Obsessive Compulsive Disorder (OCD) is the last topic in my five-part series on anxiety.
OCD is a frequently used term, but it is used generally as an insult such as “You are so OCD.”
It is important for me to clarify that OCD is not having a preference where you place the box of tissues or how you arrange a series of photos.
According to the Diagnostic and Statistical Manual (DSM), which is the gold standard for my field, OCD is when an individual displays either obsessions or compulsions or maybe even both.
So, what is an obsession? According to the DSM, obsessions are defined as:
1. Recurrent and persistent thoughts, urges or impulses that are experienced, at some time during the disturbance, as intrusive and unwanted, and that in most individuals cause marked anxiety or distress.
2. The individual attempts to ignore or suppress such thoughts, urges or images, or to neutralize them with some other thought or action (i.e., by performing a compulsion)
Translation: Frequent, upsetting thoughts that get in the way of a person’s life.
Compulsions are defined by both:
1. Repetitive behaviors (e.g., hand-washing, ordering, checking) or mental acts (e.g., praying, counting, repeating words silently) that the individual feels driven to perform in response to an obsession or according to rules that must be applied rigidly.
2. The behaviors or mental acts are aimed at preventing or reducing anxiety or distress, or preventing some dreaded event or situation; however, these behaviors or mental acts are not connected in a realistic way with what they are designed to neutralize or prevent, or are clearly excessive.
Translation: The uncontrollable urge to repeat certain rituals or behaviors. The behaviors cannot be controlled, and more often than not, the rituals actually control the individual.
It is important to consider the impact that obsessive and compulsive behaviors have on an individual’s level of functioning. They are generally time-consuming, taking up more than one hour per day of an individual’s time, thought, energy or they have to cause a significant level of distress or impairment in social, occupational or other important and necessary levels of functioning.
An individual with OCD does not get pleasure when performing the behaviors or rituals, but will receive a brief relief from the anxiety the thoughts causes.
Healthy people also have habits or rituals such as checking that the stove is off, curling iron is unplugged all before leaving the house.
The difference for individuals with OCD is that they perform the rituals even though it has a significant impact on their daily life and the repetition is distressing.
It is more common for adults to recognize the compulsive behavior as irrational and senseless, more difficult for children to learn and recognize that the behavior is out of the ordinary.
Like other mental health disorders, it is important to rule out any substance use or abuse as contributing factor into the behavior.
Stress, illness, parenting, family accommodations do not cause OCD, however these conditions may contribute to an individual’s level of stress and if an individual has a history of OCD in the family they are more likely to display the symptoms.