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Jen Hantz
Mr. Hull
Honors English II
Feb. 26th, 2016
Know the Enemy: OCD
Most people do not seem to understand what OCD truly is. OCD is not
just some cute little term to use when a person is bothered by the laces of a
hoodie being uneven, or feels the need to color coordinate their Skittles
every time they eat them. While perfectionism can be one of the signs of
OCD, that is not merely the case. OCD is a psychological disorder that
usually deals with a fear or a discomfort. The symptoms and signs of OCD
can help verify whether or not a person has the disorder, and can help the
therapist determine the best kind of treatment for the patient. Treatment can
consist of certain medications, ERP, and the person working on staying away
from their compulsive habits. If a person hides the fact that they might have
OCD instead of seeking psychiatrical help, the OCD will take control of that
persons life.
To determine whether or not one has OCD, the person needs to know
what OCD is. OCD stands for obsessive-compulsive disorder which is an
anxiety disorder of repeated intrusive thoughts followed by an extreme ritual
(Turkington 15-22). An obsession is the intrusive thought, enticed by a fear or
a discomfort, which causes anxiety invoking the compulsion. A compulsion is
the action to relieve an anxiety, often called a ritual. A person can have both

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obsessions and compulsions, or one or the other. Either way, people become
a slave to the disorder because those people will do anything they can to rid
themselves of the anxiety, no matter how strange or absurd the action is.
About half of the OCD cases are serious and not all cases of OCD are even
diagnosed. OCD can occur in children and adults with symptoms appearing
at around ages ten to twenty-one depending on when it is diagnosed.
Another component to determining OCD is differentiating the disorder
between other disorders such as OCPD and hypochondriasis. OCPD stands
for obsessive-compulsive personality disorder, and this is what people
mistakenly believe OCD is. A person who has OCPD believes that they are
always right and that things should be done their way. They are the people
that obsess over order, perfection, and taking control of things such as being
flexible, open, and efficient along with being indecisive, having a hard time
expressing themselves, and can occasionally be depressed. These people
have more of a problem with being told what to do or how to do it rather
than coping with an anxiety. Someone with OCD would incessantly try to
maintain order to appease an irrational fear or a random discomfort they
have, if that was the case with their disorder, while a person with OCPD
would maintain order because that is the way they want it to be (Obsessive
Compulsive Personality Disorder). An example of someone with OCPD could
be Sheldon Cooper from The Big Bang Theory and how Sheldon does not
allow anyone else but himself to sit in his spot on the couch.
Hypochondriasis is a disorder where a person believes that he or she has

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some serious illness based on minor symptoms such as a headache or a

cough. These people often misinterpret their symptoms assuming a
headache could lead to a tumor or a cough could lead to bronchitis. This is
different from OCD because they do not do an immediate impulse to ease
their anxiety or fear. Instead they take precautionary measures to avoid the
disease such as checking food labels, making multiple doctor appointments
within a year, and researching the disease of any possible symptoms. A
hypochondriac might believe they have a tumor because they get
headaches, but they only get the headache when they think about the
symptoms of a tumor (What is Hypochondriasis). A person with OCD might
take care of an obsession about being contaminated by washing their hands
the very moment they believe they touched something that might be dirty,
instead of trying to consult a doctor.
While people are trying to determine whether or not they have OCD,
Scientist have come up with some theories as to what the cause is for the
disorder and what parts of the brain are usually affected by OCD. One
theory, called the learning theory, explains how a person associates an
object with a learned fear which triggers the compulsion. Goodman explains
this by using an example of a student relating chalk dust to seeing a student
have an epileptic fit, even though the dust played no part in triggering the
epileptic fit. When the student performs rituals (such as washing his hands)
or tries to avoid the chalk dust, he inadvertently strengthens his fear. That
fear can soon become associated with other things in the classroom such as

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a textbook. Even though this theory can explain how compulsions are
triggered by obsessions, it reveals no solution as to why some people only
have the compulsions (Goodman 1-2). Another theory is that OCD could be a
biological disease. Research from Stanford University has shown that there is
a neuronal loop that starts at the orbitofrontal cortex (Understanding
Obsessive-Compulsive and Related Disorders) where the brain obtains
information from the five senses, mainly from sight (Rolls), and affects the
cingulate gyrus, the striatum, the globus pallidus, the thalamus, and ends at
the frontal cortex (Understanding Obsessive-Compulsive and Related
Disorders). The simple explanation is that the brain is really hyperactive
when someone has OCD. It makes sense though considering that a person
with OCD is constantly thinking about their fear or discomfort.
While theories can be interesting, the real help is in the symptoms and
diagnosis. There are various obsessions and compulsions of OCD. Most
obsessions of OCD can be broken down into three general categories:
aggression, sexual, and religious or moral obsessions. Each of these
obsessions all revolve around the fear of losing control of themselves and
unconsciously enacting the heinous thoughts that come to their minds
(Tompkins 10-19). Some other obsessions are germs and contamination
where a person has the constant thought that they are dirty, or the order and
symmetry where a person might have a discomfort if something is not done
a specific way and something bad could happen. Compulsions try to diminish
the fear or soothe the discomfort (Turkington, Davidson, and Longe 15-22).

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Some examples of the compulsions would be handwashing (to vanquish

germs), checking (making sure the oven is off), arranging (placing thigs in a
specific order or place), repeating (turning on a light switch till it feels right),
and proxy (asking someone to do the action because the person with OCD
prefers how the other person does it; an example, rearranging clothes in a
closet).
The common symptoms are easier to spot, but there are also some
specific types of OCD. One extreme, called scrupulosity, is a form of OCD
that regards either religious fears or fears concerning a persons morale. For
religious scrupulosity, a person might not encounter as many difficult
decisions as one with moral scrupulosity because a person with religious
scrupulosity can confide in religious texts to try and ease their anxiety
whereas the person with moral scrupulosity has no official text or moral
leader to guide them on their decisions. Either way, both forms of
scrupulosity have the same obsessions. These people believe that the
decision is either black or white (they will believe they are cheaters if they
accidently overheard someone talking about questions on a test), minimize
the positive aspect of what they do (such as they will believe they are bad
people if they are bad people if they forget to give to the poor even though
they normally do), have emotional reasoning (they think that they would be
considered mean if they gave a classmate constructive criticism on a paper),
they have a should/must way of thinking (they should always tell the truth
because they are good people), and have a sense of hyper responsibility (if

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they do not inform a friend to wear a seatbelt, then that friend will be
breaking the law and it will be the fault of the person that did not tell them)
(Moral Scrupulosity). Another type of OCD which is usually misdiagnosed is
ROCD. ROCD stands for Relationship OCD. It is misdiagnosed because they
have constant doubts about whether or not they love their partner, and
friends or family will go along and say that that person might not be for
them. Not only do they have doubts about how they feel about their partner,
they also focus too much on their partners negative aspects and try to look
for the one. They might even try to stay in a relationship with someone
they do not want to be with because they are afraid of hurting their partners
feelings (ROCD: Relationship).
Once a person has discovered these symptoms, they can get a
diagnosis from a professional. The only problem is that it can sometimes take
years to get a diagnosis because the patient might be misdiagnosed and
given the wrong treatment, and the patient might go from place to place to
find the proper treatment he or she needs. The diagnosis is an interview to
collect information about the patients symptoms and signs. A symptom is
what the patient can feel or experience, but the therapist himself cannot
witness. This is the fear or anxiety, and ultimately the obsession that the
patient feels. A sign is what the therapist can see which is what the
compulsions are. During the interview, the therapist will ask if the patient
has obsessions, compulsions, and if these obsessions and compulsions
interfere with their daily life. They might make up their own questions or they

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will give the patient a questionnaire such as the Obsessive-Compulsive

Inventory, the Compulsive Activity Checklist, or the Yale-Brown ObsessiveCompulsive Scale. The patient might also be tested for depression or ADHD
by taking either the Beck Depression Inventory or a screen test for ADHD
(Tompkins 32-40).
When the patient has been diagnosed with OCD, it is time to discover
the different options for treatment from medications to special therapy
sessions, and the support needed to continue on with the sessions. There are
many different choices when it comes to medications. The first option when
it comes to medication is the SSRIs which stands for serotonin reuptake
inhibitors. These SSRIs are antidepressants which can also be used for
anxiety disorders such as OCD. Some examples of these antidepressants are
Prozac, Luxov, Zoloft, and Paxil. While these medications are can be
effective, it can take weeks for the patient to notice the results if any. They
also come with some side effects such as nausea, insomnia, sweating, and
headaches. Anafrail is a tricycle antidepressant that a therapist can proscribe
when the SSRIs are not effective for the patient. The side effects consist of
dry mouth, constipation, drowsiness, and weight gain. Patients can also take
antipsychotics which can reduce the symptoms of OCD. There are two kinds
of antipsychotics: typical and atypical. The typical antipsychotics were one of
the earlier antipsychotics. The one major side effect for the typical
antipsychotics is called tardive dyskinesia. Tardive dyskinesia is the
uncontrollable movements of certain parts of the body which can become

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permanent of one does not seek treatment. The atypical antipsychotics, such
as Risperdal, Zypexa, and Seroquel, are more preferred because there is less
of a chance of tardive dyskinesia. There is, however, an increased risk of
metabolic problems which can cause weight gain, and an increase in blood
sugar and cholesterol.
Another option for treatment is a type of CBT, or cognitive behavioral
therapy, called ERP. ERP means exposure and response prevention which is
when one repeats a certain cue or trigger for the anxiety to desensitize the
person from the fear (Katz 30-31). To do this, the therapist will create some
scenarios that are possible triggers for the patient, and then he or she will
record the reactions and the level of anxiety the patent has or experiences.
Then the information is gathered to create a hierarchy which is a scale from
zero to one hundred listing the triggers within that range according to how
the patient reacted with zero being no reaction or anxiety and one hundred
being the greatest amount of anxiety imagined. The results from the
hierarchy help to determine the treatment plan created to the specific needs
of the patient. When the therapist has come up with a personalized
treatment plan for the patient, the therapy sessions can commence. For the
therapy sessions, the therapist will ask the patient to trigger the obsession
and then not perform the compulsion; for example, if the patient has a fear
about contamination, the therapist might ask the patient to touch a doorknob, but the patient will not be allowed to wash his or her hands. The
anxiety in the patient will increase a little as the session continues, but

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eventually the anxiety will decrease to about halfway from where it was
before. Sessions like these will continue until the patient begins to see the
results, and the patient will also have homework and continue their
treatment that way (Tompkins 46-47).
During treatment and recovery, it is important that the patient has
support from other people to help him or her continue with his or her
treatment. It can be hard to ask for support from friends and family members
because OCD can create a distance between the patient and the ones they
love; but it needs to be done. A spouse is a great source of support because
they have a first-hand account of the person suffering because they
understand what the patient is going through, and they will care for that
person. The patient should tell them about their diagnosis unless the spouse
is unsupportive. If the spouse does not know what OCD, then the patient
should explain to their spouse what OCD is. The spouse can even join some
of the sessions to help the patient if the therapist allows it. If there seems to
be distance between the patient and their spouse, then they can go to a
couples therapy and get guidance. Support from the whole family is another
good source because then one has multiple motivators to keep the patient
going. They also witness the patients suffering because they are witnesses
to the patients suffering which can also bring them to an understanding like
the spouse. The family members can take notes at the meetings if the
patient does not focus on what the therapist says because they might have
ADHD or if they have depression. They can also coach the patient when the

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patient needs help doing the extra ERP sessions at home. They can also
update the therapist on how the patient is doing at home and remind the
patient as well. If a parent has OCD, they can tell their kids about it because
the children might not understand what their parent was going through and
they might not have told that parent something important going on in their
life so that they would not burden the parent. It can also be a way of telling
the child that it is not their fault. The parent could also be a role model for
their children if they have OCD, showing that it is okay to seek help and
guidance. Friends are another good source of support although they might
not even know that the person is suffering because they are nit with them
most of the time (Tompkins 79-88).
In the end, one has to be careful with OCD so that it does ruin their life.
It is an anxiety disorder which is commonly mistaken for OCPD, and there are
several theories concerning how OCD occurs. There are many various
symptoms of OCD which can help diagnose a patient for OCD. There are also
multiple options for treatment where support from friends and family is
necessary. Knowing the facts about OCD can help people to empathize with
those who are suffering from the disorder, and they can be the added
support that helps that person through their recovery.

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Works Cited
Bio Behavioral Institute. Obsessive Compulsive Personality Disorder. Bio
Behavioral Institute. Bio Behavioral Institute, Inc., 9 Nov. 2009. Web. 17
Feb. 2016. <www.biobehavioralinstitute.com/viewarticle.php?id=36>.
Bio Behavioral Institute. What is Hypochondriasis? Bio Behavioral Institute.
Bio Behavioral Institute, Inc., 13 Feb 2009. Web. 17 Feb. 2016.
<www.biobehavioralinstitute.com/viewarticle.php?id=6>.
Goodman, Wayne. What Causes Obsessive-Compulsive Disorder (OCD)?
Psych Central. Psych Central, 2013. 1-2. Web. 22 Feb. 2016.
<psychcentral.com/lib/what-causes-obsessive-compulsive-disorderocd/2/>.
Katz, Jeremy. OCD Can Be Debilitating. Mens Health. (2008): Rpt. in
Obsessive-Compulsive Disorder. Ed. Heidi Watkins. Detroit: Gale, 2010.
23-32. Print.
OCD Center Los Angeles. Moral Scrupulosity in OCD: Cognitive Distortions.
OCD Center Los Angeles. OCD Center of Los Angeles California, 17 June
2014. Web. 20 Feb. 2016. <ocdla.com/mortal-scrupulosity-ocdcognitive-distortions-34057>.
OCD Center Los Angeles. ROCD: Relationship OCD and the Myth of The
One. OCD Center of Los Angeles. OCD Center of Los Angeles
California, 13 May 2015.Web. 20 Feb. 2016. <ocdla.com/rocdrelationship-ocd-myth-of-the-one-3665>.
Rolls, ET. The Functions of the Orbitofrontal Cortex. PubMed.gov: US
National Library of Medicine National Institute of Health. National
Health Center for Biotechnology Information, June 2014. Web. 17 Feb.
2016. <www.ncbi.nlm.nih.gov/pubmed/1513480>.

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Tompkins, Michael A. OCD: A Guide for the Newly Diagnosed. Oakland, CA:
New Harbinger Publications Inc., 2012. Print.
Turkington, Carol A, Helen M. Davidson, and Jacqueline L. Longe. An
Overview of Obsessive-Compulsive Disorder. Gale Encyclopedia of
Medicine. (2007): Rpt. in Obsessive-Compulsive Disorder. Ed. Heidi
Watkins. Detroit: Gale, 2010. 15-22. Print.
Understanding Obsessive Compulsive and Related Disorders. Stanford
Medicine. Stanford School of Medicine, 2016. Web. 17 Feb 2016.
<ocd.stanford.edu/about/understanding.html>.
What Causes OCD. OCD Education Station. Beyond OCD, 2016. Web. 17
Feb 2016. <www.ocdeducationstation.org/ocd-facts/what-causes-ocd>.