Dr. Natascha M. Santos: Debunking the myths of OCD

There's a common misconception that if you like to meticulously organize your things, keep your hands clean, or plan out your weekend to the last detail, you might have OCD. In fact, OCD, which stands for obsessive compulsive disorder, is a serious psychiatric condition that is frequently misunderstood by society and mental health professionals alike. So let's start by debunking some myths. Myth one: repetitive or ritualistic behaviors are synonymous with OCD. As its name suggests, obsessive compulsive disorder has two aspects: the intrusive thoughts, images, or impulses, known as obsessions, and the behavioral compulsions people engage in to relieve the anxiety the obsessions cause. The kinds of actions that people often associate with OCD, like excessive hand washing, or checking things repeatedly, may be examples of obsessive or compulsive tendencies that many of us exhibit from time to time. But the actual disorder is far more rare and can be quite debilitating. People affected have little or no control over their obsessive thoughts and compulsive behaviors, which tend to be time consuming and interfere with work, school or social life to the point of causing significant distress. This set of diagnostic criteria is what separates people suffering from OCD from those who may just be a bit more meticulous or hygiene obsessed than usual. Myth two: the main symptom of OCD is excessive hand washing. Although hand washing is the most common image of OCD in popular culture, obsessions and compulsions can take many different forms. Obsessions can manifest as fears of contamination and illness, worries about harming others, or preoccupations with numbers, patterns, morality, or sexual identity. And compulsions can range from excessive cleaning or double checking, to the fastidious arrangement of objects, or walking in predetermined patterns. Myth three: individuals with OCD don't understand that they are acting irrationally. Many individuals with OCD actually understand the relationship between their obsessions and compulsions quite well. Being unable to avoid these thoughts and actions despite being aware of their irrationality is part of the reason why OCD is so distressing. OCD sufferers report feeling crazy for experiencing anxiety based on irrational thoughts and finding it difficult to control their responses. So what exactly causes OCD? The frustrating answer is we don't really know. However, we have some important clues. OCD is considered a neurobiological disorder. In other words, research suggests that OCD sufferers brains are actually hardwired to behave in a certain fashion. Research has implicated three regions of the brain variously involved in social behavior and complex cognitive planning, voluntary movement, and emotional and motivational responses. The other piece of the puzzle is that OCD is associated with low levels of serotonin, a neurotransmitter that communicates between brain structures and helps regulate vital processes, such as mood, aggression, impulse control, sleep, appetite, body temperature and pain. But are serotonin and activity in these brain regions the sources of OCD or symptoms of an unknown underlying cause of the disorder. We probably won't know until we have a much more intimate understanding of the brain. The good news is there are effective treatments for OCD, including medications, which increase serotonin in the brain by limiting its reabsorption by brain cells, behavioral therapy that gradually desensitizes patients to their anxieties, and in some cases, electroconvulsive therapy, or surgery, when OCD doesn't respond to other forms of treatment. Knowing that your own brain is lying to you while not being able to resist its commands can be agonizing. But with knowledge and understanding comes the power to seek help, and future research into the brain may finally provide the answers we're looking for.