Obsessive-compulsive disorder is a chronic and long-lasting mental health disorder, characterized by an inability to control frequently recurring thoughts and/or behaviors. OCD is categorized as an anxiety disorder, because the obsessions and compulsions are typically attributed to a fear or disgust reaction, such as fear of illness leading to harmful and obtrusive handwashing. Anxiety and depression are most often associated with obsessive-compulsive disorder because the sufferer cannot stop the thoughts or rituals, which leads to nervousness and fear of judgment.
Although OCD has been the subject of jokes in popular culture, being a perfectionist or preferring a clean environment are not the same as OCD. This disorder gets in the way of living a normal life due to constantly intruding thoughts and ritualistic behaviors. Diagnostic criteria require that obsessive thoughts or compulsive behaviors take up at least an hour of a person’s time each day, and get in the way of enjoying regular life activities.
Common obsessive thoughts include:
- Fear of germs, sickness, illness, or contamination
- Taboo thoughts about sex or violence
- Aggressive thoughts about self-harm
- Transgressive thoughts about religious or cultural norms
- Thoughts related to symmetry or order
Compulsions are repetitive behaviors that the OCD sufferer feels required to perform or unable to stop, in order to get rid of the obsessive thoughts. These behaviors typically include:
- Obsessive cleaning of oneself or surrounding areas (for example, organizing specific parts of a house or constant handwashing)
- Counting items or arranging them in specific patterns
- Checking on the safety of an object or one’s appearance
- Desperate need for reassurance
- Strict routine
A person does not need to have both obsessions and compulsions to receive a diagnosis of OCD. When a person suffers either obsessive thoughts or compulsive behaviors, medical experts will most often diagnose the person with obsessive-compulsive disorder. The condition was named OCD both to cover repeated and uncontrolled thoughts and actions, and because the two are linked in most cases.
Causes or Triggers of Obsessive-Compulsive Disorder
The triggers for obsessive-compulsive disorder are not well understood, and there seem to be several reasons individuals develop this condition.
Risk factors for developing OCD include:
- Genetics: People who have a direct relative (parent or sibling) with obsessive-compulsive disorder are more likely to develop OCD themselves. The risk increases when the relative began showing symptoms of OCD in childhood or the teenage years. However, genes linked to OCD have not yet been discovered.
- Brain chemistry or structure: Some studies imaged the brains of people suffering from OCD and found differences in the shape of the frontal cortex and the subcortical structures. These areas are associated with judgment and planning, so abnormalities in shape or size could be linked to problems judging hazards. Additionally, some earlier studies considered that a lower level of serotonin in the brain could be linked to anxiety, which could trigger OCD.
- Infection: Some small studies showed that recurring streptococcus infection, when untreated, could trigger obsessive-compulsive disorder in children.
- Environmental factors: Environmental stress can trigger OCD in both children and adults. Abuse, illness, death, work or school stress, relationship issues, and even dramatic changes in living situation have all been linked to OCD.
- OCD Reduces Quality of Life
When people suffer from obsessive-compulsive disorder, they can lose hours each day to performing rituals and worrying about their uncontrollable, recurring thoughts. In some cases, a person who suffers from OCD may be unable to leave the house due to crippling anxiety about infection or worry about their personal safety.
Many people who struggle with OCD may know that their thoughts and rituals are unrealistic, baseless, and making their lives difficult. However, these people are unable to control or stop their behaviors without help. This increase in stress can lead to substance use disorders, abuse, and addiction as a method of self-medicating their chronic anxiety.
- The Connection between OCD and Addiction
Researchers have studied the link between anxiety disorders and addiction for decades. The comorbidity – or concurrence of both chronic anxiety and substance abuse – of the disorders has almost always been found at a greater rate than random chance, and depending on research criteria, the concurrence is between two and six times higher than in the general population. On average, 20 percent of Americans with an anxiety disorder of any kind also have a substance abuse disorder, and vice versa.
The presence of one disorder indicates an increased risk of developing the other disorder. In one study examining the prevalence of substance abuse or addiction among 323 people with obsessive-compulsive disorder, about 70 percent of participants said that OCD preceded their substance abuse by at least one year. Twenty-six participants reported that they developed OCD and a substance abuse or addiction in the same year. The younger a person was when the obsessive-compulsive disorder was triggered, the more likely that person became to suffer from substance abuse as well. Data gathered from the Epidemiological Catchment Area (ECA) suggest that 24 percent of people suffering from obsessive-compulsive disorder also have a comorbid alcohol disorder, and 18 percent also have a drug addiction disorder.
OCD Triggered by Substances
Having an anxiety disorder like OCD increases a person’s likelihood of developing a substance abuse disorder, and vice versa. However, substance-induced anxiety disorders are much rarer than comorbid anxiety and substance use disorders. About 0.2 percent of comorbid cases involve OCD or another anxiety disorder caused by the substance, rather than the addiction incited by the anxiety disorder.
Medical research identifies some substances that can trigger obsessive-compulsive disorder. These are:
- Other stimulants
The DSM-5 also includes “other substance-induced obsessive-compulsive disorder” and “unknown substance-induced obsessive-compulsive disorder” in its listings, to aid therapists and medical professionals in helping people who seem to have OCD triggered by a substance or addiction.
In some rare but documented cases, schizophrenic patients treated with risperidone began to display obsessive-compulsive behaviors, although the medication was otherwise effective in treating the original condition. OCD typically showed up when the patient took over 3 milligrams per day, and when the patient was weaned to a lower dose, the symptoms of OCD went away.
Best Practices to Treat OCD and Substance Abuse Together
Cognitive Behavioral Therapy is the leading recommended treatment for people who suffer from obsessive-compulsive disorder, and this can include Exposure and Response Prevention (ERP) therapy, sometimes combined with medications. When a person suffers both OCD and a substance use disorder, doctors tend to be especially wary of the type and quantity of medication the patient takes, but it is not unusual for people with both OCD and an addiction to temporarily take antidepressants or medications to treat anxiety. These medications can help balance brain chemistry, which can both reduce cravings for drugs and lessen intrusive thoughts and actions.
These medications include:
- Clomipramine: a tricyclic antidepressant
- Fluoxetine: an antidepressant under the brand name Prozac
- Fluvoxamine: an anti-anxiety medication
Sertraline: an antidepressant and anti-anxiety medication
In some people with OCD, antipsychotics like Risperdal have been shown to ease symptoms, especially when they have reached a stage of delusion. This medication can also treat chemical-induced psychosis from drugs or alcohol abuse. However, successful long-term treatment with antipsychotics for these conditions is rare.
For both obsessive-compulsive disorder and substance use disorders, especially when these conditions are comorbid, the best treatment involves individual therapy and group support. A good therapist can help the client begin to unlearn old habits and relearn healthier behaviors and ways of thinking. Group therapy and social support networks can help the client feel less isolated, and also develop better social skills and emotional support networks to reduce anxiety. Exercise, healthy eating, and social activities are good habits to develop and foster. Most therapists and support groups will help people suffering comorbid OCD and alcohol or drug addiction to develop these habits, as well as better methods of coping with underlying issues.