What Is Obsessive-Compulsive Disorder?
The first time I can remember exhibiting intrusive thoughts that developed into the form of compulsions, or repetitive actions, started from a young age in preschool. I had lined up my toy bears in a color-coordinated order, separating them into reds, greens, and blues. Looking at my toys that appeared to me as so well organized, I couldn’t help but feel a sense of content. The feeling obliterated just as quickly as it appeared when a boy passed through my line of bears and disrupted them into a bunched-up mess. Unable to grasp what had just happened, I couldn’t help but feel a sense of a loss of control over the situation and immediately had an anxiety attack over the destruction of my perceived creation of perfection.
Years later, as an elementary school student, I would come to find out that I suffer with an intense form of obsessive-compulsive disorder (OCD) that would take its toll on my life completely. OCD is a disorder in which people have recurring, unwanted thoughts, ideas, or sensations (obsessions) that make them feel driven to do something repetitively (compulsions). These repetitive behaviors, such as hand washing, checking on things, or cleaning, can significantly interfere with a person’s daily activities and social interactions.
Many people without OCD have distressing thoughts or repetitive behaviors. However, these thoughts and behaviors do not typically disrupt daily life like they do with people that suffer with the disorder. In my case, my OCD did disrupt my daily living and I would spend hours of a time on multiple compulsions over the course of my lifetime. This would include repetitive checking, repeating activities in even numbers, obsessive cleaning rituals when getting ready in the mornings and evenings. For people with OCD, thoughts are persistent, and behaviors are rigid. Not performing the behaviors commonly causes great distress or intrusive thoughts. Many people with OCD know or suspect their obsessions are not realistic, while others may think they could be true (known as limited insight). Even if they know their obsessions are not realistic, people with OCD have difficulty disengaging from the obsessive thoughts or stopping the compulsive actions.
A diagnosis of OCD requires the presence of obsessions and/or compulsions that are time-consuming (more than one hour a day), cause significant distress, and impair work or social functioning. OCD often begins in childhood, adolescence, or early adulthood; the average age symptoms appear is 19 years old.
What are obsessions?
Obsessions are recurrent and persistent thoughts, impulses, or images that cause distressing emotions such as anxiety or disgust. Many people with OCD recognize that these thoughts are a product of their mind, and are excessive or unreasonable. However, the distress caused by these intrusive thoughts cannot be resolved by logic or reasoning. Most people with OCD try to ease the distress of the obsessions with compulsions, ignore or suppress the obsessions, or distract themselves with other activities.
Typical obsessions can include the fear of getting contaminated by people or the environment, disturbing thoughts or images, a fear of blurting out obscenities or insults, extreme concern with order, symmetry, or precision. Other obsessions can also include recurrent intrusive thoughts of sounds, images, words, or numbers, and fears of losing or discarding something important.
What are compulsions?
Compulsions are repetitive behaviors or mental acts that a person feels driven to perform in response to an obsession. These behaviors typically prevent or reduce a person’s distress related to an obsession. Compulsions may be excessive responses that directly relate to an obsession (such as excessive hand washing due to the fear of contamination) or actions that are completely unrelated to the obsession. In the most severe cases, a constant repetition of rituals may fill the day, making a normal routine impossible.
Some typical compulsions can include:
- Excessive or ritualized hand washing, showering, brushing teeth, or toileting
- Repeated cleaning of household objects
- Ordering or arranging things in a particular way
- Repeatedly checking locks, switches, or appliances
- Constantly seeking approval or reassurance
- Repeated counting to a certain number
- Feeling the need to think about or say something over and over (for example, counting, or repeating words over and over silently in one’s head or out loud)
- Feeling the need to do something repeatedly according to certain rules that must be followed exactly in order to make an obsession go away.
People with OCD do these behaviors because they have the feeling that the behaviors put into action will prevent bad things from happening or will make them feel better.
However, the behavior is not typically connected to an actual danger of something bad happening, but rather a perceived fear. Sometimes the behaviors can border on the extreme, such as washing one’s hands multiple times per hour.
Myths about OCD
A common myth is that OCD means being really neat and orderly, or a “clean freak”. Sometimes OCD behaviors may involve cleaning, but many times someone with OCD is too focused on one thing that must be done over and over rather than on being organized. Obsessions and compulsions can also change over time. This includes obsessions going away or returning, or new compulsions appearing.
Related Conditions associated with OCD:
- Body Dysmorphic Disorder, an obsessive focus on a perceived flaw in appearance.
- Hoarding Disorder, a persistent difficulty discarding or parting with possessions.
- Hair-Pulling Disorder (Trichotillomania)– A disorder that involves recurrent, irresistible urges to pull out body hair.
- Skin-Picking Disorder (Excoriation)– The repeated urge or impulse to pick at one’s own skin.
Treatment for OCD
Treatments can include behavior therapy and medication. Behavior therapy, specifically cognitive-behavioral therapy, can change negative thoughts into more positive, effective ways of thinking, leading to more effective behavior. Behavior therapy for OCD can involve gradually exposing patients to their fears in a safe setting. Gradually exposing someone with OCD to their fears helps them learn that bad things do not really occur when they don’t do the behavior, which eventually decreases their anxiety. Behavior therapy alone can be effective, but some patients are treated with a combination of behavior therapy and medication. Families and schools can help manage stress by being part of the therapy process and learning how to respond supportively without accidentally exacerbating obsessions or compulsions, making them more likely to happen again.
Works Cited
Colon-Rivera, Hector, and Molly Howland. What Is Obsessive-Compulsive Disorder?, CMRO, Dec. 2020, www.psychiatry.org/patients-families/ocd/what-is-obsessive-compulsive-disorder.
Handel, Steven. “How to Disempower Intrusive Thoughts.” The Emotion Machine, 4 Aug. 2019, www.theemotionmachine.com/how-to-disempower-intrusive-thoughts/.
Hurley, Katie. “What Is Trichotillomania? A Closer Look at Hair-Pulling Disorder.” Psycom.net – Mental Health Treatment Resource Since 1996, LCSW, 5 May 2021, www.psycom.net/what-is-trichotillomania/.
Kelly, Owen. “How to Get the Proper Diagnosis and Treatment for Your OCD.” Verywell Mind, Daniel B. Block, M.D., 29 Aug. 2020, www.verywellmind.com/diagnosis-of-ocd-2510606.
Kelly, Owen. “Obsessions Are More Than Everyday Worries: They Cause Major Anxiety.” Verywell Mind, Steven Gans, M.D., 1 Dec. 2020, www.verywellmind.com/about-ocd-obsessions-and-compulsions-2510672.
Marques, Luana. “Body Dysmorphic Disorder (BDD): Anxiety and Depression Association of America, ADAA.” Body Dysmorphic Disorder (BDD) | Anxiety and Depression Association of America, ADAA, Jan. 2020, adaa.org/understanding-anxiety/body-dysmorphic-disorder.
Parekh, Ranna. What Is Hoarding Disorder?, M.P.H., July 2017, www.psychiatry.org/patients-families/hoarding-disorder/what-is-hoarding-disorder.
Raikes, Jennifer. “What Is Excoriation (Skin Picking) Disorder?” The TLC Foundation for BFRBs, Jan. 2020, www.bfrb.org/learn-about-bfrbs/skin-picking-disorder.
Rubin, Eugene, and Charles Zorumski. “The Importance of Insight.” Psychology Today, Sussex Publishers, 7 Apr. 2016, www.psychologytoday.com/us/blog/demystifying-psychiatry/201604/the-importance-insight.