Obsessive Compulsive Disorder

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Treatment spectrum: Obsessive-compulsive disorder

About two to three percent of all people will develop obsessive-compulsive disorder at some point in their lives. Among them are many celebrities: “Whenever I’m stressed, I have to think the same thought over and over again because I’m afraid that something bad will happen otherwise,” singer Camila Cabello tells “Cosmopolitan” magazine. Mamma Mia star Amanda Seyfried has also spoken openly about her obsessive-compulsive disorder and explains that she has been treating it with antidepressants for over eleven years.


What is obsessive-compulsive disorder?

Obsessive-compulsive disorder is a serious mental illness. Those affected feel compelled to carry out unwanted actions and rituals on a recurring basis and/or constantly think negative and threatening thoughts. The disease usually begins around the age of 20, but the first symptoms can also appear in puberty or childhood. Even healthy people can experience temporary compulsions. For example, many people have experienced anxious thoughts cropping up after leaving the house, such as: “Did I turn off the coffee machine, turn off the light and lock the door, etc.?” Even though you are well aware that you have done everything, the urge to look again anyway persists for a short time. Most people are able to calm down in these situations and very few actually turn back.


More than just a quirk …

Even people with obsessive-compulsive disorder usually know that their obsessive-compulsive thoughts are unrealistic and exaggerated, or that their compulsive actions are not helpful or even harmful. Unlike healthy people, however, they do not manage to evade coercion. As soon as they try to stop the unwanted rituals, they feel very strong pressure, which they are unable to endure in the long run. Therefore, in order to reduce the internal pressure they are feeling, they soon let the harmful thoughts and actions back in. Even though they are contradicting their own understanding and often feel downright embarrassed, they find themselves forced to repeat arising obsessions and compulsive actions over and over again in a stereotypical manner several days a week or even several times a day, often for hours at a time. This creates a vicious circle that is extremely agonising for those affected and puts an enormous strain on the everyday life, well-being and performance of the sick person.


How does obsessive-compulsive disorder manifest itself?

Obsessive-compulsive disorder can show up either through obsessive thoughts or compulsive acts. Most of the time, these obsessions and compulsions occur together. Depending on which symptoms are in the foreground, obsessive-compulsive disorder is divided into three different categories:


Obsessive-compulsive disorder: Significant indications

– Predominantly obsessive-compulsive thoughts or compulsion to brood

– Predominantly compulsive acts

– Combination of obsessive thoughts and compulsions


Obsessive-compulsive disorder predominantly with obsessive-compulsive thoughts or compulsion to brood

This form of obsessive-compulsive disorder is mainly characterised by the occurrence of recurring, usually vivid obsessive-compulsive thoughts that literally impose themselves. Obsessive-compulsive thoughts are usually negative, tormenting and unsettling for those affected. They often come in the form of thought loops. In this context, there is talk of a compulsion to brood. Obsessive-compulsive thoughts are usually experienced personally by those affected. They are often very aware how meaningless and useless these thoughts are. Nevertheless, those suffering are unable to free themselves from it. This can result in an inability to make even simple, everyday decisions because all potential as well as completely irrational alternatives must first be weighed up.


Symptoms: Examples of obsessive-compulsive thoughts

Obsessive-compulsive thoughts are typically disturbing and threatening and often contrary and completely inappropriate to the situation in which the person currently finds themselves. In particular, intellectual impulses to act are often perceived as extremely frightening, but are usually not carried out.

Typical examples of obsessive thoughts or compulsive impulses are

  • Sexually aggressive, obscene or “dirty” thoughts when visiting your in-laws or during an interview.
  • Blasphemous thoughts in church.
  • The thought of accidentally hurting or even killing your loved one or child.
  • The thought of exposing yourself in public or doing something else embarrassing.
  • The mental fear of getting dirty and then carrying this dirt with you.
  • Mentally reciting certain numbers, colours, etc. for hours at a time, believing it will bring good luck or ward off disaster.
  • Thinking of certain verses, sentences, sayings, songs in the plane, bus, etc. so that the vehicle does not have an accident.


Obsessive-compulsive disorder predominantly with compulsive acts

Obsessive-compulsive disorder can also be characterised by recurring rituals and actions that the sick person is unable to escape from. Typical examples are:


  • Compulsive washing or cleaning

Out of a fear of possible infections, those affected wash their hands with soap many times a day, shower several times a day, scrub their skin with hard brushes, constantly wash themselves and change clothes, continuously clean the apartment, disinfect doorknobs, work surfaces, objects, etc.

  • Compulsive order

Objects have to be arranged, set up or put together in a very specific order or pattern. This can be according to size, colour, number, topic, symmetry, etc. and is checked regularly and constantly readjusted.

  • Compulsive control

Constantly rechecking whether the door is locked, the windows are closed, all electrical devices are switched off, no water tap is dripping, etc.

  • Compulsive collection

Out of a fear of throwing away something important, all things, even those that are worthless and rubbish, are hoarded. If something is thrown away, there is often a strong urge to search the rubbish bins to make sure that it was not something important.

  • Compulsive repetition and neutralisation

In order to avert possible dangers, disasters, etc., certain actions have to be repeated over and over again a certain number of times and following a specific procedure. As such, this is supposed to help neutralise an impending danger. For example, it can be forbidden to touch certain tiles, stones, grains, etc.


Obsessive-compulsive disorder with combination of obsessions and compulsions

In more than 90 percent – i.e. in the vast majority of cases – obsessive thoughts and compulsive actions occur together. This means that the majority of all patients suffer from an obsessive-compulsive disorder, involving tormenting obsessive-compulsive thoughts as well as stereotypical compulsive actions.


Obsessive-compulsive disorder: Effects on everyday life

Obsessive-compulsive disorder is not the quirks of some people who may be a little superstitious, very clean, or particularly tidy. Obsessive-compulsive disorder is a very serious illness where people are no longer able to control their thoughts and actions even though they want to and therefore suffer badly. It is not uncommon for people who are ill to unintentionally spend several hours a day performing compulsive acts and dealing with obsessive thoughts. On the one hand, this puts a strain on everyday life and the performance of the sick person, but it also has massive effects on their social environment, i.e. parents, partners and children, etc. A “normal” life is usually no longer possible in the long term, with close family members withdrawing at some point and marriages breaking up. The vast psychological and social effects are usually also joined by physical symptoms. This can lead to severe skin diseases, especially when compulsive washing and cleaning is involved.


Causes of obsessive-compulsive disorder

The exact causes of obsessive-compulsive disorder have not yet been clearly identified. However, there are certain factors that are known for having a major contribution to the development or continuation of obsessive-compulsive disorder. Usually, several components have to come together for OCD to develop. The weighting of the individual causes is different for each individual. Important risk factors for developing obsessive-compulsive disorder are:


  • Genetic traits

Research shows that heredity plays a role in the development of obsessive-compulsive disorder. Although the disease is not passed on directly, the risk of a child suffering from OCD has been shown to increase if one parent or both parents suffer from OCD. This has also been confirmed by results from twin research.

  • Neurobiological characteristics

Imaging tests also found that brain metabolism and brain activity in certain areas of the brain noticeably increased in people with obsessive-compulsive disorder. In particular, abnormalities could be detected in the basal ganglia, which are responsible, among other things, for motor processes. In addition, the serotonin balance also appears to be disrupted.

  • Family characteristics

The environment a person grows up in has a strong impact on the development of their personality. A parenting style with high demands on performance, strong evaluation patterns and perfectionist demands, but also a highly cautious parenting style in which the child is overprotected and constantly warned of possible dangers can contribute to the development of obsessive-compulsive disorder.

  • Trauma as a risk factor

Other important risk factors for the development of obsessive-compulsive disorder are experiences of trauma and mental overload. Highly stressful events such as violence, abuse, rape, the death of a loved one, etc. can throw a person off course and usually lead to a great deal of insecurity. Understandably, there is also an increased desire for control and security. Performing “protective” and “neutralising” or “cleansing” compulsions and rituals can then convey a sense of control over a situation where the person would otherwise feel helpless.

  • Personal qualities

Last but not least, the individual personality structure naturally also plays a role in whether a person develops an obsessive-compulsive disorder. People who are by nature fearful, over-sensitive and less resilient have a higher risk of developing obsessive-compulsive disorder than those with self-confident and calm personalities.


Common comorbidities of obsessive-compulsive disorder

Obsessive-compulsive disorder very often occurs together with other mental as well as dermatological diseases. The most common comorbidities associated with obsessive-compulsive disorder include:


Depressive moods and depression

Eating disorders

Anxiety disorders

Social phobias

Post-traumatic stress disorder

– Dermatillomania and trichotillomania

These are impulse control disorders in which the sufferer repeatedly scratches, presses and injures their skin – also called “skin picking” – or tears out their hair, eyebrows and eyelashes.

– Body dysmorphic disorder

This is a distorted perception of the body in which a minor anomaly is assessed in a distorted way and there is an excessive preoccupation with the imagined deficiency.

– Atopic dermatitis and other skin diseases

Chronic inflammatory skin eczema occurs especially with compulsive washing due to constant over-irritation of the skin.


What therapies are available for obsessive-compulsive disorder?

People with OCD know that their thoughts, actions, and rituals are irrational, but cannot turn them off themselves. They are therefore usually very ashamed of them and try to hide and cover up their suffering from others as best they can. Obsessive-compulsive disorder is therefore often diagnosed very late. On average, it takes 10 years for patients to seek professional help – but sometimes even as long as 20 to 30 years. Often, it is not even the obsessive-compulsive disorder itself, but an accompanying illness, such as severe dermatitis, that causes those affected to see a doctor. At this stage, the disease has usually already become entrenched and the symptoms have increased significantly in number and severity.


Complex causes require multimodal treatment on several levels

As with most medical conditions, if you have OCD, it makes sense to treat it as early as possible. However, even at an advanced stage, very good therapeutic successes can still be achieved. A multimodal approach – which combines various particularly tried and tested therapeutic options – has proven particularly effective. This is because this way allows the many different possible causes to be approached with particular sensitivity and the patient to be reached and supported in the best way at every stage of treatment and at different levels. In addition, all individually possible physical deficits and imbalances can be identified and compensated for, and all comorbidities can be treated professionally.

Current therapies for the treatment of obsessive-compulsive disorder have so far primarily involved the use of psychotherapy and psychiatric drugs.


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