What is obsessive compulsive disorder (OCD)?
Most people with obsessive compulsive disorder usually experience a combination of:
- obsessive thoughts
- compulsive behaviours
Obsessive thoughts are thoughts that are unwanted, persistent (they stick around in the mind) and recurring (they come back again and again). Compulsive behaviours, or compulsions, are repeated actions that someone might take to help get rid of their obsessive thoughts.
Most people with OCD recognize that the thoughts they experience are not true. However, they still believe them and feel compelled, or forced, to perform certain behaviours (or rituals) to make the thoughts less troubling. The link between thoughts and behaviour is what creates obsessive compulsive disorder. Someone with OCD is more likely to experience obsessions and compulsions together than to experience an obsession or a compulsion on its own.
Many youths with OCD engage in the compulsive behaviour out of fear that something terrible will happen if they do not follow certain patterns. Completing the behaviour helps them feel "just right", if only for a short time.
What are the signs and symptoms of OCD?
OCD has a range of signs and symptoms that can be broken down into obsessive symptoms and compulsive symptoms.
Common obsessive symptoms in teens
The most common obsessive thoughts are:
- fears of contamination or illness
- intrusive thoughts or fears of harming others or yourself
- a need for symmetry and order
- excessive doubt
- sometimes, thoughts of a religious or sexual nature that cause a lot of distress (for example, worry about doing something that you are ashamed of or for which you will be punished)
Common compulsive symptoms in teens
The most common compulsive symptoms include:
- prolonged and repeated washing of hands or body parts
- refusing to touch things
- repeated checking or counting
- needing to do things in a specific order or specific way (such as following a specific routine or ritual)
- needing to do things a certain number of times (such as following a specific pattern)
- an excessive interest or need to do other things well beyond what would be expected (such as praying, washing or cleaning)
How common is OCD?
Between 1 and 4 percent of teens may have OCD. As many as 8 percent of teens may have a mild form of OCD. This means that while they may have some OCD symptoms, they do not interfere too much with their everyday routine.
What to do if you have concerns about excessive thoughts or compulsive behaviours
If you have concerns that you have excessive and unwanted thoughts, a first step is to speak to your parents, or a close family member or other trusted adult, or speak to your doctor. The next step often involves getting an assessment with a psychiatrist or psychologist.
How is OCD diagnosed?
A psychiatrist or psychologist will want to speak to you and your family to get a sense of what difficulties you are having. Sometimes, they will ask you and your parents to fill in different questionnaires.
At the end of the assessment, the psychiatrist or psychologist help you understand whether you have a diagnosis of OCD or have some signs and symptoms but do not have a diagnosis of OCD.
How is OCD treated?
OCD is known to be treated successfully with both psychotherapy and medications.
How to use: Use this meditation when you’d like to refocus or bring yourself back to the present moment. Follow along with the meditation to match your in-breath to your out-breath and slowly increase the length of each. If you feel out of breath or dizzy during this meditation, pause and breathe comfortably until you feel better.
Psychotherapy for OCD
Cognitive behavioural therapy
Cognitive behavioural therapy (CBT) to be a very effective treatment for OCD, as it can help someone learn to:
- recognize how their thoughts, feelings and behaviours are connected
- challenge their worries or unrealistic thoughts
- replace their thoughts with more rational or realistic thoughts
When someone has OCD, they place a great deal of importance on their intrusive thoughts, which can lead to anxiety. As a result, they may repeat a ritual (compulsive behaviour), usually several times or "a special number of times", until they "feel right". CBT can help with this pattern, but often a specific type of treatment, exposure response prevention, needs to be part of the treatment plan.
How to use: This video explains some of the things you can try when you feel overwhelmed by your thoughts. After the video, take a few moments to observe your thoughts with curiosity, paying attention to how each one makes you feel. Paying attention to your thoughts and sorting through them takes practice and patience.
Exposure response prevention (ERP)
As its name suggests, ERP consists of two major parts: exposure and response prevention.
- Exposure involves having you confront the feared situation (for example touching an object you think is dirty).
- Response prevention involves keeping you from acting on your immediate compulsion (for example washing your hands immediately).
ERP is designed to allow you to tolerate anxiety without following a ritual. At first, not following the ritual is the most difficult part of treatment, but, over time, your anxiety naturally reduces and the link between the fear and ritual weakens.
Medications for OCD
CBT remains the first approach to treatment for mild to moderate OCD symptoms.
For moderate to severe symptoms, both CBT and medications called selective serotonin reuptake inhibitors (SSRIs) can be successful. Your doctor or psychiatrist may consider medications first if your anxiety is too severe to allow you to engage in CBT or other treatment on its own.
How to use: Use this meditation to steady yourself when you are feeling overwhelmed or have any unwanted thoughts, feelings or sensations. Follow along with the meditation, paying attention to the rhythm of your in-breath and out-breath.
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