Obsessive–compulsive disorder

"OCD" redirects here. For other uses, see OCD (disambiguation).

For other uses, see Oxford Classical Dictionary, obsession (disambiguation) or compulsion (disambiguation).

Obsessive–compulsive disorder
Specialty	Psychiatry, psychology

Obsessive-compulsive disorder (OCD) is a psychiatric disorder; more specifically, it is an anxiety disorder. OCD is manifested in a variety of forms, but is most commonly characterized by a subject's obsessive, distressing, intrusive thoughts and related compulsions (tasks or rituals) which attempt to neutralize the obsessions.

The phrase "obsessive-compulsive" has worked its way into the wider English lexicon, and is often used in an offhand manner to describe someone who is meticulous or absorbed in a cause. Such casual references should not be confused with obsessive-compulsive disorder; see clinomorphism. It is also important to distinguish OCD from other types of anxiety, including the routine tension and stress that appear throughout life. A person who shows signs of infatuation or fixation with a subject/object, or displays traits such as perfectionism, does not necessarily have OCD, a specific and well-defined condition.

To be diagnosed with Obsessive-Compulsive Disorder, one must have either obsessions or compulsions alone, or obsessions and compulsions, according to the DSM-IV-TR diagnostic criteria. The Quick Reference to the diagnostic criteria from DSM-IV-TR (2000) describes these obsessions and compulsions:

Obsessions are defined by:

1. Recurrent and persistent thoughts, impulses, or images that are experienced, at some time during the disturbance, as intrusive and inappropriate and that cause marked anxiety or distress.
2. The thoughts, impulses, or images are not simply excessive worries about real-life problems.
3. The person attempts to ignore or suppress such thoughts, impulses, or images, or to neutralize them with some other thought or action.
4. The person recognizes that the obsessional thoughts, impulses, or images are a product of his or her own mind.

Compulsions are defined by:

1. Repetitive behaviors or mental acts that the person feels driven to perform in response to an obsession, or according to rules that must be applied rigidly.
2. The behaviors or mental acts are aimed at preventing or reducing distress or preventing some dreaded event or situation; however, these behaviors or mental acts either are not connected in a realistic way with what they are designed to neutralize or prevent or are clearly excessive.

In addition to these criteria, at some point during the course of the disorder, the sufferer must realize that his/her obsessions or compulsions are unreasonable or excessive. Moreover, the obsessions or compulsions must be time consuming (taking up more than one hour per day), cause distress, or cause impairment in social, occupational, or school functioning (Quick Reference from DSM-IV-TR, 2000). OCD often causes feelings similar to that of depression.

Symptoms and prevalence

Modern research has revealed that OCD is much more common than previously thought. An estimated 1 in 50 adolescents and adults are thought to have OCD. However, because of the condition's personal nature, and the lingering stigma that surrounds it, there may be many unaccounted-for OCD sufferers, and the actual percentages could be even higher.

The typical OCD sufferer performs tasks (or compulsions) to seek relief from obsession related anxiety. To others, these tasks may appear odd and unnecessary. But for the sufferer, such tasks can feel critically important, and must be performed in particular ways to ward off dire consequences and to stop the stress from building up. Examples of these tasks: repeatedly checking that one's parked car has been locked before leaving it; turning lights on and off a set number of times before exiting a room; repeatedly washing hands at regular intervals throughout the day.

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Symptoms may include some, all or perhaps none of the following:

• Repeated hand-washing.
• Specific counting systems — e.g. counting in groups of four, arranging objects in groups of three, grouping objects in odd/even numbered groups, etc.
  • One serious symptom which stems from this is "counting" your steps, e.g. you must take twelve steps to the car in the morning.
• Perfectly aligning objects at complete, absolute right angles, etc. This symptom is shared with OCPD and can be confused with this condition unless it is realized that in OCPD it is not stress-related.
• Having to "cancel out" bad thoughts with good thoughts. Examples of bad thoughts are:
  • Imagining harming a child, and having to imagine a child playing happily to cancel it out.
  • Unwanted sexual thoughts. Two classic examples are fear of being homosexual or fear of being a pedophile. In both cases, sufferers will obsess over whether or not they are genuinely aroused by the thoughts.
• A fear of contamination; some sufferers may fear the presence of human body secretions such as saliva, sweat, tears, or mucus, or excretions such as urine or feces. Some OCD sufferers even fear that the soap they're using is contaminated. [1]
• A need for both sides of the body to feel even. A person with OCD might walk down a sidewalk and step on a crack with the ball of their left foot, then feel the need to step on another crack with the ball of their right foot. Also, if one hand gets wet, the sufferer may feel very uncomfortable if the other is not.

There are many other possible symptoms, and one need not display those above to suffer from OCD. It is important to remember that one must be diagnosed by a doctor to officially suffer from OCD in medical terms; furthermore, possessing the symptoms above is not an absolute sign of OCD.

Obsessions are thoughts and ideas that the sufferer cannot stop thinking about. Common OCD obsessions include fears of acquiring disease, getting hurt, or causing harm to someone. Obsessions are typically automatic, frequent, distressing, and difficult to control or put an end to. People with OCD who obsess about hurting themselves or others are actually less likely to do so than the average person.

Compulsions refer to actions that the person performs, usually repeatedly, in an attempt to make the obsession go away. For an OCD sufferer who obsesses about germs or contamination, for example, these compulsions often involve repeated cleansing or meticulous avoidance of trash and mess. Most of the time the actions become so regular that it is not a noticeable problem. Common compulsions include excessive washing and cleaning; checking; hoarding; repetitive actions such as touching, counting, arranging and ordering; and other ritualistic behaviors that the person feels will lessen the chances of provoking an obsession. Compulsions can be observable — washing, for instance — but they can also be mental rituals such as repeating words or phrases, or counting.

Most OCD sufferers are aware that such thoughts and behavior are not rational, but feel bound to comply with them to fend off feelings of panic or dread. Because sufferers are consciously aware of this irrationality but feel helpless to push it away, untreated OCD is often regarded as one of the most vexing and frustrating of the major anxiety disorders.

In an attempt to further relate the immense distress that those afflicted with this condition must bear, Barlow and Durand (2006) use the following example. They implore readers not to think of pink elephants. Their point lies in the assumption that most people will immediately create an image of a pink elephant in their minds, even though told not to do so. The more one attempts to stop thinking of these colorful animals, the more one will continue to generate these mental images. This phenomenon is termed the "Thought Avoidance Paradox”, and it plagues those with OCD on a daily basis, for no matter how hard one tries to get these disturbing images and thoughts out of one's mind, feelings of distress and anxiety inevitably prevail. Although everyone may experience unpleasant thoughts at one time or another, these are usually warranted concerns that are short-lived and fade after an adequate time period has lapsed. However, this is not the case for OCD sufferers. (K. Carter, PSYC 210 lecture, February 14, 2006).

People who suffer from the separate and unrelated condition obsessive compulsive personality disorder are not aware of anything abnormal about themselves; they will readily explain why their actions are rational, and it is usually impossible to convince them otherwise. People who suffer from OCPD tend to derive pleasure from their obsessions or compulsions, while those with OCD do not feel pleasure but are ridden with anxiety. OCD is ego dystonic, meaning that the disorder is incompatible with the sufferer's self-concept. Because disorders that are ego dystonic go against an individual's perception of his/herself, they tend to cause much distress. OCPD, on the other hand, is ego syntonic — marked by the individual's acceptance that the characteristics displayed as a result of this disorder are compatible with his/her self-image.