Obsessive-Compulsive Disorder (or OCD) is a psychiatric condition that, according to the National Institute of Mental Health, affects an estimated 2.3% of the American adult population. It is classified in the DSM-V as an Anxiety Disorder.

Because OCD is characterized by obsessive thoughts and compulsive behavior, many people jokingly claim to have it, but clinical OCD is no joking matter. It is perfectly natural to become hung up on a lingering thought that causes mild discomfort. Even ritualistic behaviors can be considered a natural phenomenon since humans have been performing rituals since our beginning. However, minor obsessions and compulsions do not always equate to Obsessive-Compulsive Disorder. The disorder itself is a challenging and distressing part of life for those who suffer from it, so the struggles of those with OCD should be validated and recognized as more than vague identification with symptoms that we all exhibit at one time or another. Just because you like to drink your coffee from a specific mug or prefer the TV volume on an even number does not mean that you have Obsessive Compulsive Disorder.

What are Obsessions in OCD?

According to an article published in the British Journal of School Nursing by Katie Lang of King’s College London’s Department of Psychology, obsessions are “intrusive thoughts, images, or impulses that are experienced as repetitive and unwanted.”^[1]

These obsessions may center on rational subjects like contamination and personal safety, but the sufferer becomes distressed due to the high intensity of the thoughts. Volz and Heyman, in an article published in 2007 in The Journal of the American Academy of Child & Adolescent Psychiatry, also point out that obsessions can be “bizarre, senseless or magical.”^[2]

Common obsessions include^[3]:

• fears about germs and contamination
• excessive worry about disease, illness, or dirt
• harm-based fears concerning themselves or loved ones
• fears about hurting other people
• distressing or disturbing sexual thoughts (especially in adolescents)
• a need for perfection, symmetry, or order.

What are Compulsions in OCD?

According to Lang, compulsions are “repetitive or stereotyped (ritualistic) behaviours, performed in order to neutralise an obsessional fear, and therefore release anxiety.”^[4]

Common compulsions include^[5]:

• extreme hand washing/cleanliness
• checking behaviors (pockets, appliances, switches, etc)
• repeating tasks over and over
• arranging items in a highly detailed fashion
• tapping/touching
• counting
• repeating a behavior until it feels right

Rational and Irrational

The “magical thinking” mentioned in Volz and Heyman’s 2007 article is a motivator to complete or repeat a certain action that differs from some of the more rational obsessive thoughts that drive behavior, in that there is no reason or evidence to support the relationship between the thought and the action.

Let’s use a common example. Excessive hand washing is a compulsion that results from an obsessive fear of germs or contamination, which can indeed cause illness to the individual. Therefore, there is at least a small element of rational thinking, despite the extreme intensity of the thought. However, “magical thinking” and the compulsions that follow have no real connection. I have worked with clients who have suffered from hand washing to the point that their hands are chaffed and bleeding, and yet washing, as painful as it is, becomes the only way to mitigate their anxiety. The compulsive behavior continues despite the negative consequences.

Another example of magical thinking would be a person who is compelled to open and close their car door a specific number of times because they fear that failure to do so would cause the car to crash. Many sufferers who experience this type of thinking are aware that it is irrational but would rather not risk finding out whether or not the connection is real.

Causes of OCD

There is currently no verified cause of OCD, but its onset and development are believed to be linked to:

• family history (the disorder is present in a relative)
• brain chemistry (higher activation in some areas when compared to activation in a “normal” brain’s serotonin levels)
• significant life events (e.g., a traumatic experience, premature responsibility)

What OCD is Not

Sometimes OCD is confused with Obsessive-Compulsive Personality Disorder (OCPD), which involves a preoccupation with perfectionism and control in almost every part of a person’s life.^[6] A person living with OCPD will be inclined to keep their space in a tidy, orderly state and feel more comfortable when things are symmetrical or in alignment. Such a person might expend great energy and time in cleaning their home or on their personal hygiene. While disturbing the orderly spaces of people living with OCPD annoys them and elicits discomfort, their reactions are nowhere near as overwhelming as the sense of anxiety  people with OCD feel when they are disturbed or triggered.

People with OCPD are often far more tolerant of their condition than someone with OCD because individuals with OCPD are able to manipulate their environment to appease their needs/preferences through structure and order.

With OCD, the sufferer gains no satisfaction or enjoyment from their compulsions. Compulsions are merely a means of dealing with uncontrollable and overwhelmingly disturbing or unsettling thoughts and fears that take over their minds.

How is an Obsessive-Compulsive Disorder Diagnosed?

In order to be clinically diagnosed with Obsessive-Compulsive Disorder, an individual must meet the diagnostic criteria outlined in the latest version of the Diagnostics and Statistics Manual, the DSM-V.

According to DSM-V, obsessions constitute^[7]:

1. Recurrent and persistent thoughts, urges, or images that are experienced as intrusive and unwanted, and that in most individuals cause noticeable anxiety or distress.
2. Attempts to ignore or suppress obsessive or persistent thoughts, urges, or images, or to neutralize them with a thought or action (e.g., by performing a compulsion).

Compulsions are defined by the DSM-V as^[8]:

1. Repetitive behaviors or mental acts (e.g., praying, counting).
2. Behaviors or mental acts that are aimed at preventing or reducing distress or preventing some dreaded event or situation.
3. Time-consuming obsessions or compulsions (i.e., take more than 1 hour per day).
4. A disturbance which is not better explained by the symptoms of another mental disorder.
5. A disturbance that is not due to the direct physiological effects of a substance.

Don’t Suffer in Silence

If you believe that OCD has been affecting your life or the life of a loved one, seek professional help if you haven’t already done so. The distress caused by OCD can have serious consequences for your overall well-being, so any help and guidance you can find will be useful. Evidence-based treatment methods for OCD are widely available and can help sufferers cope more effectively with their condition.

Sources:

^[1] Lang, Katie. (2009). Understanding obsessive compulsive disorder.. The Journal of School Nursing. 4(8). 390-394.

^[2] Volz, C. and Heyman, I., 2007. Case Series: Transformation Obsession in Young People With Obsessive-Compulsive Disorder (OCD). Journal of the American Academy of Child & Adolescent Psychiatry, [online] 46(6), pp.766-772. Available at: <https://www.researchgate.net/publication/6318585_Case_Series_Transformation_Obsession_in_Young_People_With_Obsessive-Compulsive_Disorder_OCD> [Accessed 12 June 2020].

^[3]  Lang, Katie. (2009). Understanding obsessive compulsive disorder. The Journal of School Nursing. 4(8). 390-394.

^[4] ibid

^[5] ibid

^[6] Ocduk.org. n.d. Obsessive Compulsive Personality Disorder (OCPD) | OCD-UK. [online] Available at: <https://www.ocduk.org/related-disorders/obsessive-compulsive-personality-disorder/> [Accessed 13 June 2020].

^[7] Substance Abuse and Mental Health Services Administration. Impact of the DSM-IV to DSM-5 Changes on the National Survey on Drug Use and Health [Internet]. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2016 Jun. Table 3.13, DSM-IV to DSM-5 Obsessive-Compulsive Disorder Comparison. Available from: https://www.ncbi.nlm.nih.gov/books/NBK519704/table/ch3.t13/

^[8] Substance Abuse and Mental Health Services Administration. Impact of the DSM-IV to DSM-5 Changes on the National Survey on Drug Use and Health [Internet]. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2016 Jun. Table 3.13, DSM-IV to DSM-5 Obsessive-Compulsive Disorder Comparison. Available from: https://www.ncbi.nlm.nih.gov/books/NBK519704/table/ch3.t13/