Understanding Co-occurring Disorders in OCD

In this article, I want to look at the relationship between Obsessive-Compulsive Disorder (OCD) and co-occurring mental health conditions, also known as comorbidity. I shall start by explaining how OCD often coexists with other disorders like anxiety, depression, and substance use and try to outline some of the reasons why this happens including shared genetic and neurological factors, the stress associated with OCD, and the use of compulsions as coping mechanisms. An important aspect and my main reason for writing this article is how comorbidities can affect the treatment you receive for OCD, highlighting how it is crucial that all of your mental health conditions are treated, not just the OCD and to help you do this I shall include a section at the end of how to seek professional help.

Obsessive-Compulsive Disorder (OCD) is a complex mental health condition that involves persistent, intrusive thoughts (obsessions) and repetitive behaviours or rituals (compulsions) performed to alleviate anxiety. I won’t go into any more detail explaining OCD, as I have already covered the condition in this article. If you want to read more on the condition, I recommend starting with the following articles.

What Are Co-occurring Disorders?

A co-occurring disorder, also known as comorbidity or dual diagnosis, refers to the presence of one or more additional mental health conditions alongside a primary diagnosis. For example, let’s say your doctor referred you to my clinic for treatment for OCD, but during our assessment, we also found out you had an anxiety disorder, this would mean that you have a dual diagnosis; OCD and anxiety, with your primary disorder being OCD. Going forward we would devise a treatment plan that focuses on your OCD and anxiety disorder. For individuals with OCD, it’s common to experience other mental health challenges that can complicate both daily functioning and treatment. These additional disorders can develop due to shared underlying mechanisms or as a result of the stress and strain that living with OCD often entails.

For example, consider a person who spends hours each day checking and re-checking their locks to the point where they’re unable to leave the house on time for work. The frustration and anxiety caused by these compulsions might lead to symptoms of depression, creating a cycle of mental health difficulties.

Common Co-occurring Disorders with OCD

Several mental health conditions commonly co-occur with OCD. Here are the most frequent ones:

1. Generalised Anxiety Disorder (GAD)

Generalised Anxiety Disorder involves chronic, excessive worry about various aspects of life. This can overlap significantly with OCD, where individuals not only worry about specific obsessive thoughts but also feel generalised anxiety about everyday situations. A person with OCD and GAD might find themselves fixated on intrusive thoughts about cleanliness while also experiencing persistent anxiety about their job, relationships, or finances.

2. Depression

Depression is one of the most common co-occurring disorders with OCD. The emotional toll of dealing with obsessive thoughts and compulsions can lead to feelings of hopelessness and despair. For instance, someone who feels overwhelmed by their inability to control compulsions might become discouraged and start to believe that things will never improve, leading to clinical depression. The cycle of guilt, frustration, and helplessness feeds both the OCD and the depression.

3. Panic Disorder

People with OCD may also experience panic disorder, characterised by sudden, intense episodes of fear (panic attacks). A person might obsess over the fear of having a panic attack in public, which can then become a self-fulfilling prophecy as the fear itself triggers the panic.

4. Body Dysmorphic Disorder (BDD)

Body Dysmorphic Disorder involves an intense preoccupation with perceived flaws in one’s appearance. While BDD is technically a separate condition, it shares many similarities with OCD in terms of obsessive thoughts. For example, someone with both OCD and BDD may fixate on a minor imperfection in their appearance and develop elaborate rituals, such as repeatedly checking mirrors or seeking reassurance from others.

5. Attention Deficit Hyperactivity Disorder (ADHD)

Individuals with ADHD may struggle with attention, hyperactivity, and impulsivity, which can exacerbate OCD symptoms. The constant need to check, organise, or perform rituals can make it difficult for someone with ADHD to stay focused on other tasks. An individual with both disorders might find themselves caught in a loop of distractions and compulsions, hindering productivity at work or school.

6. Eating Disorders

Eating disorders, such as anorexia nervosa and bulimia nervosa, can co-occur with OCD, particularly when the individual’s obsessions revolve around body image or food. In such cases, the compulsions might manifest as restrictive eating behaviours or obsessive exercise. A person might be driven by intrusive thoughts about weight gain, which fuels both the eating disorder and the OCD.

7. Substance Use Disorders

Unfortunately, some individuals with OCD turn to alcohol or drugs to cope with their intrusive thoughts and compulsions. Substance use may offer temporary relief but ultimately exacerbates OCD symptoms, creating a vicious cycle that can be difficult to break. The use of substances as a form of self-medication is particularly concerning as it can interfere with treatment and recovery.

Why Do Co-occurring Disorders Develop in People with OCD?

There are several reasons why people with OCD often develop additional mental health conditions:

  1. Shared Genetic and Neurobiological Factors
    OCD and many co-occurring disorders, such as anxiety and depression, share common genetic and neurobiological roots. These shared factors make it more likely that someone with OCD will experience other mental health challenges.
  2. The Stress of Living with OCD
    The relentless nature of obsessive thoughts and compulsive behaviours can lead to chronic stress, which in turn increases the risk of developing conditions like depression or generalised anxiety disorder. The constant pressure to perform rituals to prevent feared outcomes can leave individuals feeling emotionally drained.
  3. Compulsions as Coping Strategies
    In some cases, people with OCD use their compulsions as a way of coping with other stressors. However, when the compulsions become overwhelming or fail to reduce anxiety, this can lead to the development of other disorders, such as substance use disorder or depression.

How Co-occurring Disorders Impact the Treatment of OCD

This, for me anyway is the most important part of this post, and as I said at the beginning, the reason why I choose to write this article today; how having a dual diagnosis affect your treatment. Throughout the course of my 20 year career as a psychologist, I appreciate the importance of recognising and helping a person with all of their presenting concerns. For example, your treatment may not be as successful, or not succeed at all, if your therapist focusing solely on OCD and applies all the principles of treatment by the book but fails to see the impact that your alcohol consumption has. You might drink purely to relieve that anxiety related to your OCD, and this coping mechanism needs to be addressed delicately at in addition to treating your OCD.

Treating OCD on its own is challenging enough, but when co-occurring disorders are present, treatment becomes even more complex. For instance, depression or substance use can significantly impact a person’s motivation to engage in therapy. Moreover, some co-occurring disorders, such as ADHD, may interfere with the individual’s ability to participate fully in therapeutic activities like Exposure and Response Prevention (ERP), a core component of Cognitive Behavioural Therapy (CBT) for OCD.

It’s crucial that treatment for OCD and any co-occurring disorders be integrated. A multidisciplinary approach that addresses both conditions is essential for successful outcomes. Here’s how co-occurring disorders might affect the treatment process:

  • Depression and Anxiety: Individuals with both OCD and depression may need antidepressant medications, such as SSRIs, alongside therapy like ERP. These medications can help to regulate mood, making it easier for patients to engage in their OCD treatment.
  • Substance Use: If substance use is part of the picture, addiction treatment will need to run concurrently with OCD treatment. In the USA, organisations like the Substance Abuse and Mental Health Services Administration (SAMHSA) offer resources to help individuals access integrated care for both addiction and mental health.
  • ADHD: For people with ADHD, medications like stimulants may be used to improve focus, while behavioural therapy helps them manage their compulsions.

Recognising Co-occurring Disorders

It can be difficult to recognise when additional disorders are present alongside OCD, especially when the symptoms overlap. However, some key signs can help you identify co-occurring conditions:

  • If you find that your compulsions are driven by broader anxieties about your daily life, this could be a sign of generalised anxiety disorder.
  • Feelings of hopelessness, lack of motivation, or difficulty enjoying previously pleasurable activities may indicate depression.
  • The urge to use alcohol or drugs to cope with OCD symptoms could be a sign of a substance use disorder.

For example, imagine a university student who develops OCD related to academic performance, leading to hours spent rewriting notes or perfecting essays. Over time, this student might begin using alcohol to “wind down” after a long day of compulsions. What begins as casual drinking could develop into dependence, further complicating the management of both disorders.

Seeking Help for OCD and Co-occurring Disorders

If you or a loved one are struggling with OCD and suspect you may have a co-occurring disorder, it’s important to seek professional help. In the USA, resources such as the National Institute of Mental Health (NIMH) and the Anxiety and Depression Association of America (ADAA) provide valuable information on finding the right support. In the UK, organisations like OCD-UK and Mind can connect you with specialist services and support groups.

Conclusion

Co-occurring disorders are common in individuals with OCD, but with the right treatment approach, it’s possible to manage both conditions effectively. Addressing all aspects of mental health, including co-occurring disorders, is key to a successful recovery. If you think you or someone you know is experiencing co-occurring disorders with OCD, reach out to a healthcare professional for guidance and support.

For more information on co-occurring disorders and how to get help, visit OCD-UK or NIMH for resources tailored to your region.

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