When rituals make life more difficult: Diagnosis and treatment of OCD

Imagine being late to all your appointments because getting out of your house entails so many time-consuming rituals that you’re spending an hour repeatedly going back to your house to make sure the door is locked.

That’s a scenario that could occur if you have OCD, obsessive compulsive disorder.

“I should point out that Obsessive-Compulsive Personality Disorder is different from OCD,” explained Dean Hickman, M.D., Ochsner psychiatrist and system chairman of the Behavioral Health Service Line.

“The personality disorder is an obsession with orderliness, perfectionism and cleanliness, just to name a few of the obsessions and compulsions.

“But these are less intrusive than a true case of OCD, in which the obsession consists of persistent and unwanted thoughts and urges, which are intrusive.

“The compulsion portion involves repetitive behaviors that act on those urges.”

For the diagnosis to apply, “the rituals have to be excessive and take up more than an hour a day. If you circle the block six times because you think you may have hit a squirrel, this is an example of OCD.”

Those who cannot throw things out, known as hoarders, fall into the OCD category as well.

Even when the hoarded objects take over an entire house, those with the disorder cannot stop collecting superfluous items. They may know their behavior makes no sense, but they can’t help themselves.

Shower after shower

Comedian Howie Mandel has talked extensively about his OCD, which he says wasn’t diagnosed until he was an adult, though he displayed all of the symptoms in his childhood.

Obsessed with germs, he would take shower after shower. He would find himself lining up the fringe on his friends’ rugs.

“Psychiatrists have had some of the best results with Exposure and Response Prevention therapy,” said Kathleen Crapanzano, M.D., associate professor of clinical psychiatry at LSU Baton Rouge.

“With germaphobia, for example, we might gradually make the patient’s hands dirty, and try to get them to tolerate not washing their hands. It’s a form of cognitive behavioral therapy that involves confronting the thoughts, images and situations that make you anxious and/or provoke your obsessions in a safe environment, in the hope that you learn to deal with these obsessions in a healthy way.”