February 1, 2023

Studio Talk Podcast: Real Conversations About Mental Health

A Conversation About Obsessive Compulsive Disorder (OCD)

Season 2 Episode 6

In this episode our co-hosts discuss Obsessive Compulsive Disorder (OCD). The discussion covers this wildly misunderstood condition and makes an effort to clear up some basic misinformation about it. Mental Health Counselor Victoria Lockridge discusses her personal experience with OCD and how she has learned to manage it effectively. She provides tips on how to recognize OCD in yourself or in a loved one and provides resources to find support and treatment for it. 

The co-hosts, Xiomara A. Sosa and Victoria Lockridge have an honest and open discussion regarding OCD and invite the listeners to share their stories with them in the comments. 

As always, Studio Talk Podcast encourages their listeners to provide feedback, comments as well as their opinions and experiences about their own experiences with major life transitions that impacted their mental health. The discussion offers resources and references for listeners to review and examine and listeners are encouraged to do their own research and draw their own conclusions about the issues discussed. As with most issues, there are negatives and positives found and the co-hosts recognize that as reality and have an honest conversation about it.

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Following are some points for reference: 

• OCD is one of the most misdiagnosed mental health disorders (Takes approximately 14 years of treatment services until someone is accurately dx with OCD)
• OCD can be incredibly disabling 
• Important not to make jokes about being “OCD” because you are organized or clean. 
• OCD is more than excessive hand washing and checking behaviors 
• Compulsions do not have to be behaviors- often compulsions are “hidden” mental acts (ie. avoidance, mental rituals, reassurance seeking, rationalizing).

Clinical Definition of OCD

The DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition) provides clinicians with official definitions of and criteria for diagnosing mental disorders and dysfunctions.  Although not all experts agree on the definitions and criteria set forth in the DSM-5, it is considered the “gold standard” by most mental health professionals in the United States.

DSM-5 Diagnostic Criteria for Obsessive-Compulsive Disorder (300.3)

A.    Presence of obsessions, compulsions, or both:

Obsessions are defined by (1) and (2):

1. Recurrent and persistent thoughts, urges, or impulses that are experienced, at some time during the disturbance, as intrusive and unwanted, and that in most individuals cause marked anxiety or distress.

2.The individual attempts to ignore or suppress such thoughts, urges, or images, or to neutralize them with some other thought or action (i.e., by performing a compulsion).

Compulsions are defined by (1) and (2):

1. Repetitive behaviors (e.g., hand washing, ordering, checking) or mental acts (e.g., praying, counting, repeating words silently) that the individual feels driven to perform in response to an obsession or according to rules that must be applied rigidly.

2.The behaviors or mental acts are aimed at preventing or reducing anxiety or distress, or preventing some dreaded event or situation; however, these behaviors or mental acts are not connected in a realistic way with what they are designed to neutralize or prevent, or are clearly excessive.

Note: Young children may not be able to articulate the aims of these behaviors or mental acts.

B. The obsessions or compulsions are time-consuming (e.g., take more than 1 hour per day) or cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

C. The obsessive-compulsive symptoms are not attributable to  the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition.

D. The disturbance is not better explained by the symptoms of another mental disorder (e.g., excessive worries, as in generalized anxiety disorder; preoccupation with appearance, as in body dysmorphic disorder; difficulty discarding or parting with possessions, as in hoarding disorder; hair pulling, as in trichotillomania [hair-pulling disorder]; skin picking, as in excoriation [skin-picking] disorder; stereotypies, as in stereotypic movement disorder; ritualized eating behavior, as in eating disorders; preoccupation with substances or gambling, as in substance-related and addictive disorders; preoccupation with having an illness, as in illness anxiety disorder; sexual urges or fantasies, as in paraphilic disorders; impulses, as in disruptive, impulse-control, and conduct disorders; guilty ruminations, as in major depressive disorder; thought insertion or delusional preoccupations, as in schizophrenia spectrum and other psychotic disorders; or repetitive patterns of behavior, as in autism spectrum disorder).

Specify if:

With good or fair insight: The individual recognizes that obsessive-compulsive disorder beliefs are definitely or probably not true or that they may or may not be true.

With poor insight:  The individual thinks obsessive-compulsive disorder beliefs are probably true.

With absent insight/delusional beliefs: The individual is completely convinced that obsessive-compulsive disorder beliefs are true.

Specify if:

Tic-related: The individual has a current or past history of a tic disorder.

The previous edition of the DSM (DSM-IV) categorized Obsessive-Compulsive-Disorder (OCD) under ‘Anxiety Disorders’.  However, some experts controversially suggested that the revised edition of the DSM remove OCD from this category and group it with loosely related conditions under the heading of ‘Obsessive-Compulsive and Related Disorders‘, which is what they did indeed do for DSM-5.

The most frequent reason for supporting a move out of the anxiety disorders section was that obsessions and compulsions, rather than anxiety are the fundamental features of the disorder. The main reasons for disagreeing with such a move were that OCD and other anxiety disorders respond to similar treatments and tend to co-occur.

DSM-5 Categorisation

In DSM-5, Obsessive-Compulsive Disorder sits under its own category of Obsessive-Compulsive and Related Disorders and within that the following subcategories were placed:

• Obsessive Compulsive Disorder (OCD)
• Body Dysmorphic Disorder (BDD)
• Hoarding Disorder
• Trichotillomania
• Excoriation (Skin Picking) Disorder
• Substance/Medication-induced Obsessive-Compulsive and related Disorder
• Obsessive-Compulsive and Related Disorder due to another medical condition
• Other specified Obsessive-Compulsive and Related Disorder
• Unspecified Obsessive-Compulsive and Related Disorder

OCD is characterized by the presence of obsessions and/or compulsions. Obsessions are recurrent and persistent thoughts, urges, or images that are experienced as intrusive and unwanted, whereas compulsions are repetitive behaviors or mental acts that an individual feels driven to perform in response to an obsession or according to rules that must be applied rigidly. Some other obsessive-compulsive and related disorders are also characterized by preoccupations and by repetitive behaviors or mental acts in response to the preoccupations.  Other obsessive-compulsive and related disorders are characterized primarily by recurrent body-focused repetitive behaviors (e.g., hair pulling, skin picking) and repeated attempts to decrease or stop the behaviors.

OCPD versus OCD

What is obsessive-compulsive personality disorder (OCPD)? Obsessive-compulsive personality disorder (OCPD) isa mental health condition that causes an extensive preoccupation with perfectionism, organization and control. These behaviors and thought patterns interfere with completing tasks and maintaining relationships.

People with OCPD have rigid beliefs and specific ways of doing different tasks. They don’t allow for any flexibility and are unable to compromise with others. People with OCPD often don’t realize their behavior and way of thinking are problematic.

OCPD is one of a group of conditions called “Cluster C” personality disorders, which involve anxiety and fear.

What is the difference between OCD and OCPD?

Even though they sound similar, obsessive-compulsive personality disorder (OCPD) and obsessive-compulsive disorder (OCD) are different conditions.

OCD is an anxiety disorder in which you have frequent unwanted and intrusive thoughts (obsessions) that cause you to perform repetitive behaviors (compulsions). Examples of compulsions include flipping a light switch a certain number of times or repeatedly washing your hands.

People with OCD usually are aware that the condition is causing their behavior and accept that they need professional help to treat it. People with OCPD usually have little, if any, self-awareness of their behaviors.

Who does obsessive-compulsive personality disorder (OCPD) affect?

Obsessive-compulsive personality disorder usually begins in your late teens or early 20s. It’s more common in adults whose highest education level is high school graduation or less.

OCPD is also more likely to affect people with the following mental health conditions:

• Anxiety disorders (24%), such as panic disorder and generalized anxiety disorder.
• Mood disorders (24%), such as bipolar di
• Mild to moderate substance use disorders (12% to 25%).

How common is OCPD?

Studies suggest that OCPD is the most common personality disorder in the general population in the United States. It affects 3% to 8% of adults.

SYMPTOMS AND CAUSES

What are the symptoms of OCPD?

The main sign of obsessive-compulsive personality disorder is a pervasive preoccupation (obsession) with order, perfectionism, control and specific ways of doing things. These behaviors make it difficult to complete tasks and cause issues with relationships.

Symptoms of OCPD usually begin by early adulthood.

A person with obsessive-compulsive personality disorder (OCPD) may:

• Be preoccupied with and insist on details, rules, lists, order and organization.
• Have perfectionism that interferes with completing tasks.
• Have excessive devotion to work and productivity. This results in neglecting hobbies and spending less time with loved ones.
• Have excessive doubt and indecisiveness.
• Use extreme caution to avoid what they perceive to be failure.
• Be rigid and stubborn in their beliefs and ways of doing things.
• Be unwilling to compromise.
• Be unwilling to throw out broken or worthless objects, even if they have no sentimental value.
• Have difficulty working with others or delegating tasks unless they agree to do things exactly as the person wants.
• Frequently become overly fixated on a single idea, task or belief.
• Perceive everything as “black or white” (dichotomous thinking).
• Have difficulty coping with criticism.
• Over-focus on flaws in other people.

At a glance, people with OCPD usually appear confident, organized and high-achieving. Their exacting standards may even benefit them in certain jobs. However, their inability to compromise or change their behaviors usually negatively affects their relationships.

What causes obsessive-compulsive personality disorder?

Personality disorders, including obsessive-compulsive personality disorder, are among the least understood mental health conditions.

Researchers are still trying to figure out the exact cause of them, but they think personality disorders develop due to several factors, including:

• Genetics: Scientists have identified a malfunctioning gene that may be a factor in OCPD. Researchers are also exploring genetic links to aggression, anxiety and fear, which are traits that can play a role in personality disorders. People are also more likely to have OCPD if they have biological family members with personality disorders, anxiety or depression.

• Childhood trauma: One study revealed a link between childhood traumas, such as child abuse, and the development of personality disorders.

DIAGNOSIS AND TESTS

How is OCPD diagnosed?

OCPD can be difficult to diagnose, as most people with a personality disorder don’t think there’s a problem with their behavior or way of thinking.

When they do seek help, it’s often because of anxiety or depression due to the problems created by their personality disorder, such as losing their job or relationships, not the disorder itself.

When a mental health professional, such as a psychologist or psychiatrist, suspects someone might have obsessive-compulsive personality disorder, they often ask broad, general questions that won’t create a hostile, defensive environment. They ask questions that shed light on:

• Relationships.
• Work history.
• Reality testing.
• Impulse control.

Because a person suspected of having OCPD may lack insight into their behaviors, mental health professionals often work with the person’s family and friends to collect more information about their behaviors and history.

Mental health providers base a diagnosis of OCPD on the criteria for the condition in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders.

For a diagnosis of OCPD, the person must have a persistent pattern of preoccupation with:

• Order.
• Perfectionism.
• Control of themselves, others and situations.

This pattern is portrayed by four or more of the behaviors listed in the symptoms section.

MANAGEMENT AND TREATMENT

How is obsessive-compulsive personality disorder treated?

In most cases, people with obsessive-compulsive personality disorder (OCPD) don’t believe their behaviors are problematic. However, they might seek help if another issue causes them distress.

Psychotherapy (talk therapy) is usually the treatment of choice for personality disorders. The goal of treatment is to help the person uncover the motivations and fears associated with their thoughts and behavior. In addition, they can learn to relate to others more positively.

Two specific types of psychotherapy that can help people with OCPD include:



• Psychodynamic therapy: This type of therapy focuses on the psychological roots of emotional suffering. Through self-reflection and self-examination, the person undergoing therapy looks into problematic relationships and behavior patterns in their life to better understand themselves and change how they relate to other people and their environment.
• Cognitive behavioral therapy (CBT): This is a structured, goal-oriented type of therapy. A therapist or psychologist helps them take a close look at their thoughts and emotions. They’ll come to understand how their thoughts affect their actions. Through CBT, someone with OCPD can unlearn negative thoughts and behaviors and learn to adopt healthier thinking patterns and habits.

While there’s currently no medication that can treat personality disorders, there’s medication for depression and anxiety, which people with OCPD may also have. 

Treating these conditions can make it easier to treat OCPD.

PREVENTION

Can OCPD be prevented?

While you can’t prevent OCPD, many of the related problems might be lessened with treatment. Seeking help as soon as symptoms appear can help decrease the disruption to the person’s life, family and friendships.

OUTLOOK / PROGNOSIS

What is the prognosis for OCPD?

The prognosis (outlook) for OCPD depends on if it’s treated or not.

Left untreated, OCPD may result in:

• Poor relationships.
• Occupational difficulties.
• Impaired social functioning.

A note from Cleveland Clinic

It’s important to remember that obsessive-compulsive personality disorder (OCPD) is a mental health condition. As with all mental health conditions, seeking help as soon as symptoms appear can help decrease the disruptions to your life. Mental health professionals can offer treatment plans that can help you manage your thoughts and behaviors.

The loved ones of people with OCPD often experience stress, depression and isolation. It’s important to take care of your mental health and seek help if you’re experiencing these symptoms.

If you are curious please reach out! www.wildvioletcounseling.com 

References: 

www.treatmyocd.com 

NOCD’s website contains a lot of great information on the subtypes of OCD, symptoms, statistics, and treatment for OCD. 

International OCD Foundation (IOCDF)- also a great resource for up to date information on OCD. 

https://beyondocd.org/information-for-individuals/clinical-definition-of-ocd 

https://www.ocduk.org/ocd/clinical-classification-of-ocd/dsm-and-ocd/

https://my.clevelandclinic.org/health/diseases/24526-obsessive-compulsive-personality-disorder-ocpd#:~:text=What%20is%20obsessive%2Dcompulsive%20personality,completing%20tasks%20and%20maintaining%20relationships.

www.treatmyocd.com

Mental Health Resources:

https://www.thex-studio.org/resources

Studio Talk contact: studiotalkmentalhealth@gmail.com

Learn more about our co-hosts: 

Xiomara A. Sosa https://www.swmhs.net/

Victoria Lockridge https://www.wildvioletcounseling.com/

Lisa Early https://www.psychologytoday.com/us/therapists/lisa-a-early-summerville-sc/1044400

The Studio Talk podcast and the information provided by Xiomara A. Sosa, Victoria Lockridge and Lisa Early are solely intended for educational and social change advocacy purposes and are not a substitute for advice, diagnosis, or treatment regarding medical or mental health conditions. Although they are licensed mental health counselors, the views expressed on this site or any related content should not be taken for medical, psychological, or psychiatric advice. Always consult your physician or appropriate mental health provider before making any decisions related to your physical or mental health.

Copyright XAS Consulting, LLC DBA Studio Talk Podcast: Real Conversations About Mental Health

PLEASE READ: If you or someone you know is in immediate danger, please call a local emergency telephone number or go immediately to the nearest emergency room. If you are in crisis, please contact the National Suicide Prevention Hotline at https://suicidepreventionlifeline.org/ or 1-800-273-TALK (8255) or your local emergency services.