Obsessive–compulsive disorder is an anxiety disorder characterized by intrusive thoughts that produce uneasiness, apprehension, fear, or worry, by repetitive behaviours aimed at reducing anxiety, or by a combination of such thoughts, or obsessions, and behaviours, or compulsions.
Symptoms may include repetitive hand-washing; extensive hoarding; preoccupation with sexual or aggressive impulses, or with particular religious beliefs; aversion to odd numbers; and nervous habits, such as opening a door and closing it a certain number of times before one enters or leaves a room. These symptoms can be alienating and time-consuming, and often cause severe emotional and financial distress. The acts of those who have OCD may appear paranoid and come across to others as psychotic. However, OCD sufferers generally recognize their thoughts and subsequent actions as irrational, and they may become further distressed by this realization.
OCD is the fourth-most-common mental disorder, and is diagnosed nearly as often as asthma and diabetes mellitus. In the United States, one in fifty adults has OCD. The phrase “obsessive–compulsive” has become part of the English lexicon, and is often used in an informal or caricatured manner to describe someone who is meticulous, perfectionist, absorbed in a cause, or otherwise fixated on something or someone. Although these signs may be present in OCD, a person who exhibits them does not necessarily have OCD, and may instead have obsessive–compulsive personality disorder OCPD, an autism spectrum disorder, or no clinical condition. Multiple psychological and biological factors may be involved in causing obsessive–compulsive syndromes.
Obsessive-compulsive disorder is a psychiatric anxiety disorder that includes distressing, intrusive thoughts and related compulsions, tasks, or so-called rituals to neutralize the obsessions. Obsessions are usually upsetting and the compulsions lead to temporary feelings of relief. To be diagnosed with obsessive-compulsive disorder, one must have either obsessions or compulsions alone, or obsessions and compulsions together, but most people with OCD have both.
Examples of obsessions are:
– Recurrent and persistent thoughts, impulses, or images that are intrusive and inappropriate. The thoughts cause severe anxiety or distress.
– The thoughts, impulses, or images are not just excessive worries about real-life problems.
– The person tries to ignore or suppress the 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, and are not based in reality.
Examples of compulsions are:
– Repetitive behaviours or mental acts that the person feels they must perform in response to an obsession, or according to rigid rules.
– The behaviours or mental acts to prevent or reduce distress or prevent some dreaded event or situation; however, these behaviours or mental acts either are not connected in a realistic way with what they are supposed to neutralize or prevent or are clearly excessive.
In addition, at some point during the course of the disorder, the person must realize that his obsessions or compulsions are unreasonable or excessive, which is why people with OCD are not considered to be detached from reality or psychotic. The obsessions or compulsions must be time-consuming, taking up more than one hour per day, cause distress, or cause difficulty in social, work, or school functioning. Having OCD is stressful and can lead to feelings of hopelessness and depression.
Obsessions are often described as ‘intrusive thoughts’. A typical person with OCD performs tasks, or compulsions, to seek relief from obsession-related anxiety. Within and among individuals, the initial obsessions, or intrusive thoughts, can vary in their clarity and vividness. A relatively vague obsession could involve a general sense of disarray or tension, accompanied by a belief that life cannot proceed as normal while the imbalance remains. A more articulable obsession could be a preoccupation with the thought or image of someone close to them dying. Other obsessions concern the possibility that someone or something other than oneself—such as God, the Devil, or disease—will harm either the person with OCD or the people or things that the person cares about. Others may sense that the physical world is qualified by certain immaterial conditions. These people might intuit invisible protrusions from their bodies, or could feel that inanimate objects are ensouled.
Some people with OCD experience sexual obsessions that may involve intrusive thoughts or images of kissing, touching, fondling, oral sex, anal sex, intercourse, incest and rape with strangers, acquaintances, parents, children, family members, friends, co-workers, animals and religious figures, and can include both heterosexual or homosexual content with persons of any age. As with other intrusive, unpleasant thoughts or images, most people have some disquieting sexual thoughts at times, but people with OCD may attach extraordinary significance to the thoughts. For example, obsessive fears about sexual orientation can appear to the person with OCD, and even to those around them, as a crisis of sexual identity. Furthermore, the doubt that accompanies OCD leads to uncertainty regarding whether one might act on the troubling thoughts, resulting in self-criticism or self-loathing.
The person with OCD understands that their notions do not correspond with the external world; however, they feel that they must act as though their notions were correct. For example, an individual who engages in compulsive hoarding might be inclined to treat inorganic matter as if it had the sentience or rights of living organisms, but such an individual might find their consequent behaviour irrational on a more intellectual level. In severe OCD, obsessions can shift into delusions when resistance to the obsession is abandoned and insight into its senselessness is lost.
Compulsions include the so-called compulsive behaviour. While some people with OCD perform compulsive rituals because they inexplicably feel they must, others act compulsively so as to mitigate the anxiety that stems from particular obsessive thoughts. The person with OCD might feel that these actions somehow either will prevent a dreaded event from occurring, or will push the event from their thoughts. In any case, the individual’s reasoning is so idiosyncratic or distorted that it results in significant distress for the individual with OCD or for those around them. Excessive skin picking (i.e. dermatillomania) or hair plucking (i.e. trichotillomatia) and nail biting (i.e. onychophagia) are all on the Obsessive-Compulsive Spectrum. Individuals with OCD are aware that their thoughts and behaviour are not rational, but they feel bound to comply with them to fend off feelings of panic or dread.
Some common compulsions include counting specific things, such as footsteps, or in specific ways – for instance, by intervals of two – and doing other repetitive actions, often with atypical sensitivity to numbers or patterns. People might repeatedly wash their hands or clear their throats, making sure certain items are in a straight line, repeatedly check that their parked cars have been locked before leaving them, constantly organizing in a certain way, turn lights on and off, keep doors closed at all times, touch objects a certain number of times before exiting a room, walk in a certain routine way like only stepping on a certain colour of tile, or have a routine for using stairs, such as always finishing a flight on the same foot.
People rely on compulsions as an escape from their obsessive thoughts; however, they are aware that the relief is only temporary, that the intrusive thoughts will soon come back. Some people use compulsions to avoid situations that may trigger their obsessions. Although some people do certain things over and over again, they don’t necessarily perform these actions compulsively. For example, bedtime routines, learning a new skill, and religious practices are not compulsions. Whether or not behaviours are compulsions or mere habit depends on the context in which the behaviours are performed. For example, arranging and ordering DVDs or videos for eight hours a day would be expected of one who works in a video store, but would seem abnormal in other situations. Put another way, if the activity helps bring efficiency to one’s life, it is probably a habit, if it interferes with one’s normal enjoyment of life, it is probably a compulsion.
In addition to the anxiety and fear that typically accompanies OCD, some people may spend hours performing such tasks (i.e. compulsions) every day. In such situations it can be hard for the person to fulfil their work, family, or social roles. In some cases, these behaviours can also cause adverse physical symptoms. For example, people who obsessively wash their hands with antibacterial soap and hot water to remove what they consider to be contamination can make their skin red and raw with dermatitis.
People with OCD can use rationalizations to explain their behaviour; however these rationalizations do not apply to the overall behaviour but to each instance individually; for example, a person compulsively checking the front door may argue that the time taken and stress caused by one more check of the front door is much less than the time and stress associated with being robbed, and thus the check is the better option. In practice, after that check, the person is still not sure and deems it is still better in terms of time and stress to do one more check, and this reasoning can continue as long as necessary.
Scholars generally agree that both psychological and biological factors play a role in causing the disorder, although they differ in their degree of emphasis upon either type of factor.