A comprehensive guide to Checking OCD

Checking OCD is a type of OCD that is characterized by obsessions and compulsions that revolve around checking things over and over again.

According to clinical research, this is the most common form of OCD with 80% of OCD patients engaging in checking-related compulsions.

The aim of this guide is to provide you with useful information about Checking OCD, namely how it can be treated, what the causes are, and more.

How many people have Checking OCD?

It is common knowledge in psychological/psychiatric academia that about 2-3% of the general population suffers from some kind of OCD; as 4 in 5 OCD patients have checking-related obsessions and compulsions, it can therefore be assumed that ~1.6-2.4% of the general population suffers from Checking OCD.

This, of course, is the rough estimate of how many people have a clinically diagnosable form of the disorder; however, there are many more people who have a subclinical (less intense/distressing) type of Checking OCD.

What causes Checking OCD?

One current view in science about checking-related compulsions involves something called the memory deficit hypothesis – that the problem lies in an impairment in autonoetic consciousness, which is “the sense of self we experience when recalling a memory from our life“.

In other words, the cause might be an inability or a difficulty for the sufferer to mentally relive or chronologically recall the things they have done in the past.

One study from 2004 found that there are certain areas of the brain that show more activity than usual in relation to checking compulsions (specifically – the putamen/globus pallidus, thalamus, and dorsal cortical areas).

Another more general answer is that it can be the result of inflammation within the brain’s neurocircuitry.

Examples of Checking OCD

These actions are often repeated over and over:

• making sure that the oven is turned off before leaving the house

• checking whether all the doors in your house are locked

• checking whether the refrigerator door is open

• checking whether the lights are turned off before leaving the house

• checking whether you locked your car

• verifying that you’ve packed the correct items when going on a trip

• verifying that you didn’t make any mistakes while doing something (e.g. math homework)

How can Checking OCD be treated?

Specifically, in regards to checking-related obsessions and compulsions, it can be very helpful to receive formal training on the usage of prospective memory, which, if the memory deficit hypothesis is true, could be an excellent way to help the sufferer train themselves to remember that they have indeed already checked something, which reduces the need for further compulsive checking.

In more general terms, the most common and demonstrably effective form of treatment for OCD is something called CBT (cognitive behavioral therapy), which has a 70% response rate according to a 2016 meta-analysis of 25 randomized/controlled trials on CBT.

Another excellent option is ERP (exposure and response prevention), which has been shown to usually result in a 50 to 60% reduction in symptoms on the Y-BOC (Yale-Brown Obsessive Compulsive) scale; this type of therapy has also shown to work long-term and ERP’s effect is likely to stick after treatment is completed.

If the previous options do not work, then one can also try certain medications; quite often the most typical sort of medications one gets prescribed for moderate or severe OCD are SSRIs (selective serotonin reuptake inhibitors), which are the most common type of antidepressant. For OCD, the first-line medications from this category are escitalopram (Cipralex), paroxetine (Paxil), sertraline (Zoloft), fluvoxamine (Luvox/Fevarin) and fluoxetine (Prozac). Sometimes, your psychiatrist will choose to prescribe clomipramine (Anafranil), which is also an antidepressant, although it is not in the SSRI category, as it is instead a tricyclic antidepressant.

“TR-OCD” – what if my Checking OCD is treatment-resistant?

In some cases, one’s Counting OCD may not yield to first-line treatments; this is often abbreviated/referred to as “TR-OCD” (Treatment-Resistant OCD). As a result, it may be reasonable to explore other options, such as:

• An SSRI-type antidepressant in combination with an antipsychotic (neuroleptic) medication – for example, the combination of aripiprazole (Abilify) with an SSRI in a 2010 study with 12 patients showed efficacy in terms of significantly reducing OCD symptoms on the Y-BOC (Yale-Brown Obsessive Compulsive) scale. However, some antipsychotic medications have not been found to be more effective than placebos, such as quetiapine (Seroquel) or olanzapine (Zyprexa).

• Electroconvulsive therapy – this is a type of intervention that involves electrical stimulation of the brain under an anaesthetic; it is known to be relatively safe, and there have been positive results in some studies for treating OCD, such as this one from 2021.

• Deep Brain Stimulation (DBS) – a last resort, yet often highly effective treatment for patients who suffer from severe treatment-resistant OCD, is something called DBS – it involves the introduction of a device (similar to a pacemaker) to deliver frequent electrical stimulation to specific areas of the brain. DBS, specifically focused towards the ventral/capsule/ventral striatum areas of the brain, is approved by the FDA for treating OCD in patients whose symptoms have not yielded to treatment. This type of treatment has been shown to be quite effective; however, there can be side effects or risks with DBS (such as seizures, infections or hemorrhages) – this means that caution, proper clinical consultation and awareness is required before proceeding with this treatment.

• Ablative surgery – This is another treatment, and it is seen as being equally as effective as DBS (yet having fewer adverse side effects). The term “ablation” derives from the Latin word for “carried away” (“ablatus“; the “ab-” part meaning “away”, and “latus” meaning “carried”). There are several types of ablative surgery, such as the capsulotomy, cingulotomy and subcaudate tractotomy, which are all aimed at creating a lesion (a cut) in a specific part of the brain.

What is the Y-BOC (Yale-Brown Obsessive-Compulsive) Scale?

The Y-BOCS, often considered the gold standard scale for determining the severity of OCD symptoms, is essentially a clinical interview that’s been constructed on the basis of current clinical evidence and diagnostic manuals. The interview is built to measure both a person’s compulsions as well as their obsessions.

There are other scales that are occasionally used, such as the GAF (Global Assessment of Functioning) scale and HAM-A (Hamilton Anxiety Rating Scale), but these are not considered as effective for quantifying a person’s obsessive-compulsive symptoms.

Is Checking OCD ego-dystonic or ego-syntonic, and what does that mean?

Most forms of OCD in general are ego-dystonic, which essentially means that a person’s compulsions and obsessions are unwanted, anxiety-inducing and caused by intrusive thoughts.

However, an ego-syntonic manifestation of obsessions and compulsions is called Obsessive-Compulsive Personality Disorder (OCPD); this essentially means that you feel like your thoughts are “true” and a representation of who you really are, and that they are rational.

Talk to other people about Checking OCD

You can check out our community forum where we have an actual subcategory for Checking OCD; here you can engage with other people and talk to them about experiences, treatments and so on!