Obsessive-compulsive Disorder

Summary

• Learn as much as you can about OCD.
• Do not try to help by taking part in daily rituals.
• Praise improvements and downplay setbacks.

Obsessive-compulsive disorder (OCD) tends to run in families. There is about a one-in-four chance of getting OCD if a parent or sibling already has it. However, even if only one family member has the disorder, the whole family is affected. This is because OCD can be very time consuming and disruptive to one’s daily lifestyle. This in turn may cause the entire family to feel anxious and frustrated.

Become informed

It is important for everyone involved to learn as much as they can about OCD. This is true for the person with OCD, as well as friends and loved ones. A person with the disorder may very well know his fears and rituals are irrational. His inability to make them stop, however, leaves him feeling frustrated and ashamed. What he needs is your acceptance and support, rather than judgment.

OCD is not the result of a character defect or bad parenting. Therefore, a person with OCD should not blame himself or his parents. Neither should those closest to him try to place blame or guilt on him. Instead, rally behind the person and let him know you are there to help.

How to help

Watching a friend or loved one go through obsessions and compulsions can be difficult. You may be tempted to try to help her by taking part in her daily rituals. This might help things run more smoothly in the short-term. In the long-term, however, this is simply feeding and prolonging her obsessive-compulsive behavior.

Research the disorder and go over the information with her. Talk to her about ways you can be supportive without further enabling her disorder. Involve the entire family or a small group of close friends in the discussion. Make sure it is presented in a well-meaning, non-accusing manner. Allow her to make and agree to decisions she is comfortable with.

Whatever is decided, try to go about changes slowly. A person with OCD will already be stressed and fearful. Adding further anxiety by trying to change too much too soon will only make matters worse. Focus on making small steps forward. Be patient and keep a positive attitude.

Help the person to get help

OCD does not go away on its own. Talking about it can be helpful, but it will not make the symptoms disappear. A person with OCD needs professional help. He may be reluctant to reach out for help by himself, however. As a friend or loved one, you can assist him in getting the help he needs. Encourage him to call his doctor or offer to make the call with him. Attend the appointment with him. Then plan to be there for follow-up appointments and support group meetings. Make sure he is being cared for by a doctor or licensed health care worker familiar with OCD.

Once he is in treatment, encourage him to follow through with the recovery options he has chosen. Be patient with his progress. Praise his improvements and downplay any setbacks. Let him know that you are with him through the entire healing process.

Get help for yourself

Living with OCD can be very draining on everyone. If you are caring for a loved one with the disorder, make sure other family members help out. If you are helping a friend with OCD, try to get other friends involved as well. Do not carry the burden alone. Reach out to a support group. Finally, do not neglect your own health. Take care of yourself by eating healthily and getting proper rest and exercise.

Resources

Mental Health Recovery/ WRAP®: Wellness Recovery Action Plan
www.mentalhealthrecovery.com/about/overview.php

National Alliance on Mental Illness, Obsessive-Compulsive Disorder Fact Sheet
www.nami.org/NAMI/media/NAMI-Media/Images/FactSheets/OCD-FS.pdf

By Kevin Rizzo

©2014-2019 Carelon Behavioral Health

Source: Better Health Channel/State Government of Victoria (Australia), www.betterhealth.vic.gov.au/health/conditionsandtreatments/obsessive-compulsive-disorder-family-and-friends?viewAsPdf=true, NHS Choices/ Department of Health (UK), www.nhs.uk/Conditions/Obsessive-compulsive-disorder/Pages/Familyfriends.aspx; National Alliance on Mental Illness, www.nami.org/Learn-More/Mental-Health-Conditions/Obsessive-Compulsive-Disorder; National Institute of Mental Health, www.nimh.nih.gov/health/topics/obsessive-compulsive-disorder-ocd/index.shtml

Reviewed by Paulo Correa, MD, Medical Director, Beacon Health Options

Summary

• Many people display OCD-like symptoms from time to time.
• OCD causes a great amount of concern.
• A person will spend over an hour each day dealing with OCD.

You have a real attention to detail. You like things done a certain way. You admit to being a perfectionist. Some of your peers poke fun at you because you take so long to finish projects. Your own family teases you when you become “obsessed” with a new thought or idea. Some of your friends have playfully suggested that you have OCD. Could they be right?

The truth is many people display OCD-like symptoms from time to time. This does not necessarily mean they have OCD. Someone with OCD will have these thoughts and behaviors for over an hour each day. OCD causes great concern and can really interfere with a person’s everyday life.

As the name implies, OCD consists of obsessions and compulsions.

Obsessions

Obsessions are thoughts or images that occur over and over again in one’s mind. They can be very disruptive and disturbing. The person will often realize his obsessions are foolish. At the same time, he is unable to stop them. This leaves him feeling anxious and afraid.

Some common obsessions include:

• Feeling one’s hands are full of germs
• Feeling something important is being left undone
• Feeling of impending doom
• Feeling of causing harm to one’s self or loved ones
• Feeling items are out of place or order
• Feeling excessive guilt regarding religion
• Feeling repulsed by sexual urges

Compulsions

Compulsions are rituals done in response to obsessions. These acts are an attempt to control the obsessions. The person does not want to repeat the rituals, but feels compelled to do so. She feels something bad will happen if she does not do them. Performing the rituals will not make the obsessions go away but may provide temporary relief.

Some common compulsions include:

• Repeatedly washing hands
• Checking and rechecking things
• Touching and arranging things
• Repeating sequences of steps
• Repeating words
• Counting

Related disorders

There are a number of other mental illnesses related to OCD. Many focus on various parts of the body. Skin-picking disorder and hair-pulling disorder are among them. Others include chronic nail-biting and lip-biting. Some center on perceived flaws or defects in appearance.

Hoarding used to be considered a symptom of OCD. It is now known as a separate disorder. Tic-related disorders and eating disorders often co-occur with OCD. This is also true for ADHD, autism, bipolar disorder, schizophrenia, and depression.

Diagnosis

OCD is a popular topic in today’s culture. The term is often misused to describe anyone who may be fussy or routine-oriented. Friends sometimes refer to each other as “being OCD” whenever they become obsessed over something. A person who truly has OCD will be very distressed by it. She will spend over an hour each day dealing with it.

Sometimes OCD symptoms can be substance-induced or medication-induced. They may also be due to some other health issue. If you think you may have OCD you should be checked out by a doctor. If nothing is physically found wrong, you may be referred to a mental health specialist. If you do get diagnosed with OCD, do not fret. OCD is a long-term disease, but through proper treatment recovery is possible.

Resources

National Alliance on Mental Illness
www.nami.org
www.nami.org/NAMI/media/NAMI-Media/Images/FactSheets/OCD-FS.pdf

By Kevin Rizzo

©2014-2019 Carelon Behavioral Health

Source: National Alliance on Mental Illness, www.nami.org/Learn-More/Mental-Health-Conditions/Obsessive-Compulsive-Disorder; National Institute of Mental Health, www.nimh.nih.gov/health/topics/obsessive-compulsive-disorder-ocd/index.shtml; Mental Health America, www.mentalhealthamerica.net/conditions/ocd; Centers for Disease Control and Prevention, www.cdc.gov/ncbddd/tourette/ocd.html; The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), www.DSM5.org

Reviewed by Paulo Correa, MD, Medical Director, Beacon Health Options

Summary

• Sometimes mistaken for autism or Tourette syndrome
• Often co-occurs with other disorders
• Symptoms may be due to some other health issue

Obsessive-compulsive disorder (OCD) has become a popular topic in today’s culture. It is common to hear others refer to a classmate or co-worker as having OCD. A person who is fussy or routine-oriented may be thought to have it. Some people even say they are “being OCD” during times of worry or stress.

The fact is most people will show OCD-like symptoms from time to time. This does not mean they have the disorder. OCD is more than just having certain routines or worries. OCD involves a series of obsessions and compulsions that upset one’s life. A person with OCD has these thoughts and rituals for over an hour each day.

Symptoms of OCD

Obsessions

Obsessions are thoughts or images that happen over and over again in one’s mind. They can be very disturbing. The person will often realize these obsessions are not reasonable. At the same time, the person is not able to stop them.

Some common obsessions can be:

• Feeling one’s hands are full of germs
• Feeling something important is being left undone
• Feeling of impending doom
• Feeling of causing harm to one’s self or loved ones
• Feeling items are out of place or order
• Feeling too much guilt about religion
• Feeling repulsed by sexual urges

Compulsions

Compulsions are rituals done due to obsessions. The person does not want to repeat the rituals, but feels compelled to do so. She feels something bad will happen if she does not do them. Doing the rituals will not make the obsessions go away but may give some short-term relief.

Some common compulsions are:

• Repeatedly washing hands
• Checking and rechecking things
• Touching and putting things in order
• Repeating sequences of steps
• Repeating words
• Counting

Sometimes it’s something else

OCD is sometimes mistaken for other ailments such as autism or Tourette syndrome.

Autism spectrum disorder (ASD)

ASD is an illness that affects the way a person interacts and learns. A person with ASD will sometimes repeat actions. In this way it is like OCD. Other symptoms include not understanding the ways people typically relate. For example, a person with ASD might avoid eye contact or not take another person’s feelings into account.

Tourette syndrome (TS)

TS is a disorder of the nervous system. It causes a person to repeat movements and utterances. These tics cannot be controlled by the person. Examples include eye blinking and throat clearing. Tic disorders often co-occur with OCD.

Co-occurring disorders

Besides tic disorders, many other illnesses can co-occur with OCD. These include bipolar disorder, schizophrenia, ADHD, and depression. Eating disorders and substance use disorders are also quite common. OCD should always be treated apart from any co-occurring disease.

Bipolar disorder

Bipolar disorder is a mental illness marked by extreme mood swings. A person with the disease may go back and forth between very high and very low feelings. The high periods are called mania. The low periods are called depression.

Schizophrenia

Schizophrenia is a long-term mental illness that affects millions of adults. It disrupts a person’s thinking, causing odd outward behavior. People with the illness often hear voices. They may also see things that aren’t really there.

ADHD

ADHD stands for attention-deficit/hyperactivity disorder. It is one of the most common disorders among school-aged kids. ADHD can also continue into adulthood. People with ADHD will have trouble staying focused. Many of them will also act hyper and impulsive. Boys are three to four times more likely to have ADHD than girls.

Getting help

Sometimes OCD symptoms can be substance-induced or medication-induced. They may also be due to some other health issue. If you think you might have OCD, you should be checked out by a doctor. If nothing is physically found wrong, you may be referred to a mental health specialist. If you do get diagnosed with OCD, do not fret. OCD is a long-term disease, but through proper treatment recovery is possible.

Resources

National Alliance on Mental Illness
www.nami.org
www.nami.org/NAMI/media/NAMI-Media/Images/FactSheets/OCD-FS.pdf

By Kevin Rizzo

©2014-2019 Carelon Behavioral Health

Source: National Alliance on Mental Illness, www.nami.org/Learn-More/Mental-Health-Conditions/Obsessive-compulsive-Disorder and www.nami.org/Learn-More/Mental-Health-Conditions/Schizophrenia; National Institute of Mental Health, www.nimh.nih.gov/health/topics/obsessive-compulsive-disorder-ocd/index.shtml, www.nimh.nih.gov/health/topics/bipolar-disorder/index.shtml and www.nimh.nih.gov/health/topics/attention-deficit-hyperactivity-disorder-adhd/index.shtml; Mental Health America, www.mentalhealthamerica.net/conditions/ocd; Centers for Disease Control and Prevention, www.cdc.gov/ncbddd/autism/index.html, www.cdc.gov/ncbddd/tourette/index.html and www.cdc.gov/ncbddd/tourette/ocd.html

Reviewed by Paulo Correa, MD, Medical Director, Beacon Health Options

Summary

• OCD is an anxiety disorder involving unwanted thoughts.
• OCPD is a personality disorder marked by controlling thoughts.
• People with OCPD have no compulsions and no desire to change.

Obsessive-compulsive personality disorder (OCPD) sounds a lot like obsessive-compulsive disorder (OCD). But, there are some distinct differences. OCD is an anxiety disorder involving repetitive unwanted thoughts and ritualized actions. OCPD is a personality disorder marked by controlling thoughts. One major difference between the two is in self-awareness. People with OCD are very tuned in to the negative aspects of their condition. Those with OCPD often do not think they are doing anything unusual.

What is OCD?

OCD is made up of obsessions and compulsions. Obsessions are unwanted thoughts or images that repeatedly occur in one’s mind. They can be very disruptive and disturbing. The person will often realize her obsessions are not rational. At the same time, she is not able to stop them. This leaves her feeling anxious and afraid. Some common obsessions are feeling that things are out of order or left undone. Others include feeling one’s hands are full of germs, or a feeling of coming doom.

Compulsions are rituals done in response to obsessions. These acts are an attempt to control the obsessions and the feeling of anxiety that goes with them. The person does not want to repeat the rituals, but feels compelled to do so. She feels something bad will happen if she does not do them. Doing the rituals will not make the obsessions go away but may give some brief relief. Some common compulsions include washing hands over-and-over or checking and rechecking things.

What is OCPD?

In contrast to those with OCD, people with OCPD often have no desire to change. They are convinced that their way of doing things is the best way. They demand if everyone else just followed their example, things would go smoothly. This rigid thinking often causes problems with others.

A person with OCPD is unaware of the hardship he causes others. This can be very true in the workplace. His over-attention to detail often becomes a source of frustration to his co-workers. Those working under him may feel they are being micro-managed. He also may have a hard time meeting his work deadlines.

The actual quality of work of someone with OCPD may be better than that of his peers. But, it will often come at the expense of his relationships with those peers.

Other differences

OCD usually starts in childhood. OCPD usually does not begin until the teen or early adult years. A person with OCD will be distressed about her condition. This will often prompt her to seek treatment on her own.

A person with OCPD will more likely cause distress to those around him. Most often it is when resulting conflicts threaten his job or closest relationships that he seeks treatment.

People with OCPD do not have the compulsions that are common with OCD. They also do not have the high anxiety. They are content with their way of doing things. Their obsession with lists and rules does not cause them any stress. In fact, quite the opposite is true. People with OCPD feel relieved, not burdened, when they stick to their strict routine.

Diagnosis

Having some obsessive traits or behaviors does not mean a person has OCD or OCPD. Neither does a person have to have all the traits to be diagnosed with either disorder. Proper evaluation should be done by a mental health professional. People found to have either disorder can and do recover. There is hope.

Resource

International OCD Foundation
Obsessive-Compulsive Personality Disorder (OCPD) Fact Sheet

By Kevin Rizzo

©2015-2019 Carelon Behavioral Health

Source: International OCD Foundation, https://iocdf.org/wp-content/uploads/2014/10/OCPD-Fact-Sheet.pdf; National Institute of Mental Health, www.nimh.nih.gov/health/topics/obsessive-compulsive-disorder-ocd/index.shtml U.S. National Library of Medicine, National Institutes of Health, http://www.nlm.nih.gov/medlinepl us/ency/article/000942.htm; NHS Choices, www.nhs.uk/Conditions/Personality-disorder/Pages/Symptoms.aspx

Reviewed by Philip Merideth, M.D., J.D., Physician Advisor, Beacon Health Options

Summary

• OCD is not the result of bad parenting.
• OCD can lead to excessive hand washing, questioning, and double checking.
• PANDAS is an intense onset of OCD caused by strep infections.

Obsessive-compulsive disorder (OCD) is one of the most common childhood mental illnesses. It can start as early as the toddler years but may not be noticed right away. Often a teacher or school counselor may be the first one to spot it. Students with OCD may take an extra-long time with schoolwork. This is due to a constant checking and rechecking of answers.

Along with doubt, kids with OCD also become obsessed with fear. This could be the fear of illness, being impure, or being in some other danger. This fear and doubt compels the child to repeat rituals. Some of these are too much hand washing, and endless questioning and double checking. The child can also become obsessed with certain numbers or with having things done a certain way. This can lead to urges to count, repeat, touch, organize, and rearrange things. Children who display OCD-type symptoms should be referred to a child and adolescent psychiatrist for proper diagnosis.

Development

The peer pressure of trying to fit in is only made stronger by OCD. While younger children may not realize anything is wrong, older kids with OCD may feel ashamed. They may try to hide their compulsions at school or when out with friends. Some may even try to hide them from their own family. Other kids try to involve family members in their OCD rituals. This can put a great need on parents and siblings. A number of children with OCD will also tend to have tic disorders. This is very true of boys.

Causes

OCD may be passed down through families, but it is not the result of bad parenting. It is not clear why some children will get OCD while others will not. It is thought to be caused by a chemical imbalance in the brain. While most symptoms of OCD come slowly, in some cases they seem to appear overnight. Research shows that these sudden cases are often due to untreated strep infections.

Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS)

PANDAS is a sudden, intense onset of OCD symptoms in children that is due to strep infections. This is often a strep throat or scarlet fever infection that was untreated. It may have occurred months before but went unnoticed. In some cases it was noticed but only partly treated.

The OCD symptoms come on very quickly and can become full blown within one to two days. The child may also display tics or signs of other mental illness. These can involve major separation anxiety and other panic-type behaviors. The child may have trouble focusing or become hyper, irritable, or depressed. Some kids will show signs of regression. This could be using baby talk, throwing temper tantrums, or bed-wetting.

Treatment of PANDAS and OCD

The sudden and severe nature of PANDAS can be very scary to parents. They may feel like their child has become a different person overnight. Kids who display symptoms of PANDAS need to be tested right away for active strep infection. If the results are positive, antibiotics should be given. This will take care of the infection and also lessen most of the symptoms. The child should also be checked for tic disorder or Tourette syndrome.

Children with OCD can be treated with cognitive-behavioral therapy, antidepressants (SSRIs), or both. This is true whether the symptoms are PANDAS-related or not. SSRIs should be started at very low doses to cut down on side effects. This is even more vital for children with PANDAS who can be overly sensitive to drugs. WRAP® for Kids can also be effective.

Resources

Swidey, Neil (2012) “The PANDAS puzzle: Can a common infection cause OCD in kids?” Boston Globe Magazine, The Medical Issue: Mysteries Within
www.bostonglobe.com/magazine/2012/10/27/the-pandas-puzzle-can-common-infection-cause-ocd-kids/z87df6Vympu7bvPtapETLJ/story.html

Ten Turtles on Tuesday: A Story for Children About Obsessive–Compulsive Disorder by Ellen Flanagan Burns, Magination Press/American Psychological Association, 2014.

By Kevin Rizzo

©2014-2019 Carelon Behavioral Health

Source: National Alliance on Mental Illness; National Institute of Mental Health, www.nimh.nih.gov/labs-at-nimh/research-areas/clinics-and-labs/pdnb/web.shtml

Reviewed by Paulo Correa, MD, Medical Director, Beacon Health Options

Summary

• A person with OCD will need proper treatment.
• Non-drug therapies include CBT, ERP, and WRAP®.
• Drug therapies include antidepressants and antipsychotics.

Obsessive-compulsive disorder (OCD) may be a long-term illness. OCD symptoms can get better or worse over time, but will not simply go away. A person with the illness will need proper care. This can be given through a doctor or licensed health care worker trained in treating OCD.

Treatment can be behavior therapy, drug therapy, or both. Some people will do better with one versus the other. Sometimes a mixture of the two works best. When treatment is blended with a healthy life and other recovery tools, the outlook can be very good.

Cognitive-behavioral therapy (CBT)

CBT is an interactive form of therapy used to treat a range of issues. It is often the first line of treatment for OCD. It also can work well when mixed with antidepressants. CBT helps change the way a person thinks, feels and reacts. It has even been shown in studies to change a person’s brain activity. One purpose of CBT is to help show and reject harmful thoughts. This results in a decrease of harmful feelings and actions.

Exposure and response prevention (ERP)

This is a special form of CBT proven to be very useful in treating OCD. ERP involves putting a person in a perceived fearful situation within a controlled setting. This exposure can be real or imagined. The person is not allowed to react with a ritual. One example is to have the person touch something dirty and not let her wash her hands. When repeated over time, this can help lessen or even break the obsessive-compulsive cycle.

Antidepressants

Antidepressant drugs (SSRIs) are often used to treat OCD. These drugs may take a number of weeks before they start working. They can be helpful but may give certain side effects, such as upset stomach, headaches, and dizziness. They also may cause sleep issues and sexual side effects. SSRIs come with a warning label. Any person who is starting these drugs should be watched closely.

Common SSRIs:

• Celexa® (citalopram)
• Lexapro® (escitalopram)
• Paxil® (paroxetine)
• Prozac® (fluoxetine)
• Zoloft® (sertraline)

Antipsychotics

Sometimes antipsychotic drugs are given for OCD. These tend to work more quickly than SSRIs. They can be used for a long time but for some, these medications may only be needed for a short time. Common side effects are weight gain, dizziness, drowsiness, and constipation. Dry mouth and blurred vision may also happen. More severe problems are muscle movement issues as well as metabolic syndrome. This is a serious condition that can lead to heart disease, diabetes, and stroke.

Common antipsychotic drugs:

• Abilify® (aripiprazole)
• Haldol® (haloperidol)
• Risperdal® (risperidone)
• Seroquel® (quetiapine)

Alternative treatments

There is very little proof to support the use of other treatments for OCD. Two that are known for helping with depression have shown some promise in studies. Cranial electrotherapy stimulation (CES) is a method of exciting the brain using very low current. Inositol (vitamin B8) is part of our diet but is also sold as a supplement. Both treatments are low risk but more research is needed to make sure that they work for OCD.

Recovery

A person with OCD can do well with proper treatment. A healthy lifestyle can also help recovery. This includes getting regular sleep and exercise, as well as eating a balanced diet. One more helpful way to promote your health is through the Wellness Recovery Action Plan® (WRAP®). This self-designed plan lets you easily develop tools, supports, and resources for staying well. Some people with OCD have also found a variety of helpful coping methods that include guided breathing, yoga, physical activity, mindfulness, and more. These things might be listed as wellness tools in the person’s WRAP®.

Resources

Mental Health Recovery/WRAP®: Wellness Recovery Action Plan®
www.mentalhealthrecovery.com/about/overview.php

National Alliance on Mental Illness
www.nami.org/NAMI/media/NAMI-Media/Images/FactSheets/OCD-FS.pdf
www.namihelps.org/assets/PDFs/fact-sheets/General/Cognitive-Behavioral-Therapy.pdf

By Kevin Rizzo

©2014-2019 Carelon Behavioral Health

Source: National Alliance on Mental Illness, www.nami.org/Learn-More/Mental-Health-Conditions/Obsessive-compulsive-Disorder/Treatment and; National Institute of Mental Health, www.nimh.nih.gov/health/topics/obsessive-compulsive-disorder-ocd/index.shtml; National Institute of Health, www.ncbi.nlm.nih.gov/pmc/articles/PMC3423997/; Mental Health America, www.mentalhealthamerica.net/cranial-electrotherapy-stimulation and www.mentalhealthamerica.net/inositol; Mental Health Recovery, www.mentalhealthrecovery.com/wrap

Reviewed by Paulo Correa, M.D., Medical Director, Beacon Health Options

Summary

• Obsessions are repeated thoughts or images.
• Compulsions are rituals done in response to obsessions.
• Both can be managed with treatment.

Obsessive-compulsive disorder (OCD) is a widely known but misunderstood disease. It is at least half as common as bipolar illness, and as frequent as schizophrenia. OCD affects about one percent or more of adults in the U.S. It seems to affect men and women of all ethnic groups equally. OCD was once blamed on character flaws or poor parenting. It is now thought to be caused by genetic and environmental factors. OCD may be a long-term illness, but through proper treatment recovery is possible.

As its name implies, OCD is made up of obsessions and compulsions.

Obsessions

Obsessions are thoughts or images that repeatedly occur in one’s mind. They can be very disruptive and disturbing. The person will often realize his obsessions are irrational. At the same time, he is not able to stop them. This leaves him feeling nervous and afraid.

Some common obsessions:

• Feeling one’s hands are full of germs
• Feeling something important is being left not done
• Feeling of impending doom
• Feeling of causing harm to one’s self or loved ones
• Feeling items are out of place or order
• Feeling too much guilt about religion
• Feeling repulsed by sexual urges

Compulsions

Compulsions are rituals done in response to obsessions. These acts are an attempt to control the obsessions. The person does not want to repeat the rituals, but feels compelled to do so. She feels something bad will happen if she does not do them. Doing the rituals will not make the obsessions go away but may give some temporary relief.

Some common compulsions:

• Repeatedly washing hands
• Checking and rechecking things
• Touching and arranging things
• Repeating sequences of steps
• Repeating words
• Counting

Many people have obsessive thoughts or compulsive behaviors from time to time. This does not mean the person has OCD. OCD causes a real disruption in one’s everyday life. A person with OCD has these thoughts and behaviors for over an hour each day.

Causes and treatment

OCD usually begins in childhood, or the teen or early adult years. OCD tends to run in families. If a parent or sibling has it, there is about a one-in-four chance that their child will also get it. There is evidence to suggest a chemical imbalance may be involved. Serotonin is one such chemical that has been linked to OCD. Stimulating certain brain areas through drug or behavior therapy can help reduce OCD symptoms.

There may be periods of time when OCD symptoms will get better or worse. Stress and other factors can play a role in how OCD develops. A healthy lifestyle can prove to be helpful. This includes eating a balanced diet and getting regular sleep and exercise.

OCD symptoms do not just go away on their own. Through proper treatment recovery is possible. This may be in the form of behavior therapy, drug therapy and other recovery tools. Many people try to hide their OCD. However, OCD is nothing to be ashamed of. If you believe you may have OCD, reach out for help.

Resources

National Alliance on Mental Illness
www.nami.org/Learn-More/Mental-Health-Conditions/Obsessive-compulsive-Disorder

National Institute of Mental Health
www.nimh.nih.gov/health/topics/obsessive-compulsive-disorder-ocd/index.shtml

By Kevin Rizzo

©2014-2019 Carelon Behavioral Health

Source: National Alliance on Mental Illness, www.nami.org/Learn-More/Mental-Health-Conditions/Obsessive-compulsive-Disorder; National Institute of Mental Health, www.nimh.nih.gov/health/statistics/prevalence/obsessive-compulsive-disorder-among-adults.shtml

Reviewed by Paulo Correa, M.D., Medical Director, Beacon Health Options

Summary

• Rooted in poor self-esteem
• Lying for many reasons, or no reason at all
• Not officially a mental disorder
• Suggests deeper psychological problems

Almost everyone has encountered a pathological liar—the type of person who in one conversation claims to have dined with the Queen of England, danced back-up for Madonna, and dived with great white sharks. The problem for pathological liars is that their attempts to impress often backfire.

Instead of getting the love and attention they seek, they usually earn scorn and ridicule. A habit of lying can quickly ruin a person’s reputation and interfere with his ability to establish meaningful relationships.

We all lie, in many different ways, many times a day—mainly to avoid hurting ourselves or others. Experts believe that children figure out by the age of 4 that they can mislead others with lies. But what makes a person leap from social- or self-defense lying to habitual, compulsive lying? 

Why they lie

Some psychologists theorize that a chronic liar is trying to deceive herself as much as she is trying to deceive others. Because of poor self-esteem, she wants to believe her lies, and often does believe them, at least while she’s telling them.

Some of the hallmarks of pathological liars include telling outrageously dramatic stories, telling fibs that are easily disputed, changing stories when challenged and, most importantly, lying even when there’s no apparent benefit in telling the lie. Compulsive liars lie for many reasons, including no reason at all, but most often they lie to:

• Feel admired
• Gain popularity
• Control and manipulate
• Compensate for feelings of inadequacy and low self-esteem
• Cover up failures

Although not officially designated as a mental disorder, pathological lying is often seen as the tip of the iceberg for deeper psychological problems including narcissistic personality disorder, antisocial personality disorder, and obsessive-compulsive disorder. Narcissists, for example, constantly fear being revealed as frauds and, thus, weave ever-increasing lies to bolster their fragile self-esteem. People with antisocial personality disorder do not experience guilt and, therefore, lying becomes an easy option.

One psychologist came up with the term “double consciousness” to describe the ability of a habitual liar to carry two stories in his head at any time: the real story and the desired one. Some simply get addicted to the instant gratification associated with telling the desired, ego-boosting lie.

Other research indicates that many pathological liars have a neurological imbalance: Their verbal skills are high, but there’s a slight impairment in the frontal lobes, the part of the brain that censors speech. It has also been reported that children with such brain disorders as autism have a hard time lying successfully, further making a case for a physical connection.

Often, pathological lying masks problems related to childhood, including trauma, neglect, lack of attention, lack of guidance, or failure by parents to set realistic limits. Some researchers suggest that pathological liars often have parents who are pathological liars and that lying was part of the family dynamics.  

Help for problem liars

Understanding why a person lies all the time is key to solving the problem. In that way, pathological lying is similar to such other addictions as overeating, drinking, gambling, or shoplifting. What is the person trying to compensate for with his problem behavior, what needs is he trying to fill? To get to the root of pathological lying and to develop an appropriate plan of action, therapy is commonly recommended.

The first step, however, is for the person to admit she has a problem. If you would like to help a pathological liar, you should consult a mental health expert for guidance. An intervention in a proper setting with caring individuals may be in order.

Self-help steps for pathological liars include:

• Making a conscious decision not to lie
• Keeping a written record of all lies, even small ones
• Understanding the “why” behind each lie; for example, is the lie for self-promotion or pain/conflict avoidance?
• Seeking therapy

By Amy Fries

©2005-2019 Carelon Behavioral Health

Source: “A Highly Inflated Version of Reality: Researchers Challenge Notions About What Drives the Chronic Liar” by Benedict Carey, Los Angeles Times, March 3, 2003; “Knowing Why People Lie Is Positive Step by Doris Wild Helmering, St. Louis Post-Dispatch, Oct. 26, 1998; “Truth About Lies: They Tell a Lot About a Liar” by Richard A. Friedman, MD, New York Times, Aug. 5, 2003; “When Lives Are Spun from Skein of Lies” by Alison Bass, Boston Globe, June 6, 1988