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Obsessive-compulsive disorder was thought to be a type of anxiety disorder, but is now considered distinct and widespread enough to be thought of as its own condition. Notwithstanding that it affects around 2 percent of the population, it is, in the words of FOX News, “one of the least misunderstood mental illnesses.” Given how similarly poorly substance abuse is often grasped, it’s important to shed light on how the two conditions overlap, and what treating OCD and addiction entails.
Those with obsessive-compulsive disorder are compelled to fixate their thoughts, energy, and attention on one fear; common examples are fear of infection, fear of a home invasion, and fear of personal or bodily harm. Such concerns are common to most people, but in proportional, relative amounts. We wash our hands, lock our doors, and take basic precautions when leaving home. But in the mind of those with OCD, those concerns become obsessions. They cannot control or prevent the fear of contracting an infection, of someone breaking into the house, or of the possibility (however remote) that they are in mortal danger. Their social, professional, and academic lives suffer because they cannot break the “endless cycle,” in the words of WebMD, of their thoughts.
Psych Central explains that a diagnosis of obsessive-compulsive disorder will be tendered if the OCD symptoms cause tangible distress and disruption in a person’s daily life. Furthermore, the symptoms have to be time-consuming; for example, washing hands for 30 minutes at a time would fit this criteria.
On the other hand, those who are compelled to perform a precise task – locking a door a certain number of times before leaving the house – but without the habit affecting their regular functioning may have a compulsive disorder; however, they would not be diagnosed with obsessive-compulsive disorder.
For an official diagnosis, OCD has to cause impairment, whether mild (where the person can still function, albeit with inconveniences and potentially cumbersome adjustments) or severe (where the person cannot function because of the obsessive compulsions and experiences significant psychological distress as a cause or result of this). Of the 2.2 million Americans with OCD, the National Institute of Mental Health estimates that 50.6 percent have severe OCD.
Obsessive-compulsive disorder compels sufferers to do very specific and precise things, in an attempt to allay concerns that never fully dissipate. Checking involves the person repeatedly and insistently checking and double-checking doors, windows, locks, lights, etc. to make sure they are safe in whatever area they are in (home, office, or car). If the person is prevented from checking, the person becomes convinced that something terrible will happen and might experience a panic attack as a result of the perceived insecurity of the situation. Checking behaviors might have their origins in childhood, when the person feared that a traumatic event might take place, or the person might have been affected by such an event happening to a close friend or relative.
Intrusive thoughts, which the person cannot ignore, are also common with OCD. Intrusive thoughts take on the form of a hypothetical situation that might happen, but the OCD sufferer is convinced it will happen, even if the (perceived) reality of the situation remains ambiguous.
This can mean refusing to drive or walk along a particular street, because the person was struck by the thought of being in a vehicular collision on that street.
Psychology Today explains how the thought process might play out: “I saw a car driving fast on that street,” becomes “That car is going to hit me,” which becomes “I must avoid that street at all costs.” While pedestrian safety and awareness are obviously good practices, those with OCD are paralyzed by the uncertainty and lack of control they have over the given situation. To regain some measure of perceived balance, they will inconvenience themselves and go out of their way to avoid the street, perhaps even refusing rides from friends if there is a risk of driving down that particular street.
Intrusive thoughts also include images and ideations of performing violent or sexual acts on another person. There is no tangible danger of the individual with OCD actually carrying out these particular thoughts, but they cannot get past the fact that they had such thoughts and that they might carry them out. As a result, they studiously avoid any contact with the individuals they unwillingly targeted, and feel deep guilt and shame for experiencing the thoughts.
As an example, the International OCD Foundation talks about parents who think about harming their children. The parents have no intention whatsoever of laying a hand on their offspring, but they are nonetheless consumed by remorse and depression for the notion entering their heads, unbidden though it may have been.
Similarly, intrusive OCD thoughts might affect a relationship. Partners with obsessive-compulsive disorder cannot control suspicions that their partners are cheating on them, turning every neutral, average moment into a reason for doubt and fear. This form of OCD even has its own name: relationship OCD, or ROCD. An article published by CBS News explains that even as sufferers know that their misgivings are not rooted in reality, they are nonetheless helpless to prevent them and similarly powerless to control acting them out – a dilemma that further compounds their anxiety and depression.
Why might a person develop OCD? Researchers writing in the journal of Molecular Psychiatry posited an OCD “genetic marker,” which suggests that people who have this modification in the chemistry of their brain are more susceptible to the development of OCD than people who do not have the marker.
Other factors that could contribute to the formation of obsessive-compulsive disorder could be trauma that was so significant, it caused a person to become fixated on a detail of the traumatic event, to the point of adjusting life to compensate for the presence of the detail. Psychology Today explains how many people with OCD attribute their condition to something that happened to them in childhood, then grow up as adults who studiously try to control the world around them, such that the key detail of their trauma is kept at bay (for example, by compulsive washing hands to protect against infection, compulsive locking of doors to protect against home invasion, etc.).
While most people would be able to moderate their protective behaviors, individuals with OCD may have the chemical imbalance (the genetic marker) in their brains. This may aggravate the obsessive-compulsive reaction to a potential trigger related to the memory of the traumatic event.
People with obsessive-compulsive disorder are already at risk for anxiety, but the depression that arises from the impact the OCD has on their lives may cause even greater problems.
Some individuals may resort to taking drugs or alcohol to try and get some relief from the persistent and intrusive thoughts that take hold of them, or to make themselves feel better after their OCD leads to embarrassing and difficult situations.
For this reason, the Anxiety and Depression Association of America estimates that people who have OCD are 2-3 times more likely than the general population to struggle with drug or alcohol use. OCD sufferers have elevated levels of fear and stress in their daily lives, which can lead to drug and alcohol abuse and then dependence and addiction.
As much as OCD is undeniably stressful for its sufferers, the genetic markers and chemical imbalances mentioned above may also prime people with OCD for addiction. Research and testing have suggested that the people who have obsessive-compulsive disorder, and people who have drug or alcohol addictions, “share a lack of control or behavior,” according to New Scientist. In the same way that people who experience overwhelming fear or anxiety in childhood are at risk for developing a substance abuse disorder later in life, those same people are more likely to develop OCD symptoms as a way to cope with how their worlds have changed.
The Journal of Anxiety Disorders published the results of a study that looked at 323 people diagnosed with OCD, where 27 percent of that population “met the lifetime criteria for a [substance use disorder].” Seventy percent of the population reported that the development of their obsessive-compulsive disorder preceded the onset of their drug or alcohol problem by at least one year.
In fact, such is the overlap that the American Journal of Psychiatry writes about “the obsessive-compulsive chronic alcoholic,” a person who uses alcohol to moderate feelings of intense fear that cause obsessive thoughts and compulsive behaviors.
Certain medications and recreational substances might also act as a catalyst for pre-existing OCD risk factors (like the genetic markers or trauma mentioned above). Behaviors associated with OCD, such as the intrusive thoughts and resultant compulsive behaviors, can develop as a result of exposure to drugs like:
Obsessive-compulsive disorder and addiction being what they are, they cloud a person’s perspective on consumption of drugs and alcohol. Individuals may not be able to see that their substance intake is exacerbating their symptoms or causing social and financial ruin in their lives.
Furthermore, even though the depressant quality of alcohol may provide a sensation of temporary relief for anxiety, long-term exposure can trigger panic attacks or other OCD symptoms. Alcohol imbalances blood sugar and can disrupt sleep, thereby worsening any pre-existing symptoms of anxiety or stress.
Obviously, alcohol taken in conjunction with prescribed medications for OCD can beextremely dangerous, enhancing the properties of anti-anxiety drugs to the point of putting the individual at risk of death.
A goal of treating people with co-occurring obsessive-compulsive disorder and substance abuse is strengthening their confidence; pointing out that their use of obsessive-compulsive defenses have a justification, but only in principle. Building up self-confidence, by telling these individuals that they are strong enough to modify some of their methods, is the first step into helping them get ahead of their trauma and fears (and to stop being victimized by them).
The idea behind this is to help people understand the dynamics behind the defenses that they employ as part of their OCD. This may entail challenging the pattern of obsessions and compulsions in a creative, supportive way, to get people comfortable with accepting that some realities cannot, and do not, need to be controlled (for example, that germs are a natural part of life, or that a cursory examination of locks and doors is enough before going to sleep).
To that effect, one form of therapy for OCD is Exposure and Response Prevention Therapy(ERP). This sees a person being gradually and carefully exposed to a situation that would normally trigger an obsessive-compulsive response, such as shaking hands with a stranger. The crux is that the response is prevented; clients are taught how to approach a situation in such a way that they can resist the rituals they might otherwise be helpless to perform. A therapist will encourage the client to resist handwashing after coming into contact with a stranger for increasing periods of time, habituating the client to the relative harmlessness of a handshake. ERP therapy can last for up to 16 weeks, accounting for inevitable setbacks and learning curves.
A large part of Exposure and Response Prevention Therapy is making people aware of their levels of anxiety. A therapist might employ methods of Cognitive Behavioral Therapy (CBT), which helps people understand their thought patterns and learn how to control unhelpful or harmful patterns. When people have insight into how they think and react to a stressful situation, they can apply the dynamics of CBT to Exposure and Response Prevention Therapy, staying in control of their instinctive responses to the point where their obsessive thoughts weaken and their compulsive reactions are not as pronounced.
Cognitive Behavioral Therapy also plays a key role in the treatment of addiction.
Teaching how to understand the thought patterns of stress and anxiety, and how those patterns lead to substance abuse, is one of the cornerstones of using CBT to help people overcome their compulsions to consume drugs and alcohol.
Therapy is a critical component of treating co-occurring disorders like OCD and addiction, as addressing only the physical effects (compulsive behaviors or the abuse of drugs or alcohol) ignores the underlying issues behind the obsessive thoughts or why the individual uses illicit drugs to cope with feelings.
The ideas and strategies imparted during therapy sessions are intended to serve people long after they have completed their treatment. The world will always be full of triggers that might hearken back to memories of the obsessive-compulsive behavior, but therapy seeks to empower individuals to take control of their stress and anxiety. With that insight, co-occurring OCD and addiction can be effectively managed.