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What are signs of OCD?

Watch our exert Dr. Benjamin Greenberg talk about some common symptoms of OCD.

My question is about OCD. I am the complete opposite of a hoarder, I clean my house constantly even when its not dirty. If one little thing is out of place it really bothers me, I like a clean house but I find myself not doing things like going out because I feel like I need to clean until my house is perfect. What causes this and what can I do about it? I've been this way all my life.

Cleaning, ordering and arranging are classic compulsions for people with OCD. OCD usually starts in childhood or adolescence. Although the cause is unknown, OCD, including the ordering/arranging subtype, runs in families and probably has a genetic component. A common motivation for those symptoms is "incompleteness," someone has to clean, order, arrange until it feels done "just right." There is no imagined harm they are trying to prevent, only a great deal of distress if they don't carry the compulsion to "completion," that is, until it "feels right." In behavior therapy, the sufferer is coached to delay cleaning, arranging, and gradually to avoid it entirely in situations when it is usually triggered. Often such symptoms are worse at home, and so some therapy might even be arranged to take place where the OCD is worst - at home. The goal is gradually reducing the distress associated with not cleaning/arranging. Medications may help reduce the distress associated with not performing the compulsions, and make the therapy easier. The first step is to consult a psychiatrist or behavior therapist expert in OCD.

I have diagnoses of major depressive disorder, severe panic disorder, and anxiety with possible personality disorder. My landlady thinks I'm a hoarder. I do let things pile up, but I think it's from the fatigue and lack of motivation caused by my depression and diabetes swings. What do you think about one vs. the other?

Many people who suffer depressive symptoms and/or fatigue "let things pile up." If the clutter is simply a product of a mood disorder or fatigue, then treating the underlying cause will result in having more energy so you will be able to organize and discard clutter. However, individuals with hoarding also have an attachment to possessions, difficulty with decision-making about their possessions, problems with organizing, and excessive acquiring. Even when their energy improves, they often procrastinate working on the clutter or are inefficient when they do so (e.g. moving piles from one space to another).

I have had chronic and severe OCD since childhood. Now I am 24 and having troubles with drugs because SSRIs make me hyper and fast while anaferanil makes me sleepy and drowsy. What should I do at this stage? I have also tried some mood stabilizers with SSRIs but the combination makes me slow.

It can take an uncomfortably long time to find the best combinations of medications for OCD in any single individual. And even the best medication regimen will have side effects. The combination of mood instability and OCD, which is not unusual, presents what can be a difficult problem, as you have experienced, since the anti-OCD SRI antidepressants can worsen mood instability. Many people, unfortunately, just have to keep trying to find the best combinations. In doing that, it is helpful to work with your psychiatrist to continue trying, and give any new medicine added to your regimen a trial that lasts long enough to be able to tell if the medicine is in fact helpful and if the side effects improve over time. Another important suggestion is to make sure you have had really good behavior therapy for OCD, which may result in the use of less medication over time. Consider looking into a behavior therapy-focused day treatment or residential treatment program for OCD, such as the OCD Institute at McLean Hospital outside of Boston, or other programs (see the International OCD Foundation website for a listing).

Are you working with Suzanne Haber, PhD, with the OCD study? She is with the University of Rochester.

Yes. Dr. Benjamin Greenberg co-directs the National Institute of Mental Health (NIMH) Conte Center for Translational Research on the neural network of DBS in OCD, with principal investigator Suzanne Haber at the University of Rochester. The Center studies anatomical, behavioral, and neuroimaging studies on mechanisms of action of psychiatric neurosurgeries and prediction of treatment outcomes. Dr. Greenberg leads a multicenter trial of deep brain stimulation (DBS) for intractable OCD at Butler Hospital, which collaborates closely with the Conte Center.

I abuse counting numbers. Why is that?

Counting is a classic compulsion for people with OCD. As with other behaviors that people with this illness feel compelled (the C on OCD) to perform, counting has two kinds of motivations—both irrational, and recognized as irrational by the OCD sufferer. One motivation is called harm avoidance, which means that the person counts to prevent something bad from happening, either to themselves, a loved one, or to somebody else. Of course there is no logical connection between counting (for example, the number of tiles in a floor), and preventing harm to someone. The other motivation is called incompleteness. That means that someone has to count until the behavior feels as if it has been done "just right." There is no imagined harm they are trying to prevent, only a great deal of distress if they don't carry the compulsion to completion, that is, until it "feels right." In behavior therapy for counting compulsions, the sufferer is coached to delay counting or not count at all in situations when counting symptoms are usually triggered. The goal is gradually reducing the distress associated with not counting.

I'm from Holland and I wonder if it's possible to enter a BDD therapy in your hospital? I suffer from BDD quite a lot. Could you send me information about the therapy? I can't find anything on the web. Could you also tell me about the costs of the therapy?

For specialized treatment in Body Dysmorphic Disorder (BDD), we recommend contacting Katharine Phillips, MD. She can be reached at (401) 444-1644 (USA). Dr. Phillips' Body Image Program is located in Providence, Rhode Island.

Is any research being conducted specifically around hoarding? Has it led to any new information regarding potential causes or treatments?

Over the last decade, researchers have specifically focused on hoarding. This has led to a much better understanding of hoarding, including the perspective that hoarding can be a separate syndrome (vs a symptom of another psychiatric problem such as OCD or OCPD). From those results, new treatments are emerging such as a hoarding-specific cognitive behavioral therapy protocol developed by researchers Gail Steketee and Randy Frost.

We don't understand the relationship between OCD and hoarders. OCD people seem fanatically neat and orderly or collect lots of the same kinds of things. But there doesn't seem to be a rhyme or reason for the stuff hoarders accumulate, like just tons of everything and anything, garbage, germy stuff, animals.

Individuals who suffer compulsive hoarding may or may not have OCD. In fact, the majority of individuals with hoarding do not have other OCD symptoms. However, some do have obsessive compulsive personality disorder. This is a condition characterized by a preoccupation with orderliness, extreme attention to detail, perfectionism, and rigidity. When these symptoms are paired with the hallmark symptoms of hoarding (excessive acquiring, difficulty discarding, trouble with organizing), then you see massive amounts of miscellaneous items that do not appear to have any "rhyme or reason".

How do you begin to get help for someone who hoards?

Visit our hoarding page for a list of treatment resources ranging from self-help interventions (books and online support groups) to treatment providers to other helpful websites, like the OCD Foundation.

Are there any vitamin supplements out there that are known to be good for OCD or any research being done in that area?

There is not much good evidence that supplements are helpful for OCD. Low vitamin D levels might be associated with depression, which commonly occurs with OCD. Since during a depressive episode obsessions and compulsions can get worse, it is worth having your vitamin D level checked once (via a blood test). N-acetyl cysteine, or NAC, an antioxidant supplement mainly known as an antidote to Tylenol poisoning, has been tried in a few cases. NAC is inexpensive and well-tolerated, but the evidence that it helps OCD is extremely thin so far.

If any supplements eventually prove to be helpful in OCD, it is highly likely that they will need to be added to standard behavior therapy and medications for OCD, not instead of those proven treatments.

I understand how cognitive behavioral therapy (CBT) can be used to challenge thoughts and change the way we think when dealing with negative thoughts about self-worth, achievement, etc. But, how does the CBT approach work with OCD since the actual thoughts in themselves are not 'rational' and so cannot be engaged with in a logical way.

Since the key approach in treating OCD is behavioral (changing what you do) rather than cognitive (changing what you think), that the thoughts are illogical (by definition true of OCD) is not the key issue. The therapy is called "exposure and response prevention," exposure to an OCD-triggering situation with the OCD sufferer "coached" to avoid engaging in the response—the compulsion that would be triggered.

Over time, people who respond to this therapy find that the urge to engage in compulsive rituals has lessened, and later the thoughts do too. Other people need medications, often used in combination with behavior therapy, which lessens the emotional impact of an obsessive thought or compulsive urge, enabling resistance to ritualizing.

Is someone who was "once a hoarder always a hoarder?" I am, I guess, a "recovering hoarder" and am wondering if this is something I'm going to have to guard against throughout the rest of my life.

Hoarding is usually a chronic, life-long problem. It's great that you've recovered! And, it is best to look for signs or "red flags" that the problem may be returning such as piles of clutter or excessive acquiring and intervene early. We also offer a free monthly support group on compulsive hoarding at Butler Hospital, which may be helpful to attend in order to stay in recovery.

Are there times in life when OCD (or OCD-like behavior) is more likely to occur?

OCD symptoms typically begin in childhood or adolescence (these cases seem more likely to run in families). In another group, symptoms begin in early adulthood. In much smaller number of people, symptoms begin later in life. In addition, some people are "gainers," that is they have OCD symptoms only when they are suffering with an episode of clinical depression. A higher proportion are "keepers," which means that they have OCD whether they are clinically depressed or not, although the OCD symptoms might get worse during a depression compared to before the depressive episode began. There is a lot of unnecessary stuff piled up in areas around my parent's house, but I'm not sure it would be considered hoarding. If it doesn't look as bad as it does on TV, is it possible there is still a problem that requires professional intervention?

People who have a hoarding problem usually have difficulties in three areas: collecting or acquiring too many items, letting go of items, and organizing their possessions. We usually recommend professional intervention when the clutter prohibits or limits use of living spaces (e.g. using appliances or rooms for the intended purposes), interferes with day-to-day living, results in significant distress, or poses safety and/or health concerns.

Is "hoarding" an actual clinical diagnosis?

Compulsive hoarding syndrome is being proposed as a separate clinical diagnosis in the upcoming DSM-V (Diagnostic and Statistical Manual of Mental Disorders). Currently, hoarding is listed in the DSM-IV as a symptom of obsessive compulsive personality disorder and is also consider a symptom subtype of obsessive compulsive disorder. Do you see OCD symptoms and diagnoses among pregnant and postpartum women?

Yes, this is not uncommon. In fact, postpartum OCD has even been reported in the fathers of newborns. Legal Disclaimer: Responses to questions should not be construed as medical advice or treatment. Readers should not rely on the information contained on this web page for diagnosing or treating any illness, condition, or disorder. If emergency medical or mental health care is needed, call 911 or go to the nearest emergency room. Neither Butler Hospital nor the authors of the answers are responsible for how readers use the information.