What is OCD?
Sarah Allen Benton, LMHC, and Denise Egan Stack, LMHC

    Obsessive-Compulsive Disorder (OCD) affects 3 to 5% of the American population, which means that seven and a half million people will experience OCD symptoms at some point in their lives.¹ Males and females are affected at the same rate and genes play a role in the development of OCD in a significant number of cases.² OCD is a neurological disorder that is characterized primarily by obsessions and compulsions and is considered to be an anxiety disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV TR). OCD symptoms manifest at any time from preschool age to adulthood, usually presenting before age 40. Often times OCD symptoms are unrecognized and untreated because many healthcare providers are unfamiliar with the symptoms of the disorder or are not trained in providing effective treatments and because sufferers are reluctant to discuss their symptoms due to shame and guilt.³

     Obsessions are persistent and intrusive impulses, ideas, images or thoughts that create excessive worry and anxiety. Examples of typical obsessions are a fear of dirt and germs or a fear of something bad happening to a loved one. Compulsions are mental acts or repetitive behaviors that are performed in response to an obsession in order to relieve anxiety. Because compulsive rituals don't provide anxiety relief permanently, over time, the person with OCD may need to increase and change rituals in order to feel relief. OCD sufferers may experience compulsions as a glitch or feeling that their brain is "stuck in gear."⁴ Examples of typical compulsions are excessive hand washing and repeatedly checking doors to see that they are locked.⁵

    Ritualistic behavior, such as prayer, may be a normal part of life for many people, and some worries are rational and necessary to protect us from danger. It is only when obsessions and compulsions are irrational, cause distress, take up time (more than an hour a day), and negatively impact daily functioning (work, social life, etc.) that an individual should seek professional help.

    The Yale Brown Obsessive Compulsive Symptom Checklist categorizes OCD symptoms in the following way:

• Aggressive Obsessions: fears of causing harm to self or others or doing something embarrassing, like blurting out obscenities.
• Contamination Obsessions: excessive fear of dirt, germs, chemicals, bodily fluids or animals. Also, an excessive fear of getting sick from different contaminants.
• Sexual Obsessions: forbidden or perverse intrusive sexual thoughts that might involve children or aggressive acts.
• Hoarding or Saving Obsessions
• Religious Obsessions: excessive concern with right and wrong and /or sacrilege or blasphemy
• Miscellaneous Obsessions: include fears of certain numbers, colors, losing things or not saying just the right thing.
• Somatic Obsessions: include fear of getting sick or a preoccupation with a certain part of one's appearance.
• Cleaning or Washing Compulsions: behaviors performed in response to contamination obsessions and may include excessive hand washing, showering and avoidance of contaminants.
• Checking Compulsions: behaviors performed in response to aggressive obsessions and involve checking to make sure things are turned off (stove, lights) or that people are not harmed. Also, people with OCD sometimes check to make sure that they did not make a mistake.
• Repeating Compulsions: behaviors repeated over and over again in order to produce anxiety relief.
• Counting Compulsions: behaviors such as counting up to a certain number, counting a certain number of times or avoiding certain numbers in order to produce relief from anxiety.
• Ordering and Arranging Compulsions
• Hoarding and Collection Compulsions
• Miscellaneous Compulsions: includes list making, touching, tapping and rubbing things, and rituals involving blinking and staring.

For more information on OCD, visit the Obsessive Compulsive Foundation website link: http://www.ocfoundation.org/

For more information on anxiety disorders, visit the Anxiety Disorders Association of America website link: http://www.adaa.org/

 

Problems Confused with OCD:

• Obsessive-Compulsive Personality Disorder (OCPD): People with OCPD are often overly punctual, orderly, perfectionistic, excessively devoted to work, preoccupied with details and rules, rigid and stingy and many insist that others abide by their way of doing things. Some of these traits may occur in people with OCD, however, they aren't related to the typical obsessions and compulsions characteristic of OCD. It is important that OCD and OCPD not be confused with each other because their treatment differs.⁶ People with OCPD are often more resistant to getting treatment.
• Substance abuse, sexual addiction, compulsive overeating and compulsive gambling: People with these problems act compulsively but not in response to an obsession. With each of these issues, the person derives pleasure and/or a high from engaging in their activity of choice.⁷ In contrast, when engaging in compulsions, a person with OCD simply experiences relief from their obsession and/or anxiety.
• Delusional thoughts: Delusional thoughts are thoughts not grounded in reality but are believed to be true by the person experiencing them. Paranoid delusions are common in paranoid disorders and schizophrenia.⁸ People with OCD are generally able to recognize that their obsessive thoughts are irrational even if they behave in response to them. In the past, people with OCD were misdiagnosed as schizophrenic because some of their thoughts and beliefs resembled delusions.

Problems Related to OCD:

• Body Dysmorphic Disorder (BDD): BDD affects about 2% of the American population, manifesting at the same rate in men and women. People with BDD imagine that they have physical defects that others cannot see and/or focus excessively on minor defects, like a scar or high hair line, for up to eight hours a day. BDD preoccupations cause the individual significant distress in all areas of functioning. A subtype of BDD is muscle dysmorphia, which affects mainly men. Muscle dysmorphia is considered to be the reverse of anorexia because the person thinks that they are physically too small. This belief may lead people to engage in excessive exercise, steroid abuse and/or padding of their clothes.⁹

For more BDD information and treatment options, you may go to the Body Image Program at Butler Hospital website link: http://www.butler.org/body.cfm?id=123

• Trichotillomania is a disorder which involves individuals pulling hair from their scalp, eyelashes, eyebrows and/or pubic region. Trichotillomania occurs mostly in women, and in extreme cases may lead to baldness, causing an individual to have to wear a wig, hair extensions or fake eyelashes in order to cover up bald spots. Individuals claim that pulling hair feels good and is often the only way that one knows how to relieve stress.¹⁰

For more information, you may explore the Trichotillomania Learning Center Online website link: http://www.trich.org/

• Tourette's Disorder: Tourette's disorder is characterized by involuntary motor and vocal tics, which are rapid movements or sounds that are repeated in effort to relieve built up tension. Tics are sometimes referred to as a "psychic itch". Examples of tics include: eye rolling, coughing, throat clearing, licking lips, squealing, yelling, leg jerking and many more. ¹¹ Sometimes tics and compulsive behavior look similarly; however, they are not the same. Compulsions are performed in order to relieve anxiety created by an obsession. Tics are behaviors performed in order to relieve built up tension, like scratching an itch.

For more information on Tourette's Disorder, referrals, support groups, and research studies you may access the Massachusetts Chapter of the Tourette's Syndrome Association website link: http://www.tsamass.org/

Endnotes

1. Baer, L. (2000). Getting Control: Overcoming Your Obsessions and Compulsions. New York: Plume. 10.
2. Gravitz, H.L. (1998). Obsessive Compulsive Disorder: New Help for the Family. Santa Barbara, CA: Healing Visions Press. 42.
3. Obsessive Compulsive Foundation. About OCD. (2007). Retrieved August 23, 2007 from the World Wide Web: http://www.ocfoundation.org/what-is-ocd.html
4. Ibid. 43.
5. Hyman, B. and Pedrick, C. (1999). The OCD Workbook: You Guide to Breaking Free from Obsessive-Compulsive Disorder. Oakland, CA: New Harbinger Publications, Inc.. 8.
6. Baer, L. (2000). Getting Control: Overcoming Your Obsessions and Compulsions. New York: Plume. 25, 26.
7. Ibid. 27.
8. Ibid. 28.
9. Wilhelm, Sabine. Overcoming BDD with CBT Strategies. Obsessive Compulsive Foundation of Greater Boston: Les Grodberg Memorial Lecture Series at McLean Hospital. Belmont, MA. April 3, 2007.
10. Baer, L. (2000). *Getting Control: Overcoming Your Obsessions and Compulsions.* New York: Plume, 157.
11. Tourette's Disorder: Information, Support, Hope. (2004). Tourette Syndrome Symptoms. Retrieved August 28, 2007 from the World Wide Web: http://www.tourettes-disorder.com/symptoms/symptoms.html