Obsessive-compulsive disorder (OCD) is a psychiatric disorder, more specifically, an anxiety disorder. OCD is manifested in a variety of forms, but is most commonly characterized by a subject's obsessive (repetitive, distressing, intrusive) thoughts and related compulsions (tasks or rituals), which attempt to neutralize the obsessions.
The phrase "obsessive-compulsive" has worked its way into the wider English language, and is often used in an offhand manner to describe someone who is meticulous or absorbed in a cause. Such casual references should not be confused with obsessive-compulsive disorder; see clinomorphism. It is also important to distinguish OCD from other types of anxiety, including the routine tension and stress that appear throughout life. A person who shows signs of infatuation or fixation with a subject/object, or displays traits such as perfectionism, does not necessarily have OCD, a specific and well-defined condition.
To be diagnosed with Obsessive-Compulsive Disorder, one must have either obsessions alone or obsessions and compulsions (K. Carter, PSYC 210 lecture, February 14, 2006). The Quick Reference to the diagnostic criteria from DSM-IV-TR (2000) describes these obsessions and compulsions: Obsessions are defined by:
- 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
Compulsions are defined by:
- repetitive behaviors or mental acts that the person feels driven to perform in response to an obsession, or according to rules that must be applied rigidly.
- the behaviors or mental acts are aimed at preventing or reducing distress or preventing some dreaded event or situation; however, these behaviors or mental acts either are not connected in a realistic way with what they are designed to neutralize or prevent or are clearly excessive.
In addition to these criteria, at some point during the course of the disorder, the sufferer must realize that his/her obsessions or compulsions are unreasonable or excessive. Moreover, the obsessions or compulsions must be time consuming (taking up more than one hour per day), cause distress, or cause impairment in social, occupational, or school functioning (Quick Reference from DSM-IV-TR, 2000).
There is a condition in between OCD and schizophrenia, where the people don't realize their obsession and compulsions are unreasonable. For example, one young man believed in a power that could bring him luck if he did the rituals correctly. He would see a black dot leave his body and enter an object, and then he'd have to do rituals to get it back.
The typical OCD sufferer performs tasks (or compulsions) to seek relief from obsessions. To others, these tasks may appear odd and unnecessary. But for the sufferer, such tasks can feel critically important, and must be performed in particular ways to ward off dire consequences and to stop the stress from building up. Examples of these tasks: repeatedly checking that one's parked car has been locked before leaving it; turning lights on and off a set number of times before exiting a room; repeatedly washing hands at regular intervals throughout the day.
Symptoms may include some, all or perhaps none of the following:
- Repeated hand-washing
- Fear of contamination
- Specific counting systems - i.e. counting in groups of four, arranging objects in groups of three, having objects grouped in odd/even numbered groups, etc...
- One serious symtom which stems from this is "counting" your steps, e.g. you must take twelve steps to the car in the morning, etc...
- Perfectly aligning objects at complete, absolute right angles, etc.. This symptom is shared with OCPD and can be confused with this condition unless it is realised that with OCPD it is mainly stress-related.
- Having to "cancel-out" bad thoughts with a good thought. Examples are:
- Imagining harming a child, and having to imagine (for example) a child playing happily to "cancel" it out.
- Heterosexual person experiencing a homosexual thought and immediately imagining a heterosexual thought to counter the "bad" thoughts, even to the point of masturbating using heterosexual fantasies to "cancel" out the thought.
- Also, there are many other symptoms. It is important to remember you must be diagnosed by your doctor to lawfully suffer from OCD; furthermore if you do have any symptoms above it is not a firm sign you do not have OCD and vice verca.
Another symptom of the disorder is fear of contamination; some sufferers may fear the presence of human body secretion such as saliva, sweat, tears or mucus, or excretions such as urine or feces. Some OCD sufferers even fear the soap they're using is contaminated. Source
Obsessions are thoughts and ideas that the sufferer cannot stop thinking about. Common OCD obsessions include fears of acquiring disease, getting hurt, or causing harm to someone. Obsessions are typically automatic, frequent, distressing, and difficult to control or put an end to by themselves. People with OCD who obsess about hurting themselves or others are actually less likely to do so than the average person.
Compulsions refer to actions that the person performs, usually repeatedly, in an attempt to make the obsession go away. For an OCD sufferer who obsesses about germs or contamination, for example, these compulsions often involve repeated cleansing or meticulous avoidance of trash and mess. Most of the time the actions become so regular that it is not a noticeable problem. Common compulsions include excessive washing and cleaning; checking; hoarding; repetitive actions such as touching, counting, arranging and ordering; and other ritualistic behaviors that the person feels will lessen the chances of provoking an obsession. Compulsions can be observable — washing, for instance — but they can also be mental rituals such as repeating words or phrases, or counting.
Most OCD sufferers are aware that such thoughts and behavior are not rational, but feel bound to comply with them to fend off fears of panic or dread. Because sufferers are consciously aware of this irrationality but feel helpless to push it away, untreated OCD is often regarded as one of the most vexing and frustrating of the major anxiety disorders.
In an attempt to further relate the immense distress that those afflicted with this disease must bear, Barlow and Durand (2006) utilize an odd example. Strangely enough, they implore readers not to think of pink elephants. Their point lies in the assumption that many people will immediately create an image of a pink elephant in their mind even if told not to do so. The more one attempts to stop thinking of these colorful animals, the more they will succeed in generating these mental images. This phenomenon is termed: the “Thought Avoidance Paradox”, and it plagues those with OCD on a daily basis, for no matter how hard one tries to get these disturbing images and thoughts out of his/her mind, feelings of distress and anxiety inevitably prevail. Although everyone may experience unpleasant thoughts at one time or another, these are usually warranted concerns that are short-lived and fade after an adequate time period has lapsed. However, this is not the case for OCD sufferers. These disconcerting thoughts are ever-present and because of the Thought Avoidance Paradox, never dissipate (K. Carter, PSYC 210 lecture, February 14, 2006).
People who suffer from the separate and unrelated condition obsessive compulsive personality disorder are not aware of anything abnormal with them; they will readily explain why their actions are rational, and it is usually impossible to convince them otherwise. People who suffer with OCPD tend to derive pleasure from their obsessions or compulsions. Those with OCD do not derive pleasure but are ridden with anxiety. OCD is ego dystonic, meaning that the disorder is incompatible with the sufferer's self-concept. Because disorders that are ego dystonic go against an individual's perception of his/herself, they tend to cause much distress. OCPD, on the other hand, is ego syntonic--marked by the individual's acceptance that the characteristics displayed as a result of this disorder are compatible with his/her self-image. Ego syntonic disorders understandably cause no distress (K. Carter, PSYC 210 lecture, April 11, 2006). This is a significant difference between these disorders.
Equally frequent, these rationalizations do not apply to the overall behavior, but to each instance individually; for example, a person compulsively checking their front door may argue that the time taken and stress caused by one more check of the front door is considerably less than the time and stress associated with being robbed, and thus the check is the better option. In practice, after that check, the individual is still not sure, and it is still better in terms of time and stress to do one more check, and this reasoning can continue as long as necessary.
Not all OCD sufferers engage in compulsive behavior. Recent years have seen increased diagnoses of Pure Obsessional OCD, or "Pure O." This form of OCD is manifested entirely within the mind, and involves obsessive ruminations triggered by certain thoughts. These mental "snags" can be debilitating, often tying up a sufferer for hours at a time. As of 2004, headway continues to be made by specialists. It is believed by many that Pure O OCD is in fact more prevalent than other types of OCD, although it is likely the most underreported as it is not visibly apparent, and sufferers tend to suffer in silence. In this disorder, the sufferer tries to "disprove" the anxious thoughts through logic and reasoning, yet in doing so becomes further entrapped by the obsessions. "Pure O" OCD is thought to be the most difficult form of OCD to treat.
Some OCD sufferers exhibit what is known as overvalued ideas. In such cases, the person with OCD will truly be uncertain whether the fears that cause them to do their compulsions are irrational or not. After some (possibly long) discussion, it is possible to convince the individual that their fears may be unfounded. It may be extra difficult to do ERP therapy on such a patient, because they may be, at least initially, unwilling to do it.
OCD is different from behaviors such as gambling addiction and overeating. People with these disorders typically experience at least some pleasure from their activity; OCD sufferers do not actively want to perform their compulsive tasks, and experience no tangible pleasure in doing so.
OCD is placed in the anxiety class of mental illness, but like many chronic stress disorders it can lead to clinical depression over time. The constant stress of the condition can cause sufferers to develop a deadening of spirit, a numbing frustration, or sense of hopelessness. OCD's effects on day-to-day life — particularly its substantial consumption of time — can produce difficulties with work, finances and relationships.
Violence is rare among OCD sufferers, but the disorder is often debilitating and detrimental to their quality of life. Also, the psychological self-awareness of the irrationality of the disorder can be painful. For people with severe OCD, it may take several hours a day to carry out the compulsive acts. To avoid perceived obsession triggers, they also often avoid certain situations or places altogether.
It has been alleged that sufferers are generally of above-average intelligence, as the very nature of the disorder necessitates complicated thinking patterns, but this has never been supported by clinical data.
The illness ranges widely in severity.
OCD in Children
Children may not recognize that their obsessions or compulsions are excessive or unreasonable. The mean age of onset in children is ten years of age The most common symptoms include the following:
- fear of contamination (such as getting HIV or another life-threatening illness)
- thoughts of harming self and/or familiar figures
- washing and cleansing rituals
- repeating and checking behaviors
- Main article: OCD: History of the disorder.
- Main article: OCD:Theoretical approaches.
- Main article: OCD:Epidemiology.
- Main article: OCD:Risk factors.
- Main article: OCD:Etiology.
- Main article: OCD:Diagnosis & evaluation.
- Main article: OCD:Comorbidity.
- Main article: OCD:Treatment.
- Main article: OCD:Prognosis.
- Main article: OCD:Service user page.
- Main article: OCD:Carer page.
- OCD: incidence
- OCD: prevalence
- OCD: morbidity
- OCD: mortality
- OCD: racial distribution
- OCD: age distribution
- OCD: sex distribution
: Risk factors
- known evidence of risk factors
- theories of possible risk factors
- known evidence of causes
- theories of possible causes
: Diagnosis & evaluation
- OCD: psychological tests
- OCD: differential diagnosis
- OCD: evaluation protocols
- outcome studies
- OCD: treatment protocols
- OCD: treatment considerations
- OCD: evidenced based treatment
- OCD: theory based treatment
- OCD: team working considerations
- OCD: followup
: For people with this difficulty
- OCD: user:how to get help
- OCD: user:self help materials
- OCD: user:useful reading
- OCD: user:useful websites
: For their carers
- OCD: carer:how to get help
- OCD: carer:useful reading
- OCD: carer:useful websites
- Asperger's syndrome
- Body dysmorphic disorder
- Cognitive/Cognitive Behavioral Therapy
- Compulsive hoarding
- Intrusive thoughts
- Mood disorder
- Obsessive-compulsive personality disorder
- Purely Obsessional OCD
- Relationship obsessive–compulsive disorder
- Tourette syndrome
- Types of disorders
- Silverman, W., Ginsburg, G., (1998) Anxiety Disorders. In T. H. Ollendick & M. Herson, (Eds.) pp. 239-268), Handbook of Child Psychopathology, Third Edition, NY: Plenum Press.
- Albano, A., Knox. L., & Barlow, D. (1995). Obsessive-compulsive disorder. In A. R. Eisen, C. Kearney, & Ca. A. Schafer (Eds.) Clinical handbook of anxiety disorder s in children and adolescents (pp. 282-3160. Northvale, NJ: Aronson.
Key Texts – Books
- Rachman, S The Treatment of Obsessions, ISBN 0198515375 .
- Salkovskis AM, Kirk J. (1997). Obsessive–compulsive disorder.New York: Oxford University Press;
Additional material – Books
- Freedom From Obsessive Compulsive Disorder: A Personalized Recovery Program for Living with Uncertainty'' (2003), ISBN 1585422460, by Jonathan Grayson.
- The Mind and the Brain: Neuroplasticity and the Power of Mental Force, ISBN 0060988479, by Jeffrey M. Schwartz, Sharon Begley.
- Brain Lock: Free Yourself from Obsessive-Compulsive Behavior, ISBN 0060987111, by Jeffrey M. Schwartz.
- The Imp of the Mind: Exploring the Silent Epidemic of Obsessive Bad Thoughts, ISBN 0452283078, by Lee Baer.
- Obsessive-Compulsive Disorders: A Complete Guide to Getting Well and Staying Well (2000), ISBN 0195140923, by Fred Penzel.
Key Texts – Papers
- Eisen JL, Goodman WK, Keller MB, Warshaw MG,
DeMarco LM, Luce DD, et al. Patterns of remission and relapse in obsessive-compulsive disorder: a 2- year prospective study. J Clin Psychiatry 1999;60:346–51.
- James IA, Blackburn IM.(1995) Cognitive therapy with obsessive-compulsive disorder. Br J Psychiatry ;166:444–50.
- Kobak KA, Greist JH, Jefferson JW, Katzelnick DJ,
Henk HJ. Behavioral versus pharmacological treatments of obsessive compulsive disorder: a meta-analysis. Psychopharmacology 1998;136:205–*Abramowitz JS. Effectiveness of psychological and pharmacological treatments for obsessive–compulsive disorder: a quantitative review. J Consult Clin Psychol 1997;65:44–52.
Additional material - Papers
- Antony, M.M., F. Downie, and R.P. Swinson. “Diagnostic Issues and Epidemiology in Obsessive-Compulsive Disorder” in Obsessive-Compulsive Disorder: Theory, Research, and Treatment, eds. M.M. Antony, S. Rachman, M.A. Richter, and R.P. Swinson. New York: The Guilford Press, 1998, pp. 3-32.
- Baer, L., M.A. Jenike, and W.E. Minichiello. Obsessive Compulsive Disorders: Theory and Management. Littleton, MA: PSG Publishing, 1986.
- Barlow, D.H. and V. M. Durand. Essentials of Abnormal Psychology. California: Thomson Wadsworth, 2006.
- BBC Science and Nature: Human Body and Mind. Causes of OCD. < http://www.bbc. co.uk/science/humanbody/mind/articles/disorders/causesofocd.shtml>. Accessed April 15, 2006.
- Belkin, L. “Can You Catch Obsessive-Compulsive Disorder?” The New York Times Magazine. < http://www.nytimes.com/2005/05/22/magazine/ 22OCD.html? ex=1145419200&en=dac0fb81aa28b46b&ei=5070>. Accessed April 12, 2006.
- Carter, K. "Obsessive-Compulsive Disorder." PSYC 210 lecture: Oxford College of Emory University. Oxford, GA. 14 Feb. 2006.
- Carter, K. "Obsessive-Compulsive Personality Disorder." PSYC 210 lecture: Oxford College of Emory University. Oxford, GA. 11 April 2006.
- Edna B. Foa & Reid Wilson, Stop Obsessing! How To Overcome Your Obsessions And Compulsions, Bantam Books, 1st Edition (July 2001), ISBN 0553381172. A self-help text for OCD patients, clear, precise and practical.
- Mineka, S., Watson, D. & Clark, L. A. (1998). "Comorbidity of Anxiety and Unipolar Mood Disorders." Annu. Rev. Psychol., 49, 377-412. Peer reviewed journal article offering a possible explanation for the high comorbidity rate of anxiety disorders and certain mood disorders.
- OCD and Contamination accessed January 26th 2006.
- Quick Reference to the Diagnostic Criteria from DSM-IV-TR. Arlington, VA: American Psychiatric Association, 2000.
- Rachman, Stanley & De Silva, Padmal Obsessive Compulsive Disorders: The Facts, Oxford University Press, 2nd edition (January 15, 1998), ISBN 0192628607. Book for patients and their families. Includes assessment and evaluation, treatment, effect on family, work, and social life, practical advice, and its relationship to other disorders.
- Rapoport, Judith, L. The Boy Who Couldn't Stop Washing : The Experience and Treatment of Obsessive-Compulsive Disorder (1991), ISBN 0451172027, A highly readable introduction to OCD, with case histories.
- Rasmussen, S.A. “Genetic Studies of Obsessive Compulsive Disorder” in Current Insights in Obsessive Compulsive Disorder, eds. E. Hollander, J. Zohar, D. Marazziti, and B. Oliver. Chichester, England: John Wiley & Sons, 1994, pp. 105-114.
- Tennen, M. 2005, June. Causes of OCD Remain a Mystery. <http://www.healthatoz.com/ healthatoz/Atoz/dc/cen/ment/obcd/alert07172003.jsp>. Accessed April 14, 2006.
- Lopez-Ibor JJ, Lopez-Ibor MI. Research on
obsessive–compulsive disorder. Current Opinion in Psychiatry 2003;16:S85–91.
- Nymberg JH, Van Noppen B. Obsessive–compulsive
disorder: a concealed diagnosis [review]. Am Fam Physician 1994;49:1129–37.
- Karno M, Golding JM, Sorenson SB, Burnam MA.
The epidemiology of obsessive–compulsive disorder in five US communities. Arch Gen Psychiatry 1988;45:1094–9.
- OCD Action and OCD-UK are national charities for people who are affected by Obsessive-Compulsive Disorder (OCD)
- The Obsessive-Compulsive Foundation (OCF)
- The OCD Centre, UK
- NOCD a community for people with OCD
OCD: Academic support materials
- OCD: Lecture slides
- OCD: Lecture notes
- OCD: Lecture handouts
- OCD: Multimedia materials
- OCD: Other academic support materials
''' OCD: Anonymous fictional case studies for training'''
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