OCD is has become a household name whenever someone we know is very strict with rules and restrictions or having a ritual that has to be followed.
But the obsessive-compulsive disorder is much more than just being very strict and adhering to rules. There is a full diagnostic criterion to diagnose a person with OCD and a therapeutic rule book to treat the disorder.
People usually confuse OCD with OCPD which is Obsessive-compulsive personality disorder. Both are different in nature and diagnosing criterion. A person can have both OCD and OCPD.
Diagnostic criteria for OCD
To diagnose a person with OCD the person must have obsessions and compulsions which are defined below.
What is Obsession:
- Unwanted thoughts and urges cause significant anxiety and stress in the person. The person wants to suppress these thoughts or replace them with other thoughts but could not.
- These thoughts cause disturbances in the person and obstruct any work the person is trying to do.
What is Compulsion:
- Repeated behaviors that follow obsessive thoughts. These behaviors include washing hands repeatedly, excessive praying, counting numbers, etc. The person performs these acts in response to the obsessions rigidly.
- These behaviors are performed to suppress the anxiety and distress caused by obsessions. In reality, these behaviors are excessive in nature and do not link with the obsessions.
| Obsessions | Compulsions |
| Obsessions are repetitive and persistent thoughts(of contamination), images- horror scenes or any violence, urges- to stab someone, other mannerisms | Compulsions are repetitive behaviors like washing hands, praying excessively, mental acts– like counting unnecessarily. that the person believes should be done to suppress the obsessions or rules that must be followed rigidly. |
| Obsessions are not pleasurable or voluntary. | Compulsions are typically followed by thoughts of obsessions- washing hands after thoughts of contamination |
| Obsessions are unwanted which causes distress and anxiety. | The aim of these behaviors is to reduce anxiety driven by obsessive thoughts. Compulsions are done for pleasure, but some may give relief to anxiety. |
List of obsessions and compulsions
- Cleaning– contamination obsessions and cleaning compulsions
- Symmetry– symmetry obsessions and repeating, counting, and ordering compulsions.
- Forbidden or taboo thoughts– aggressive, sexual, and religious obsessions.
- Harm- fear of harm from others or infection, repeated checking(did I lock the door properly).
- Difficulty in discarding– Some individuals with OCD hoard objects as they can not discard or through away. They can accumulate any object like disposable items, used earbuds, etc for years.
Risk Factors
Individuals with Obsessive compulsive disorder experience intense anxiety and even panic attacks when confronted with their compulsions and rituals.
- Individuals with contamination obsessions sometimes avoid public bathrooms, social gatherings, eating outside due to fear of contamination.
- By having harm obsessions, individuals may not even eat or drink even sometimes at home due to the thought that someone may have added poison to it.
- These obsessions and compulsions take time, sometimes hours in day obstructing the work of the person.
Causes
Temperamental:
- Having higher negative emotionality,
- internalizing symptoms(symptoms experienced internally like sadness, anxiety, and loneliness),
- Behavior inhibition in childhood.
Environmental:
- Physical or sexual abuse in childhood
- Stressful or traumatic events
Genetic
- Having first-degree relatives with OCD increases the chances of getting OCD by 10 fold.
Biological:
- Dysfunction in
- orbitofrontal cortex– a region above eyelids and responsible for making cognitive decisions.
- anterior cingulate cortex– a region responsible for making higher cognitive functions, empathy, and impulse control.
- Striatum– contains neurons that signal social actions of reward.
Word from PsychHelp
People with OCD face everyday challenges in professional and personal life. Due to obsessions of symmetry, they may not finish school/work projects as they do not feel it just right yet. Due to harm obsessions, they may fail at good relationships which they feel is hazardous.
Psychotherapy:
For many years OCD was considered to be a restraint in treating with either therapy or medication. The positive treatment results came from the exposure and ritual prevention therapy approach.
Treatment for OCD is better done under Behavior therapy than unconscious motivation. The goal in behavior therapy is to reduce obsession anxiety using exposure techniques. The process takes place from adaptation to habituation. Other techniques used are systemic desensitization, Aversion therapy, imaginal exposure.