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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 lexicon, and is often used in an offhand manner to describe someone who is meticulous or absorbed in a cause (Felix Unger). 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 (1), (2), (3), and (4):
(1) 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.
(2) the thoughts, impulses, or images are not simply excessive worries about real-life problems
(3) the person attempts to ignore or suppress such thoughts, impulses, or images, or to neutralize them with some other thought or action
(4) the person recognizes that the obsessional thoughts, impulses, or images are a product of his or her own mind
Compulsions are defined by (1) and (2):
(1) 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.
(2) 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.
Symptoms and prevalence
Modern research has revealed that OCD is much more common than previously thought. An estimated 1 in 50 adolescents and adults is thought to have OCD. Because of the condition's personal nature, and the lingering stigma that surrounds it, there may be many unaccounted-for OCD sufferers, and the actual percentages could be even higher.
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.
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.
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.
- The illness ranges widely in severity.