In Sunday's episode of Girls, everything comes in eight for main character Hannah (played by Lena Dunham). Eight potato chips, eight times opening and shutting her front door, eight elbow bumps into a stranger's shoulder—once accidentally and then seven more times to complete the pattern. She doesn't want to do these things, she has to. Hannah's experiencing resurging symptoms of obsessive compulsive disorder (OCD), a condition she thought was 'cured' in high school.
Triggered by the stress and anxiety she feels about a looming e-book deadline, Hannah reluctantly admits to the psychiatrist her parents force her to see that she is repeating the same pattern—everything in eights—she did as a kid. Dunham, the show’s creator and head writer, actually had OCD when she was younger.
And she's not alone. It’s estimated that one in 100 adults—close to 3 million Americans—suffer from OCD, an anxiety problem characterized by uncontrollable, unwanted thoughts and repetitive, ritualized behaviors. The condition can develop at any time and affects both genders equally. Many people with OCD either don’t connect their behaviors to a neurological disorder or are too embarrassed to seek help. In fact, the International OCD Foundation estimates that it can take up to 15 years for sufferers to obtain the right treatment. Fortunately, this is changing as shows like Girls raise awareness of the problem.
What is OCD?
Research suggests that OCD may be the result of a communication breakdown in the brain involving serotonin. People with OCD have involuntary obsessions or recurring thoughts, images and/or impulses. “They develop compulsive behaviors in an effort to silence these obsessive thoughts,” says Eda Gorbis, Ph.D., director of the Westwood Institute for Anxiety Disorders in Los Angeles. For instance, a person who is obsessed about germs may compulsively wash her hands. Someone concerned about his family’s safety may constantly check to make sure doors are locked or that the stove is turned off.
While it's normal to occasionally worry about your loved ones or to make sure that you really did lock the car, problems arise when these thoughts and behaviors become pervasive, consuming hours of your day and negatively affecting your job, family and social life. “Someone with OCD may be chronically late because they have to check on something one more time,” says Gorbis. “The illness can strain families to a breaking point.”
OCD is often genetic, as Hannah angrily points out to her parents, and is widely understood. Shame may lead to OCD sufferers hiding their behaviors, Gorbis says. So getting help can be a challenge.
Mental health experts base OCD diagnoses on observations and symptoms. Antidepressants can reduce some OCD behaviors by 60 percent. But cognitive-behavioral therapy, specifically a strategy called Exposure and Response Prevention (ERP), often leads to the greatest success. “You confront your fear,” explains Gorbis. A compulsive hand washer might be asked to restrain from washing after touching the door handle in a public restroom. Customized assignments, such as answering questionnaires about how you’re feeling or writing in a journal, can help distract sufferers until the compulsive urge fades. ERP also incorporates mindfulness practices. The focus isn’t on getting rid of obsessive thoughts. “Instead, you learn to accept them without having to take action,” Gorbis says. Many OCD sufferers improve after four to six months of weekly ERP sessions. But because OCD is a chronic illness, relapses, sometimes triggered by a major life stressor such as divorce, death or job change, are always a possibility.
A version of this story originally appeared on iVillage.