Obsessive Compulsive Disorder (OCD)
Obsessive compulsive disorder (OCD) can affect you in different ways. It usually causes a particular pattern of thoughts and behaviours.
This pattern has 4 main steps:
- Obsession – an unwanted and distressing thought, image or urge repeatedly enters your mind.
- Anxiety – the obsession provokes a feeling of intense anxiety or distress.
- Compulsion – repetitive behaviours or mental acts that you feel driven to perform. These can be a response to the obsessive thought pattern.
- Temporary relief – the compulsive behaviour relieves the anxiety for a short while. But the obsession and anxiety soon return, causing the cycle to begin again.
It’s possible to have obsessive thoughts, with or without the compulsion or urge to act. You may experience both.
Most of us, at some point, will have unpleasant or unwanted worrying thoughts or thoughts that make us anxious. This can be thinking you may have forgotten to lock the door of the house. You can even have sudden unwelcome violent or offensive mental images. Many of these thoughts go away as quickly as they appear.
You may have an obsession if you have a persistent, unpleasant thought that takes over your thinking. This thought may interrupt all your other thoughts. It can make it hard for you to focus on other daily activities.
Some common obsessions include:
- fear of deliberately harming yourself or others
- intense worry about catching a disease or infection
- thinking about having to do things in a certain order or number of times to feel safe and reduce anxiety
You may have unwanted sexual thoughts or images which you fear you may act on. While these thoughts can cause extreme distress, it doesn’t mean you will act on them.
Compulsions are things you do or ways you behave in response to the thoughts that make you anxious. The actions usually provide relief from the distress for a short while.
For example, if you are afraid of catching germs, you may wash your hands over and over again. Washing your hands reduces the worry that you have germs on your hands. But as that thought comes back, the urge to wash your hands increases again.
People with OCD know that compulsive behaviour is irrational (does not make sense). But they do it because it reduces distress for a short while.
Common types of compulsive behaviour include:
- excessive cleaning and hand washing
- checking – such as checking doors are locked or that switches and appliance are off
- counting and doing the same thing many times
- ordering and arranging
- asking for reassurance
- repeating words in their head
- thinking ‘neutralising’ thoughts to counter the obsessive thoughts
- avoiding places and situations that could trigger obsessive thoughts
Not all compulsive behaviours will be obvious to other people. When they are not obvious they are called “covert” behaviours. When they are obvious, they are called “overt” behaviours.
DSM-IV diagnostic criteria9,100
A. Either obsessions or compulsions:
Obsessions as defined by (1), (2), (3) and (4):
- 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.
- The thoughts, impulses or images are not simply excessive worries about real-life problems.
- The person attempts to ignore or suppress such thoughts, impulses or images, or to neutralize them with some other thought or action.
- The person recognizes that the obsessional thoughts, impulses or images are a product of his or her own mind (not imposed from without as in thought insertion).
Compulsions as defined by (1) and (2):
- Repetitive behaviours (e.g. hand washing, ordering, checking) or mental acts (e.g. praying, counting, repeating words silently) that the person feels driven to perform in response to an obsession, or according to rules that must be applied rigidly.
- The behaviour or mental acts are aimed at preventing or reducing distress, or preventing some dreaded event or situation. However, these behaviour or mental acts either are not connected in a realistic way with what they are designed to neutralise or prevent, or are clearly excessive.
B. At some point during the course of the disorder the person has recognised that the obsessions or compulsions are excessive or unreasonable. Note that this does not apply to children.
C. The obsessions or compulsions cause marked distress, are time-consuming (take more than 1 hour a day, or significantly interfere with the person’s normal routine, occupational (or academic) functioning or usual social activities or relationships.
D. If another Axis I disorder is present, the content of the obsessions or compulsions is not restricted to it (e.g. preoccupation with food in the presence of an eating disorder; hair pulling in the presence of trichotillomania; concern with appearance in the presence of body dysmorphic disorder; preoccupation with drugs in the presence of a substance use disorder; preoccupation with having a serious illness in the presence of hypochondriasis; preoccupation with sexual urges or fantasies in the presence of a paraphilia; or guilty ruminations in the presence of major depressive disorder).
E. The disturbance is not caused by the direct physiological effects of a substance (e.g. a drug of abuse, a medication) or a general medical condition.