Madeline Fletcher

ENG 1121

Heather Johnson

08/02/20

Obsessive Compulsive Disorder: It’s More Than Just A Lot of Handwashing

“I always have to keep my room clean because I’m so OCD.” “I am pretty sure I have

OCD because everything always needs to be in a straight line.” These are common phrases

people often hear from peers. When you think about obsessive compulsive disorder, or OCD,

what comes to mind? When people are asked this question, the most common answer is always

washing your hands, being a germaphobe, or counting to a certain number before doing specific

tasks. In some cases, this is true, but for most others with obsessive compulsive disorder it does

not even come close. Imagine constantly being worried that your loved ones will be dead if you

do not complete a specific task. Imagine the countless sleepless nights because you cannot shut

your mind off from thinking about horrible thoughts. Imagine the unbearable anxiety that could

even cause panic attacks at the happiest events, such as birthday parties. Imagine always feeling

like you can never take a deep breath or get a clear head. This is the reality of the many people

who suffer from OCD. When thinking about what OCD truly is, an exact answer cannot be

given. This is because this mental illness presents itself in many different ways and can be

extremely different for everyone it affects. This disorder can disruptive and cruel. According to

an article written by The New York Times by Jane Brody, “The World Health Organization

ranks OCD as one of the 10 most handicapping conditions by lost income and decreased quality

of life” (Brody). The more a person tries to ignore OCD, the worse it gets. There is not a day

that goes where this disorder does not have an impact on a person’s life. Obsessive compulsive
disorder negatively affects a person's mental health through constant anxiety and stress. This can

be seen through the different forms of OCD, treatments, and ways it can be developed.

While OCD is different in everyone, there are many core symptoms that present itself at

the essence of the disorder. According to Mayo clinic, “Obsessive-compulsive disorder (OCD)

features a pattern of unwanted thoughts and fears (obsessions) that lead you to do repetitive

behaviors (compulsions). These obsessions and compulsions interfere with daily activities and

cause significant distress” (Mayo Clinic: Obsessive Compulsive Disorder). There are two main

key components that make up obsessive compulsive disorder, which are obsessions and

compulsions. A person with obsessive compulsive disorder usually has both, but sometimes one

can be more prevalent than the other and it seems like they only have one. Obsessions are

unwanted and repeated thoughts. These thoughts are extremely intrusive and cause constant

anxiety and distress. Surprisingly, trying to distract yourself from the thoughts by doing different

activities only make them more likely to intrude. Common symptoms of OCD that are based on

obsessions, according to The National Institute of Mental Health are, “Fear of germs or

contamination, unwanted or forbidden of taboo thoughts, aggressive thoughts towards self and

others, and having things symmetrical or in perfect order” (NIMH: Obsessive Compulsive

Disorder). Once a person feels all the stress from obsessions, it is common they try to relive the

distress through compulsions, but it only lasts for a short period of time.

Compulsions are repetitive behaviors or mental actions that someone believes is

necessary to perform. It is important to note that everyone can find themselves double checking

something at one point or another. What is different is a person who suffers from this illness

thinks that when they do these acts, they are avoiding something bad from happening, but this is

more detrimental to their mental health than good. Compulsions can also bet extremely time
consuming. Some of the more obsessive symptoms of OCD are “washing and cleaning,

checking, counting, orderliness, following a strict routine, demanding reassurance” (Mayo

Clinic: Obsessive Compulsive Disorder). These symptoms can be both observable or hidden,

which can potentially make the disorder difficult to diagnose.

Like it has been previously stated, obsessive compulsive disorder is different in everyone,

and this includes the level of severity seen in symptoms. It is common that symptoms of OCD

usually start to appear in someone in their teenager to young adult years, starting around age

nineteen, but it also is possible for them to start occurring in childhood. While older people

might notice that these behaviors are not normal, children might grow up thinking that it is

normal to feel that way and never know that with help they could feel so much better. Men are

also seen to develop symptoms of obsessive-compulsive disorder earlier than women. Symptoms

can be seen to vary through different stages in life. More severe symptoms present themselves

and continue to worsen in times of greater stress. Symptoms can go from being mild and

manageable to disabling and severe and this can happen back and forth for your whole life.

While the cause of OCD is unknown, there are risk factors that play a role in developing

obsessive compulsive disorder. The first is genetics. According to the National Institute of

Mental Health, “Twin and family studies have shown that people with first-degree relatives (such

as a parent, sibling, or child) who have OCD are at a higher risk for developing OCD

themselves” (NIMH: Obsessive Compulsive Disorder). Children can also learn obsessive or

compulsive traits from their affected family member. While there are changes in specific genes

that are related to the development of OCD, there is not enough research done to confirm it.

There is hope that through gene testing this can be confirmed in the near future and the illness

can be better predicted.

 Another risk factor is biology. OCD can occur because of changes in certain chemicals in

the body and brain. For example, “Imaging studies have shown differences in the frontal cortex

and subcortical structures of the brain in patients with OCD” (NIMH: Obsessive Compulsive

Disorder). Another main area in the brain that is affected with OCD is the prefrontal cortex,

which involves regulating social behavior. According to the “Obsessive-Compulsive Disorders:

A Handbook for Patients and Families”, “Diminished activity in this area can lead to poor

impulse control, impaired judgment and lack of remorse. Increased activity may therefore be

related to increased worry about social and moral concerns, such as meticulousness, cleanliness

and fears of being inappropriate, all of which are amplified in OCD” (Obsessive Compulsive

Disorders: A Handbook for Patients and Families). There are also studies that show a connection

between abnormalities in certain parts of the brain and obsessive-compulsive disorder symptoms.

The environment can also play a role in acquiring OCD. Studies show that an association

is seen between people who had trauma earlier in life and obsessive disorder symptoms, which

shows that stress is a factor in the cause of OCD. People can also be seen developing OCD

symptoms after having a streptococcal infection, like strep throat or pneumonia. In women,

OCD symptoms can worsen during premenstrual and postpartum stages in life. This suggests that

hormones could play a role in developing OCD. It is also suggested that OCD can trigger or be

related to other mental health disorders, such as anxiety disorders, depression, substance abuse,

and schizophrenia. Obsessive compulsive disorder can also cause complications in other areas of

life, such as holding a job, being in relationships, health issues, time management, and even

suicidal thoughts and behaviors.

 This disorder makes it extremely difficult and almost impossible to improve on your own.

There are so many different ways people with obsessive compulsive disorder can try and

improve their quality of life. Since there is no cause, these symptoms may never go away, but

they will be reduced so they can be manageable. The two most common concepts would be

medication and different therapies. Doing both at the same time is known to be the best treatment

for OCD. The kind of medication used for obsessive compulsive disorder treatment use what are

called serotonin reuptake inhibitors, or SRIs. Serotonin is the chemical in our brain that controls

our feeling of well-being and happiness, as well as our overall mood. What SRIs do is they

prevent the reuptake, or reabsorption, of serotonin which boosts our mood and happiness. These

types of drugs are also used to help with depression and other mental disorders. The most

common types of medication that are forms of SRIs are Fluoxetine (Prozac) and Sertraline

(Zoloft). These drugs are highly suggested by psychiatrists and physicians for the fact that they

actually work, have little to no side effects, and safe. Side effects, if seen, would be mild stomach

pain, insomnia, and headaches.

Another SRI that has been most studied for OCD is Clomipramine, or also known as

Anafranil. This medicine is known as a tricyclic antidepressant, or TCA, which means it keeps

more serotonin is available in the body, which boosts your mood even more. Most people show

improvement with OCD symptoms, but the side effects and safety concerns make it less likely

for doctors to prescribe. With these types of medication, it can take from six to eight weeks to

feel the effect and see a change in the symptoms. Doctors say it is important to stay optimistic

during this time, because it can be discouraging when a person can feel the side effects but not

see any results. It is also recommended by doctors that someone on a new medication waits at
least three months before deciding if it is the right medication for them. If they do not feel like

their symptoms are getting better, they can switch and start the whole process over again.

It can also take time to find the therapy that helps best with a person’s specific OCD

symptoms. One of the most common therapy used around the world to help with obsessive

compulsive disorder is cognitive behavioral therapy, or specifically Exposure and Response

Prevention, or ERP. This psychological treatment is designed to make a situation that would

have originally caused anxiety to have no effect on a person by listening or being in the situation

over and over again. Psychologists that came up with this form of therapy from the concept that

anxiety is supposed to be good and we need it to survive. It is supposed to come as a response to

danger and release one’s flight or fight response when needed. People who suffer from obsessive

compulsive disorder are in a constant state of anxiety, so their fight or flight response is activated

frequently, which is not good for the body. Psychologist think that this unhealthy response to

anxiety is a learned process over time, so this kind of therapy can help them “unlearn”.

This therapy comes with multiple steps. The first is to write a list of situations where you

feel your anxiety prevalent the most, from least to most feared. Then the person will confront

each triggering situation one by one in therapy sessions. They then will repeat this on their own

to reinforce these new thoughts that help them realize that nothing bad will happen. The end goal

is that as the repetition continues, eventually the stimulus will have no effect on the person

anymore. Some people might think this form of therapy is too extreme and that it can be too

scarring for the person to undergo. Jeremy Katz’s, the author of the essay “Obsessive-

Compulsive Disorder Can Be Controlled”, saw a teenage boy go through Exposure Response

Prevention for the first time. He stated, “Jonathan had to listen to a loop tape, hearing, ‘I hope
my mother will die today’ while he pursued activities he enjoyed, because the thoughts are just

thoughts, there's no credence to that happening" (Katz). While this technique can be extremely

mentally challenging at first, “Research shows that ERP can help a person reduce their OCD

symptoms by up to 80%” (Obsessive Compulsive Disorders: A Handbook for Patients and

Families). The first time is also the worst it will be. After each time the process becomes easier

and easier to undergo.

Another form of therapy that is not quite as challenging is creating cognitive strategies.

The main goal of this therapy is to identify when unwanted thoughts are occurring, and to use

ways discussed by a person and their therapist to healthily push the intrusive thoughts away. This

is done by creating a thought record. This is a strategy that challenges a person’s thinking

patterns and makes them aware of what they are thinking. Examples of doing this would be

“rating moods, identifying thoughts that may relate to the negative or anxious feelings, and

looking at evidence that does or does not support the thoughts” (Obsessive Compulsive

Disorders: A Handbook for Patients and Families). While this seems like an easier approach than

Exposure and Response Prevention, it is seen to not be as effective on its own. It is seen to be

most effective to use both ERP and thought record strategies. This uses both cognitive and

behavioral therapy tools at the same time to create a better quality of life.

Another effective task on improving your quality of life if you have OCD is through self-

care. When you are taking so much care of your mind, it is important not to forget your body.

“The basics should not be overlooked. Taking care of your body with a healthy diet and fluids is

important for having the energy to follow through on your treatment plan, and for overall health.

You may have been so focused on dealing with your anxiety that you have lost sight of the
basics” (Obsessive Compulsive Disorders: A Handbook for Patients and Families, 2020). It is

also important to sleep. A common issue that is present in a lot of people who have obsessive

compulsive disorder is the inability to fall asleep because of all the intrusive thoughts. Sleep is

extremely important for mental health and stress. People with OCD already have enough anxiety

to deal with, but studies show that lack of sleep can cause even more. Medications can also affect

the amount of sleep you get at night. Healthy ways to help these issues are through sleeping aids,

like melatonin, or discussing ways to keep away the intrusive thoughts with a therapist. Another

important part of taking care of yourself is exercise. OCD can make someone want to lay in bed

in a dark room all day and never come out, which can also lead to depression and more intrusive

thoughts. Exercising is not only great for a person’s body, but also their mental health.

Exercising releases good endorphins for the body and also releases negative stress. Another

important task to do when you start to get better is to keep in touch with a therapist. Setbacks can

occur when you least expect them to, and it is important to not forget all the strategies you

learned. Just because you think you are better does not mean you cannot go to therapy, because

everyone has problems that is good for people to talk out.

Obsessive compulsive disorder is a lifelong illness. It can get better, but it does not go

away. It is with that person for the rest of their life, but it is important to note that mental illness

does not define who you are. I was diagnosed with Obsessive Compulsive Disorder about five

years ago. At first it, it consumed who I was. I felt like I was labeled, and I could not escape it.

After undergoing therapy and taking Prozac, my symptoms decreased and became bearable.

People with OCD struggle every day, but they are survivors. The negative effects of this illness

can be seen through the different types of symptoms, both obsessions and compulsions, that can

be exhausting. They can also be seen through the different medicines and their side effects as
well as through countless hours of different types of therapies. Like this quote says, “OCD can

take up so much time and energy that it may be easy to forget the rest of your life. Remember

that recovering from OCD means that you will have more time and energy to devote for

developing and following through on life goals. Make plans for the future, for yourself and with

those you love; make those important plans that might not have seemed possible before you

began your recovery journey” (Obsessive Compulsive Disorders: A Handbook for Patients and

Families, 2020). My hope for the future is that people are more aware of the effect this illness

has on people, to spread awareness, and to be able to find a cure for this illness that is about more

than just cleaning your room or frequently washing your hands.

 Works Cited:

Brody, Jane E. “O.C.D., a Disorder That Cannot Be Ignored.” The New York Times, The New York

Times, 13 Oct. 2014, well.blogs.nytimes.com/2014/10/13/o-c-d-a-disorder-that-cannot-be-

ignored/.

Katz, Jeremy. "Obsessive-Compulsive Disorder Can Be Controlled." Behavioral Disorders, edited by

Louise I. Gerdes, Greenhaven Press, 2010. Opposing Viewpoints. Gale In Context: Opposing

Viewpoints, https://link-gale-com.sinclair.ohionet.org/apps/doc/EJ3010640221/OVIC?

u=dayt30401&sid=OVIC&xid=800146a4. Accessed 5 July 2020. Originally published as "Are

You Crazy Enough to Succeed?" 

Mens Health, vol. 23, July-Aug. 2008, p. 150.

“Obsessive-Compulsive Disorder (OCD).” Mayo Clinic, Mayo Foundation for Medical Education and

Research, 11 Mar. 2020, www.mayoclinic.org/diseases-conditions/obsessive-compulsive-

disorder/symptoms-causes/syc-20354432

“Obsessive-Compulsive Disorder.” MedlinePlus, U.S. National Library of Medicine, 25 June 2020,

medlineplus.gov/obsessivecompulsivedisorder.html

“Obsessive-Compulsive Disorder.” National Institute of Mental Health, U.S. Department of

Health and Human Services, www.nimh.nih.gov/health/topics/obsessive-compulsive-

disorder-ocd/index.shtml.