Sarah Allen Benton, LMHC, and Denise Egan Stack, LMHC
Obsessive-Compulsive Disorder (OCD) is a neurological disorder that is characterized primarily by obsessions and compulsions. Along with certain related disorders, it is now categorized in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) within its own chapter: “OCD and Related Disorders”.
OCD affects 3 to 5% of the American population, which means that roughly seven and a half million people in the United States will experience OCD symptoms at some point in their lives.1 Males and females are affected at the same rate and genes play a role in the development of OCD in a significant number of cases.2 OCD symptoms manifest at any time from preschool age to adulthood, usually presenting before age 40. Often times OCD symptoms are unrecognized and untreated. This can occur for a variety of reasons. For example, many healthcare providers are unfamiliar with the symptoms of the disorder, or are not trained in providing the most effective treatments. At the same time, sufferers may be reluctant to discuss their symptoms due to shame/embarrassment, and a wish to avoid being misunderstood.3
Core Symptoms of OCD:
Obsessions are persistent and intrusive impulses, ideas, images or thoughts that create excessive worry and anxiety. Examples of typical obsessions are a fear of dirt and germs or a fear of something bad happening to a loved one. Compulsions are mental acts or repetitive behaviors that are performed in response to an obsession in order to relieve the anxiety that is associated with that obsession. Because compulsive rituals don’t provide relief from anxiety on a permanent basis, the obsessions (and the anxiety they cause) will recur. Over time, the person with OCD may need to increase and change rituals in order to feel relief. OCD sufferers may experience the need to perform the compulsions as a glitch or feeling that their brain is “stuck in gear.”4 Examples of typical compulsions are excessive hand washing and repeatedly checking doors to see that they are locked.5
While the above examples of obsessions and compulsions are relatively common ones, it’s also important to note that the content or subject matter of obsessions (and compulsions) can cover a very broad range. They can be highly individual. But what people with OCD share is the intrusiveness and undesired nature of the obsessions, and the compulsive nature of the response to them — whatever the obsessions may be, and whatever the actions may be that the person takes to relieve the anxiety.
Of course, some worries are rational and necessary to protect us from danger. It is only when obsessions and compulsions are irrational, cause distress, take up time (more than an hour a day), and negatively impact daily functioning (work, social life, etc.) that an individual should seek professional help.
The Yale Brown Obsessive Compulsive Symptom Checklist, which is widely used as a diagnostic tool for OCD, categorizes OCD symptoms in the following way:
- Aggressive Obsessions: fears of causing harm to self or others or doing something embarrassing, like blurting out obscenities.
- Contamination Obsessions: excessive fear of dirt, germs, chemicals, bodily fluids or animals. Also, an excessive fear of getting sick from different contaminants.
- Sexual Obsessions: forbidden or perverse intrusive sexual thoughts, including those that might involve children or aggressive acts.
- Hoarding or Saving Obsessions
- Religious Obsessions: excessive concern with right and wrong and /or sacrilege or blasphemy
- Miscellaneous Obsessions: include fears of certain numbers, colors, losing things or not saying just the right thing.
- Somatic Obsessions: include fear of getting sick or a preoccupation with a certain part of one’s appearance.
- Cleaning or Washing Compulsions: behaviors performed in response to contamination obsessions, which may include excessive hand washing, showering and avoidance of contaminants.
- Checking Compulsions: behaviors performed in response to aggressive obsessions, such as checking to make sure things are turned off (stove, lights) or that people are not harmed. Also, people with OCD sometimes check to make sure that they did not make a mistake.
- Repeating Compulsions: behaviors repeated over and over again in order to produce anxiety relief.
- Counting Compulsions: behaviors such as counting up to a certain number, counting a certain number of times or avoiding certain numbers in order to produce relief from anxiety.
- Ordering and Arranging Compulsions
- Hoarding and Collection Compulsions
- Miscellaneous Compulsions: includes list making, touching, tapping and rubbing things, and rituals involving blinking and staring.
For more information on OCD, visit the Obsessive Compulsive Foundation website link:http://www.ocfoundation.org/
For more information on anxiety disorders, visit the Anxiety Disorders Association of Americawebsite link: http://www.adaa.org/
- Baer, L. (2000). Getting Control: Overcoming Your Obsessions and Compulsions. New York: Plume. 10.
- Gravitz, H.L. (1998). Obsessive Compulsive Disorder: New Help for the Family. Santa Barbara, CA: Healing Visions Press. 42.
- Obsessive Compulsive Foundation. About OCD. (2007). Retrieved August 23, 2007 from the World Wide Web:http://www.ocfoundation.org/whatisocd.aspx
- Ibid. 43.
- Hyman, B. and Pedrick, C. (1999). The OCD Workbook: You Guide to Breaking Free from Obsessive-Compulsive Disorder. Oakland, CA: New Harbinger Publications, Inc.. 8.