OCD: What is Obsessive-Compulsive Disorder?

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OCD: What is Obsessive-Compulsive Disorder?




Guest:  Dr. Linda Austin – Psychiatry

Host:  Dr. Pam Morris – Department of Medicine


Dr. Pam Morris:  Hi.  I’m Dr. Pam Morris.  I’m here with Dr. Linda Austin, Professor of Psychiatry at the Medical University of South Carolina.  Linda, we hear a lot about these terms, obsessive, compulsive, different types of personality disorders, exactly, what do those terms mean?


Dr. Linda Austin:  It’s really confusing.  And this is a legacy we have from none other than Sigmund Freud.  Freud lumped together a lot of different symptoms and personality traits under the umbrella of Obsessive-Compulsive.  Now we know, based on research, that there are really two distinct entities.  There is so-called Obsessive-Compulsive Personality Disorder, and Obsessive-Compulsive Disorder (proper); two different things.


Dr. Pam Morris:  Now, what is the difference between a disorder and a personality?


Dr. Linda Austin:  Well, a so-called personality disorder basically means, this is the way your personality is, and has been, and will be for a long time.  When I was a medical student, I learned that personality disorders tend to be chronic.  The person says, well, this is the way I am, as opposed to, let’s say, a depression where the person will say, gee, I haven’t always been depressed, and now I’m depressed.  With a personality disorder, it’s the way they are, and it permeates all aspects of their personality.  That’s different from something like, let’s say, anxiety disorder or depression which are symptoms that come and go.


Dr. Pam Morris:  Now, if someone has a personality disorder, does that mean that it’s something that is not necessarily amenable to treatment or modification?


Dr. Linda Austin:  Well, let’s take obsessive-compulsive personality disorder as a good example.  That personality disorder has characteristics like being very rigid, very perfectionistic.  Those folks often have difficulty expressing warmth and tenderness and emotionality.  They always think they’re right.  They tend to be very orderly and punctual.  They’re rigid people.  Now, they’re good people to have if you want a good banker, maybe a good doctor, certainly, your rocket scientist had better have some of those traits.


But, on the other hand, sometimes those folks are very hard to live with because they’re always right and they have a hard time being flexible and a hard time showing emotion.  Yes, it can be treated, but not with a pill, not with medicine.  It has to be treated with, usually, long-term psychotherapy.  It takes some work, really, to modify your personality.


Dr. Pam Morris:  What, then, is an obsessive-compulsive disorder?


Dr. Linda Austin:  Well, OCD, or obsessive-compulsive disorder, is a symptom complex and it may come on very suddenly, so it’s not necessarily the way that person has always been.  There are so-called obsessions.  Obsessions are thoughts that are very intrusive and disturbing and, usually, the person knows that there’s something kind of nutty about the thought.  For example, you may have just washed your hands and had the thought, my hands are dirty.  And you may think, well, wait a second, I just washed my hands, or I just washed my hands five times in the last hour, but the obsessional thought comes back, yes, but they’re dirty.  That’s an obsession.  Or, maybe the obsession is, what if I didn’t lock the door, what if I didn’t turn off the stove?  That’s an obsessional thought. 


A compulsion is a behavior, let’s say, the handwashing when you think your hands are dirty, or the checking of locks; the checking of doors; that’s a compulsion.  And, sometimes obsessions and compulsions start early, in childhood, but the average age of onset is actually in one’s 20s.  So, these are symptoms that are superimposed upon a personality, and the personality may be quite normal.  The personality may not be the so-called obsessive-compulsive personality, or there may be some other personality disorder, or a normal personality, but the person just has these symptoms.


Dr. Pam Morris:  I would imagine that, in OCD, those symptoms would also be disturbing to someone.  They might perceive that they’re somewhat out of character for their usual personality?


Dr. Linda Austin:  Usually.  Now, that’s not always the case.  There is so-called obsessive-compulsive disorder where the person thinks that there may be some validity to what they think.  But, most of the time, the one suffering from it, and they truly do suffer, will say, I know it’s crazy, doc, but I just can’t get this out of my mind. 


Dr. Pam Morris:  Many of us have been accused from time to time of being obsessive or compulsive, keeping the house too neat, picking up socks after a husband, how do you know the difference between obsessive-compulsive personality and OCD?


Dr. Linda Austin:  The formal definition of OCD is that there are persistent recurring thoughts or behaviors that come up multiple times during the day, and there is, as I said, this nonsensical element to it that’s different from keeping your house clean.  Now, there can be some kind of border land in between those two.  For example, there are people who are so obsessional that they can’t get out of bed because they’re afraid that they will be contaminated when their feet touch the floor.  Or, I’m thinking of a woman I took care of who would lie in bed at night, her house was perfectly clean and neat, and if she heard a pinecone hit the roof, she had to run out, in the middle of the neat, and clean up her yard.  That’s really extreme.  We would call that obsessive-compulsive disorder.


And, you know, on the other hand, people with OC personality may generally be neat and tidy, not always; you can be OC about other things, but often times they are very neat or orderly, but there’s often a self-righteous quality about it.  OC personalities are difficult, sometimes, to be with because there is a sense of self-righteousness about it, as opposed to the OC disorder person who can say, you know, I know it’s nuts, but I just can’t get the thought of that pinecone out of my head.


Dr. Pam Morris:  Linda, are there available treatments for OCD, other than behavioral treatments or psychotherapy?


Dr. Linda Austin:  Well, there are, really, two therapeutic treatments for OCD, obsessive-compulsive disorder.  One is with medications, and the other is with a particular form of behavioral therapy.


Dr. Pam Morris:  Well, I’d like to come back again and discuss some of those forms of treatment.  Thank you for discussing OCD with us today.


Dr. Linda Austin:  Thanks.

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