Obsessive Compulsive Disorder

OCD is an anxiety disorder that includes overwhelming and often unwanted thoughts that lead to behaviors to respond to or reduce the stress caused by the thoughts. Obsessive-compulsive Disorder differs from other anxiety diagnoses because of the specific habitual or ritualized patterns of coping that are involved. These specific habits or rituals can function like process addictions were the reward is an ever diminishing reduced level of anxiety. In fact, people who struggle with OCD are also at higher risk for substance use and other addictive behavior

The DSM-5 includes the following symptoms as the main components of OCD

  • The presence of obsessions, compulsions, or both

  • Obsessions (thoughts) or compulsions (urges) are time-consuming

  • The symptoms are caused by the effects of a medical condition or substance use

  • Symptoms cannot be more accurately described by another mental health diagnosis

Some Common Symptoms of OCD

Obsessive-Compulsive Disorder has a variety of different subtypes, and obsessions and compulsions are often unique to individuals, but some common symptoms can include the following.

  • A need for symmetry or personal perfection

  • Excessive cleaning or fear of contamination

  • Disturbing intrusive thoughts

  • Feeling compelled to do something that is known to be unnecessary, excessive, or undesired.

  • Difficulty controling thoughts or behaviors despite recognizing that they are irrational.

  • 1 hour or more spent on unwanted thoughts or behaviors

  • Difficulting keeping up with work, school, or home tasks because of preoccupation with thoughts or behaviors

  • Avoidance of people, places, or things that may trigger

OCD Types

As mentioned earlier, obsessions and compulsions are often unique to individuals, but there are six categories that many OCD symptom profiles fall into. These categories are:

  • Rumination

  • Intrusive Thought

  • Checking

  • Contamination

  • Mental Contamination

  • Hoarding

Rumination

The word Rumination comes from a term used to describe the way grazing animals regurgitates and rechews its food. This description matches the way people struggling with this type of OCD feel compelled to think over and over about memories of their lives or other topics. This cycle of thoughts can be debilitating because it can make focusing on the task at hand and being productive very challenging. It can also and can cause emotional pain because the person may revisit moments that could be uncomfortable or with enough analysis become misconstrued from something positive or neutral into something negative. Imagine being stuck in a loop of your last conversation with your boss. Even if that conversation was positive or constructive, if you replay it enough times, it could become distressing.

Intrusive Thoughts

Intrusive thoughts differ from Rumination in that they are typically about topics that are disturbing for the person. Such thoughts happen involuntarily and are often in conflict with the person's needs, goals, desires, or beliefs. People with this type of OCD become flooded with unwanted fears about:

  • Sexuality – Fear of sexual thoughts about clergy, fear of becoming interested in incest or pedophilia, or fear that their sexuality could change in a way they do not desire, etc.

  • Relationships – Needing affirmation of value compulsively, overwhelming fear of infidelity, "mindreading" or analysis of partner's actions, etc.

  • Magical Thinking – Being fearful that what they think, feel, or do can have impacts on unrelated events.

  • Religion – Fear of damnation or spiritual abandonment. Repetitive prayer or other religious activity, believing they need to deal with sins that they may have committed that are perhaps unknown to them. Fear of curses or offending other or unknown religious traditions. Scrupulosity, overwhelming fear leading to obsessions and compulsions about spiritual practice.

  • Sensorimotor OCD – Extreme vigilance thoughts about autonomic body functions like breathing, heart rate, blinking, visual field, swallowing, or fixation on one body part.

  • Harm or Violence– Fears about doing something to harm a to themselves, a loved one, or stranger when they have no desire to actually do harm. Invasive and unwanted thoughts about jumping into traffic, assault, poisoning people, causing a car accident, etc.

  • Symmetry and Order – Feeling the need to keep things "just right." Adjusting books on a shelf, getting the mirror perfectly clean, the angle of pictures, specific placement of individual items, etc.

Checking

Checking is one of the more common types of OCD. It involves feeling compelled to check certain important items or things around the house multiple times because of obsessive thoughts about the possibility of misfortune. This combination of obsessive fear and compulsive behavior can be damaging to the person's ability to function and maintain relationships

Some items that are people with OCD may check compulsively are:

  • Locks on windows and doors

  • Faucets or Water Taps

  • Lights

  • Home Appliances like the Stove

  • Personal items like Wallets, Phones, or Keys

  • Editing messages over and over

  • Calling friends or loved ones repeatedly to make sure they are ok.

  • Frequent Searching for disease symptoms

  • Trying to remember every detail of information

  • Seeking assurance from others that they haven't said something offensive

Contamination

Contamination obsessions involve fear of contracting an illness or having other contaminants on or near themselves. People suffering from repeated thoughts about the possibility of the contamination may avoid certain places, people, or activities and may feel compelled to wash or take extreme measures related to cleanliness.

Mental Contamination

Mental contamination differs from the previously mentioned contamination related obsessive-compulsive symptoms because the person's washing behaviors are related to emotional or psychological experiences instead of physical concerns. For example, a person suffering from this type of symptom may be compelled to attempt to wash for hours after feeling embarrassed or upset.

Hoarding

Some obsessions connected to hoarding behaviors include:

  • Feeling compelled to collect items for fear of future scarcity or possible future needs in an excessive way.

  • Attaching emotional significance to items excessively.

  • Keeping items that could be harmful to protect others at their expense like broken glass, waste, litter, etc.

People who struggle with hoarding have extreme difficulty discarding items for a variety of reasons. Often people who struggle with this type of OCD find themselves limited by the condition of their homes and relational problems that come from the continued collection of items. This condition can become dangerous or even fatal because the state of their homes can create environmental risks of fire, being trapped or injured, fostering hazardous microbes, and other concerns.

OCD Treatment

Obsessive-Compulsive Disorder is treated with a combination of medication and psychotherapy to decrease the adverse effects of its symptoms. People with OCD are also at increased risk of experiencing Major Depressive Disorder or Substance Use Disorder, so getting help early is helpful.

If you are in crisis or having thoughts of harming yourself or others, call 9-1-1 immediately.

Other helpful resources include:

  • The National Suicide Prevention Lifeline a 24−hour crisis center or dial 911

    • 1−800−273−TALK (8255)  

  • Text the Crisis Text Line The Crisis Text Line is free, 24/7 support for those in crisis. 

    • Text "Home" to 741741 from anywhere in the US to text with a trained Crisis Counselor.

  • Contact your mental health provider.

  • Get help from your physician or other health care provider.

  • Reach out to a friend, family member, or other social support.

The information provided is not for diagnostic use or a substitute for mental health care. A mental health professional can make a proper assessment of your symptoms and help you recover.