Obsessive-Compulsive Disorder

People with Obsessive-Compulsive Disorder (OCD) live very anxious lives. Their condition leads them to think and act in repetitious ways in order to stave off some hyper-inflated threat or sense of balance in their world. Many people are under the belief that people with OCD merely keep things meticulously tidy or count and organize their belongings, and thus see no harm in that kind of behavior.

While OCD can manifest in these kinds of stereotypical behaviors, the psychological truth behind the condition is one of chronic and debilitating anxiety. The patterns of thinking and action are always unwanted for the OCD sufferer, and are often upsetting and horrific. Let's take a closer look.

Definition/Exploration
OCD is an anxiety disorder whose chief feature is the persistent thoughts (obsessions) and actions (compulsions) which come to dictate small or large aspects of a person's life and habits. People with this condition are preoccupied with patterns of thinking and behaving which consume much of their time and energy. Rituals and routines are a key part in at least half of OCD diagnoses. 2.2 million Americans are diagnosed with OCD every year, and it affects men and women equally. It's most common age of onset is 19.

How does OCD operate? Essentially, some thought or anxiety about the present or future refuses to leave a sufferer alone. The details and content of these thoughts can be graphic, lewd, or unsavory. In an attempt to alleviate these interjecting and distressing thoughts, the person invents and follows through with elaborate strings of action in the hopes of dismantling or appeasing them. Worse still, most people with OCD realize the excess and futility of their own compulsions, but their attempts to ignore these thoughts only increase their feelings of anxiety.

You may have heard of Obsessive-Compulsive Personality, which is a separate concept from OCD. This personality type is associated with traits of perfectionism, a strict adherence to rules and regulations, inflexible ideals, and overly-conscientious (detail-oriented) thinking and behavior. These traits are often the ones confused in the popular imagination with OCD. Research shows that people with OCD may or may not also have Obsessive-Compulsive Personality traits. They are not the same condition.

As with certain other anxiety disorders we've discussed, there is no definitive cause for OCD. Environmental and predispositional factors either develop the condition gradually or rapidly.

Symptoms
OCD symptoms are both general and specific to the Obsession and Compulsion sides of the disorder. Let's break them down one at a time:

General Symptoms

• Repeated images and/or thoughts. Topics can include (but are not limited to) germs, tidiness, violence (toward self or others) and sexual acts

• Perform the same rituals over and over again (locking doors, hoarding objects, counting)
• An inability to combat, control, or suppress recurrent thoughts/images

• Feel little or no pleasure completing the compulsive ritual, but temporarily relieve anxious mindset through them

• Spend 1 hour or more per day focused on these thoughts/behaviors

Obsessive Symptoms (Thoughts)

• Ceaseless worrying about dirt and contamination
• Constant worrying about order, organization, and/or symmetry
• Concerned with accidently and violently hurting yourself, loved ones, or strangers
• Hold onto exaggerated sense of responsibility for the well-being of others
• Unwanted, ugly thoughts about religious or sexual imagery
• Doubting that the things you think are irrational

Compulsion Symptoms (Rituals)

• Cleaning (bathing, handwashing, scrubbing the bathtub multiple times a day)
• Repetition (saying or thinking a name, thought, or phrase for hours; clicking a pen for hours)
• Checking (ensuring the lights are all off/on, that the thermostat hasn't changed, again and again)
• Hoarding (holding onto everything bought--every article of trash, every useless item)
• Continually repeating an old conversation, a prayer, or "conjuring" good thoughts and images in an effort to waylay anxious thoughts

Treatment for OCD can take many forms, from Cognitive-Behavioral Therapy (see here) to Psychotherapy (here) and medication (here). Often a combined approach is best, as is the case for many anxiety disorders

Case Study

In an effort to empathize and visualize what OCD feels like, here are snippets taken from an OCD sufferer's reflections on their experience:

"I couldn't do anything without rituals. They invaded every aspect of my life. Counting really bogged me down. I would wash my hair three times as opposed to once because three was a good luck number and one wasn't. It took me longer to read because I'd count the lines in a paragraph. When I set my alarm at night, I had to set it to a number that wouldn't add up to a 'bad' number.

"Getting dressed in the morning was tough, because I had a routine, and if I didn't follow the routine, I'd get anxious and would have to get dressed again. I always worried that if I didn't do something, my parents were going to die. I'd have these terrible thoughts of harming my parents. I knew that was completely irrational, but the thoughts triggered more anxiety and more senseless behavior. Because of the time I spent on rituals, I was unable to do a lot of things that were important to me.

"I knew the rituals didn't make sense, and I was deeply ashamed of them, but I couldn't seem to overcome them until I got treatment."