O Is for Obsessive Compulsive Disorder

“Everybody has some OCD tendencies,” says UCSB doctoral student Rene Staskal, who was interviewed for the latest installment of Curiouser and Curiouser. As a third year student in the Department of Counseling, Clinical, and School Psychology, Staskal has spent a fair bit of time studying Obsessive Compulsive Disorder (OCD), its treatments and effects, and upon introspection says, “It’s interesting to see those traits in yourself.” In an informal conversation over a cup of coffee, Staskal explained the finer points of what has become stereotyped as “the hand-washing disorder” due to media portrayals like the TV show Monk. She even offers insight into whether a habit of nail biting qualifies as OCD, and what the children’s chant “step on a crack, break your mother’s back” has to do with the disorder.

What is OCD?

There are two parts to it: obsessions and compulsions. Obsessions are intrusive thoughts that are disturbing, and compulsions are behaviors or mental rituals you have to alleviate anxiety from the obsessions. When researchers first started studying OCD, they thought that the compulsions always came from an obsession, but now there is more recognition that sometimes people just compulsively do things to alleviate general anxiety. Worry about contamination from germs and hand washing is the classic compulsion, but there are lots of others. Sometimes people count the number of words in a conversation and purposely end on an odd number, for example.

In the cases where there seems to only be a compulsion, would you say that it is probably linked to some other disorder? Maybe an anxiety disorder?

It’s hard to know at this point. It depends upon what causes the anxiety. Right now OCD is just considered an anxiety disorder, but they’re trying to create a different category for OCD called the OCD spectrum. People who have neurological disorders like Tourette’s syndrome and autism have compulsive behaviors that go along with their disorders, for example. This spectrum view is a different way of looking at OCD that is maybe not linked so much to anxiety but looking more at a commonality of behavior.

In this general spectrum, do you think that nail biting qualifies as an OCD behavior?

It depends on the reason for the nail biting. Recently scientists have been looking at rat models that compulsively groom. When that happens, dopamine is released into the brain, giving the rat a pleasurable feeling with a self-soothing effect. Nail biting, like twirling your hair, can be self-soothing in the same way that a compulsion can be self-soothing, but it is not related to any obsession.

What would you say the most common misconception about OCD? When I think about OCD, I think about Howard Hughes, the airplane guy. There are all these myths surrounding him and his OCD behaviors like only drinking milk or never cutting his hair.

That’s funny, because I think of that as actually a more severe but realistic idea of OCD. I think the most common misconception is OCD as a hand-washing disorder where people compulsively wash their hands and worry about germs. Most people think of OCD as it’s portrayed in Monk [the TV show]. But there are actually four factors of obsessional thought: Germ contamination is one. Also, feeling like things need to be “just right”–Monk will do things in the show like needing to have things lined up exactly. There is also doubting, which makes you go back and check things. One case study of OCD was of a man who had to keep driving around the block and checking his car because he thought he had hit someone. And the final factor is intrusive thought of a sexual, violent, or religious nature. The thoughts can be something like, “I’m going to push somebody out of a car” or “I’m going to molest a child” or “I might kill someone.”

If a mild case can almost be qualified as germ phobia, what is debilitating in more severe cases?

Mainly the problem is that it takes up a large portion of a person’s day. For some people, just getting ready could take hours. With things like showering, they could end up doing it over and over again. In the conferences I’ve gone to, they describe it as a record skipping. Eventually it compromises your ability to work and have relationships, making it a quality of life issue. Especially in cases like Howard Hughes’s, it progresses to agoraphobia when people can’t even go out because there is too much to deal with. They just isolate themselves so they can deal with their obsessions and compulsions.

Is OCD a genetic disorder?

The Obsessive Compulsive Foundation has been doing some really amazing research looking at genetic contributors and brain dysfunction with functional MRI [magnetic resonance imaging] studies. There is definitely a strong genetic link and they’ve identified the area of the brain that is affected by OCD. They’ve looked at various medications. The good thing is that OCD seems to respond well to medication. And they’ve also, for the cases that are really medication resistant, planted electrodes in that part of the brain so the patient can stimulate the electrodes themselves. Scientists have found that the region of the brain affected by OCD is the same as the one that is associated with Parkinson’s disease. Overall, they have a really good idea of what part of the brain is affected by OCD, but it’s more difficult to figure out a cure from that information.

Besides the medication and brain electroshock therapy, what are some treatments that have been useful?

Exposure and response prevention is a big psychological treatment. Basically it tries to teach you a way to combat your obsessions and resist your compulsions. You start with a list of your obsessions and compulsions and you develop a hierarchy of the most anxiety-developing things, which might be something like touching a bathroom floor without washing your hands, and the least would be something like only washing your hands once or imagining not washing your hands. And then you practice resisting the compulsion that makes you the least anxious, like you would imagine that you had touched something dirty and then resist the urge to wash your hands. Eventually you’ll get all of your compulsions under control and as they naturally change, you’ll fight the new ones in the same way.

What is the biggest concern for a case that goes undiagnosed?

Probably that OCD doesn’t go away. A lot of times, especially with children, the symptoms can go unnoticed. There is a period of naturally occurring obsessional behavior where kids play games like “step on a crack, break your mother’s back.” The difference is that not all kids are really invested in these games to the point that they will get upset when you ask them to stop. But basically, the biggest problem is that it won’t go away naturally and it can oftentimes lead to depression and other co-morbid disorders.