Making light of obsessive-compulsive disorder (OCD) is common. The phrase “I’m so OCD” has become a popular joke people say after organizing, cleaning or any task involving excessive attention to detail. Even retailers have joined in, including Target with its “Obsessive Christmas Disorder” sweater.
OCD, however, is not a preoccupation with being perfect. It’s not an eccentric or positive personality trait. The types of OCD symptoms people encounter can, as author Alison Dotson told The Atlantic, consume someone with fear and make them feel like they can’t control their own thoughts and emotions. Trivializing OCD through superficial references undermines the seriousness of the disorder. Unfortunately, those trends lead to mental health stigma about that impact whether people seek help.
“I started obsessing when I was a child, and I wasn’t diagnosed with OCD until I was two months shy of my 27th birthday. I suffered in silence for years and years because all I knew about OCD was that people wash their hands too much and always check to make sure the stove is off.” –Alison Dotson, author of “Being Me with OCD”
Overcoming the misconceptions that people have about OCD is possible through education and awareness. It’s important to become familiar with the types of OCD symptoms individuals can have and how to help them receive the proper support.
Types of OCD Symptoms
There are two types of OCD symptoms: obsessions and compulsions. Either obsessions, compulsions or both must be present to receive a diagnosis of OCD, according to the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Most affected individuals possess both types of OCD symptoms.
Note that symptoms must be time-consuming (more than 1 hour per day) or cause clinically significant distress in an important area of functioning. Symptoms must also not be attributable or better explained by use of a substance or by another medical condition or mental disorder.
Obsessions are defined in the DSM-5 by (1) and (2):
- Recurrent and persistent thoughts, urges, or images that are experienced, at some time during the disturbance, as intrusive and unwanted, and that in most individuals cause marked anxiety or distress.
- The individual attempts to ignore or suppress such thoughts, urges, or images, or to neutralize them with some other thought or action (i.e., by performing a compulsion).
In OCD, obsessions are not easily controlled. Even after attempting to suppress certain thoughts, urges or images, they return and are often accompanied by fear and powerlessness. Another key to understanding obsessions in the context of OCD is that they are not pleasurable.
In common language, “obsessing” or “being obsessed” is often used with the connotation of being preoccupied, according to the International OCD Foundation (IOCDF). The term used in that way, however, means the task described can be enjoyable for people and it doesn’t undermine daily living. For instance, someone can take pleasure in being “obsessed” with a new movie. Although in more serious circumstances, such as fearing a loved one’s health or safety, consuming thoughts wouldn’t be enjoyable, but in all cases, the individual is able to continue with daily life.
Obsessions in OCD are debilitating, causing people to struggle with everyday living. Individuals may avoid or be so overwhelmed by obsessions that they are unable to perform normal tasks and responsibilities. Emotional and physical discomfort can result due to fear, anxiety or guilt.
Compulsions are defined in the DSM-5 by (1) and (2):
- Repetitive behaviors (e.g., hand washing, ordering, checking) or mental acts (e.g., praying, counting, repeating words silently) that the individual 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 anxiety or distress, or preventing some dreaded event or situation; however, these behaviors or mental acts are not connected in a realistic way with what they are designed to neutralize or prevent, or are clearly excessive.
Note: Young children may not be able to articulate the aims of these behaviors or mental acts.
Compulsions in OCD take the form of repetitive behaviors or mental acts. Most often, compulsions are performed to help alleviate obsessions, but sometimes they are used to generally prevent bad things from happening. Compulsions typically provide little or no relief to the underlying obsession or anxiety, and the cycle of symptoms starts again. The result is the debilitating nature of OCD.
Individuals with OCD usually regard their compulsions as excessive and unreasonable. That feature is what separates compulsions in OCD from actions that most people engage in from time to time, as well as repetitive behaviors found in a condition like autism spectrum disorder.
Common Categories of Symptoms in People with OCD
|Aggression||Fear of harming others, recurring violent images||Asking for reassurance about being a good person; monitoring news for violent crimes|
|Contamination||Fear of being contaminated or contaminating others (germs, infections, environmental factors; contaminated by immoral persons)||Washing or cleaning rituals|
|Completeness/doubt||Recurring worries of doing things incorrectly or incompletely||Checking excessively; performing actions in a certain order|
|Religious||Thoughts about being immoral or eternal damnation||Asking forgiveness; praying; seeking reassurance|
|Self-control||Fear of making inappropriate comments in public||Avoid being around other people|
|Sexual||Recurring thoughts of being sexually deviant or about acting sexually inappropriate||Avoid situations that can trigger those thoughts; counteract thoughts through mental rituals|
|Superstition||Fears of specific “bad” numbers or colors||Counting excessively|
|Symmetry/exactness||Recurring thoughts of having to do things in a balanced or exact way||Ordering and arranging|
Adapted from The New England Journal of Medicine. 2014;371(7):649. (link to abstract)
Additional Information about OCD
Causes of OCD
The exact causes of OCD are not known. The IOCDF stated that based on current research, differences in the brain and genes of people affected with OCD may have a role in the development of the disorder. OCD tends to run in families; the Anxiety and Depression Association of America (ADAA) reported that about 20 percent of children with OCD have a family member with the disorder.
Prevalence of OCD
In the United States, the 12-month prevalence of OCD is 1.2 percent, according to the DSM-5. It occurs internationally in 1.1 to 1.8 percent of people.
Figures for the prevalence of OCD are widely believed to be low. “The lifetime prevalence of OCD is 2.3 percent, although this may be an underrepresentation because often only patients with moderate to severe symptoms seek help,” American Family Physician noted. The same article noted that for one study population, “only 30.9% of patients with severe symptoms and 2.9% of patients with moderately severe symptoms received treatment specific for OCD.”
OCD Treatment Options
OCD can be treated effectively with medication, therapy or a combination of both, according to the ADAA. Medication can include antidepressants. The preferred therapeutic option is cognitive-behavioral therapy (CBT), which is a type of CBT called exposure and response prevention (ERP). ERP involves gradually exposing patients to feared stimuli, such as what may trigger an obsession or compulsion. In time, patients can learn to control how they react what would ordinarily begin a debilitating cycle of OCD symptoms.
According to the IOCDF, about 70 percent of people will benefit from ERP, medication or a combination of both, and there are additional treatment options. The DSM-5 noted that without treatment, remission rates in adults are low (20 percent for people reevaluated 40 years later). Forty percent of individuals who develop OCD in childhood or adolescence may receive remission by early adulthood.
How You Can Help Someone Who May Have OCD
OCD is not a condition that people should feel like they have to live with. It is a serious mental health condition that can be controlled and even overcome through effective treatment options.
Living with the different types of OCD symptoms can be crippling and frightening. To make matters worse, the guilt associated with having OCD can spread. Not only can they experience guilt about their symptoms, but also about having a mental health disorder. That is made more challenging by some popular misconceptions and stigma about OCD and mental health in general across popular culture.
As a result, people who may have OCD often try to hide their symptoms, which can prevent them from receiving valuable support. If you think that you know someone with OCD, try to reach out to that person and encourage him or her to seek treatment. You can find a therapist today using the ADAA’s directory.
If you’d like to help support individuals and communities in managing mental health, consider earning your behavioral health degree online. You’ll be able to dedicate your work to battling mental health stigma, educating people about mental illness topics like OCD and making a difference in people’s lives. Potential careers include community health specialist, health services manager, mental health technician and residential treatment specialist. You’ll also be prepared to apply for graduate studies in psychology and counseling.
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