurring emotions, such as fear, disgust, or shame.
The following are common types of obsessions associated with OCD3:
Contamination (germs, body fluids, dirt, chemicals)
Loss of control (causing harm to others, violent outbursts, inappropriate statements, theft)
Danger and harm (accidentally hurting oneself or someone else, being responsible for harm)
Perfectionism (punctuality, grades, evenness/symmetry, memory, decision-making)
Sexual thoughts (forbidden or perverse sexual thoughts, sexual impulses, sexual orientation, illegal sexual activity, violent sexual activity)
Religious obsessions (blasphemy, morality, offending a deity, superstition)
Health (disease, illness – not related to contamination)
Compulsions are repetitive behaviors that are carried out in an attempt to neutralize or counter obsessive thoughts. Those suffering with OCD may be aware that these compulsions will only provide temporary relief from their obsessions, but even temporary relief feels necessary given the overwhelming nature of the obsessions. Compulsion can take up a lot of time and can take priority over other areas of life.
The following are some common compulsions associated with OCD4:
Cleaning (hand washing, showering or bathing, tooth-brushing, grooming)
Checking (wondering if you harmed others, mistakes, dress, news, organization)
Repeating (rereading, rewriting, body movements, routine activities, doing tasks in multiples)
Mental compulsion (reviewing, praying, counting, canceling/undoing)
Arranging (putting things in order to “feel right”)
The specific causes of Obsessive Compulsive Disorder remain unknown, but it is generally accepted that OCD develops due to:
A family history of the disorder (the disorder is present in a relative)
Brain chemical imbalance
Significant, impactful events (trauma, responsibility at an early age)
Obsessive Compulsive Personality Disorder (OCPD) is not the same as OCD. The two are often confused, but OCPD is characterized by a preoccupation with perfectionism in most areas of one’s life.5 People with OCPD do not generally suffer their condition to the same extent as a person with OCD.
The fifth edition of the Diagnostics and Statistics Manual (DSM-V) lists a number of criteria that must be met for a person to be diagnosed with Obsessive Compulsive Disorder.
Recurrent and persistent thoughts, urges or images that are experienced as intrusive and unwanted, and that in most individuals cause noticeable anxiety or distress
Attempts to ignore or suppress obsessive or persistent thoughts, urges, or images, or to neutralize them with a thought or action (e.g., by performing a compulsion)
Repetitive behaviors, or mental acts (e.g., praying, counting)
Behaviors or mental acts aimed at preventing or reducing distress or preventing some dreaded event or situation
Obsessions or compulsions that are time consuming (e.g., take more than 1 hour per day)
The disturbance is not better explained by the symptoms of another mental disorder
The disturbance is not due to the direct physiological effects of a substance
Having OCD is painful and can be debilitating. Evidence-based treatment methods for OCD are widely available and can help sufferers better cope with their condition. If you are suffering with OCD and have been using substances to cope, please seek professional help. We offer recovery services here at Heather R. Hayes & Associates, so you don’t have to suffer alone or in silence. As with any progressive condition, Trauma-Informed Responsive Intervention™ and treatment are the best solutions.
If you believe that OCD has been affecting your life or the life of a loved one, seek professional help if you haven’t already done so. The distress caused by OCD can have serious consequences for your overall well-being, so any help and guidance you can find is going to be useful.
1 “Facts & Statistics | Anxiety And Depression Association Of America, ADAA”. Adaa.Org, https://adaa.org/about-adaa/press-room/facts-statistics. Accessed 19 Oct 2020.
2 Substance Abuse and Mental Health Services Administration. Impact of the DSM-IV to DSM-5 Changes on the National Survey on Drug Use and Health [Internet]. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2016 Jun. Table 3.13, DSM-IV to DSM-5 Obsessive-Compulsive Disorder Comparison. Available from: https://www.ncbi.nlm.nih.gov/books/NBK519704/table/ch3.t13/
3 Clark, David A.; & Radomsky, Adam S. (2014). Introduction: A global perspective on unwanted intrusive thoughts. Journal of Obsessive-Compulsive and Related Disorders. Available online 18 February 2014. DOI: 10.1016/j.jocrd.2014.02.001
4 Reprinted with permission by New Harbinger Publications, Inc. This is an adaptation of the OC Checklist which appears in S. Wilhelm & G. S. Steketee Cognitive Therapy for Obsessive-Compulsive Disorder A Guide for Professionals (2006).
5 Ocd Uk.org. n.d. Obsessive Compulsive Personality Disorder (OCPD) | OCD-UK. [online] Available at: <https://www.ocduk.org/related-disorders/obsessive-compulsive-personality-disorder/> [Accessed 13 June 2020].
6 Substance Abuse and Mental Health Services Administration. Impact of the DSM-IV to DSM-5 Changes on the National Survey on Drug Use and Health [Internet]. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2016 Jun. Table 3.13, DSM-IV to DSM-5 Obsessive-Compulsive Disorder Comparison. Available from: https://www.ncbi.nlm.nih.gov/books/NBK519704/table/ch3.t13/
7 Substance Abuse and Mental Health Services Administration. Impact of the DSM-IV to DSM-5 Changes on the National Survey on Drug Use and Health [Internet]. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2016 Jun. Table 3.13, DSM-IV to DSM-5 Obsessive-Compulsive Disorder Comparison. Available from: https://www.ncbi.nlm.nih.gov/books/NBK519704/table/ch3.t13/
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