Anxiety Disorder: Obsessive-Compulsive Disorder (OCD)

Obsessive-Compulsive Disorder (OCD)

is OCD?

OCD is an anxiety disorder that is associated with obsessions and compulsions,
each of which is defined below.

Obsessions are the mental component of OCD. They are thoughts, images,
or impulses that repeatedly enter the mind, and feel out of the individual’s
control. The person with OCD does not want to have these ideas, finds
them intrusive, and usually at some point has recognized that they don’t
truly make sense. This is an important feature of obsessions, as it
helps to distinguish them from other non-OCD symptoms such as worry
or depressive preoccupations, and from other human experiences like
fantasy. Obsessions are accompanied by troubling feelings that can take
many forms, such as fear or apprehension, anxiety, disgust, tension,
or a sensation that things are “not just right.”

Recent research shows that the symptoms of OCD follow a few broad themes;
within these themes, obsessions can take a countless number of forms.
Common examples include the following:

• Contamination (e.g., fears of germs, dirtiness, chemicals,
AIDS, cancer)
• Symmetry or exactness (e.g., of belongings, spoken or written
words, the way one moves or completes actions)
• Doubting (e.g., whether appliances are turned off, doors are
locked, written work is accurate, etc.)
• Aggressive Impulses (e.g., thoughts of stabbing one’s
children, pushing loved ones into traffic, etc.)
• Accidental Harm to Others (e.g., fears of contaminating or poisoning
a loved one, or of being responsible for a break in or a fire)
• Religion (e.g., sexual thoughts about a holy person, satanic
thoughts, distressing thoughts regarding morality)
• Sexual (e.g., thoughts about personally upsetting sexual acts)
• Other miscellaneous obsessions having to do with themes such
as lucky or unlucky colors or numbers, or with the need to know “trivial”
details (e.g., house numbers, license plates)

The distressing feelings that arise from obsessions motivate people
with OCD to engage in specific behaviors or rituals that may temporarily
provide relief from their distress. These are compulsions, the main
behavioral component of OCD. Compulsions are acts the person feels driven
to perform over and over again, or sometimes according to specific personal
“rules.” OCD compulsions do not give the person pleasure;
they are performed to obtain relief from discomfort caused by the obsessions.
This is an important feature of compulsions because it helps to distinguish
them from other non-OCD problems like gambling or addictions, other
impulsive behaviors (e.g., spending too much money, stealing), or normal
behaviors such as avid hobbies or pastimes. Even though compulsions
are usually recognized as excessive, embarrassing, or problematic, people
with OCD feel powerless to resist them.

Like obsessions, compulsions can take many forms, which can include
the following:

• Washing and Cleaning (e.g., excessive showering, hand washing,
house cleaning)
• Checking (e.g., locks, appliances, paperwork, driving routes)
• Counting (e.g., preferences for even or odd numbers, tabulating
• Repeating Actions or Thoughts (e.g., turning lights on and off,
getting up and down in chairs, re-reading, re-writing)
• Need to Ask or Confess (e.g., asking for reassurance)
• Hoarding (e.g., magazines, flyers, clothing, information)
• Ordering and Arranging (e.g., need for things to be straight,
sequenced, or in a certain order)
• Repeating Words, Phrases, or Prayers to Oneself (e.g., repeating
“safe” words or prayers)

Compulsions can take up considerable time, and often cause problems
in day-to-day life in many ways. For example, people with contamination
obsessions may wash so often and so long that their hands become inflamed.
A person with doubting obsessions about whether she has performed routine
activities may be chronically late for appointments, due to repeated
checking of appliances or taps.

Other Behavioral Features of Obsessive-Compulsive

Although obsessions and compulsions are the key symptoms of OCD, other
common features include the following:

• Avoidance – Compulsions are performed in the attempt
to reduce negative emotions, such as anxiety, that arise from obsessions.
Another behavior that can also perform this function is avoidance. People
with OCD often find that they avoid situations that provoke obsessions.
Avoidance can take many forms – some of them quite subtle –
and can have a profound impact on the individual’s day-to-day
life. For example, a person with intrusive thoughts about harming his
child may feel a need to avoid being alone with the child, bathing or
dressing the child, or even looking at pictures of the child, all because
these situations have the power to evoke distressing obsessions.

• Thought Suppression – Some obsessions, particularly those
that are personally offensive or frightening, can prompt the person
to spend a lot of energy deliberately trying to force obsessive thoughts
out of awareness, or to suppress them. Although thought suppression
is an understandable strategy, research has shown it to be problematic
in OCD in several ways: a) deliberately trying not to think of a specific
thing usually has the contrary effect of making the thought more likely
to return, and b) unintentionally, it reinforces the notion that the
obsession is a valid belief or fear, when in fact it is not; this can
serve to strength the distress power of the obsession. Either way, the
effect of thought suppression may be to increase obsessions.

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Obsessive Compulsive Resources and Treatment Options