Obsessive-Compulsive Disorder

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Description and Symptoms

Obsessive-compulsive disorder (abbreviated OCD in this literature), one of the most debilitating of all anxiety disorders, as its name suggests, manifests with obsessions Opens in new window and compulsions Opens in new window, and is characterized by habitual thoughts, urges, or images that create apprehension or concern (“obsessions”), or behavioral or mental actions that the patient feels driven to undertake in a repetitive, systematic fashion in order to reduce apprehension or avoid some feared outcome (“compulsion”).

Compulsions Opens in new window are usually performed in response to obsessions Opens in new window. Typical obsessions include:

• fears of being contaminated by germs or poison,
• fears of causing harm to oneself or significant others by not being careful enough, and
• fears of doing something unacceptable.

Persons who have OCD manifest recurrent and persistent, intrusive and unwanted, unjustified, and anxiety-inducing thoughts or obsession.

They attempt to resist or reduce those obsessions by repeatedly performing some behavior or compulsion, which can be mental or physical. For example, an OCD sufferer might be constantly anxious about contamination by germs, so s/he compulsively washes her/his hands many times each hour and avoids touching others.

Compulsions are also known as rituals, Opens in new window and may be either overt acts (i.e., repeatedly checking that a stove is turned off) or mental acts (as in silently repeating a prayer). Typical compulsions include excessive or ritualized washing/cleaning and repeated checking, occurring in 53% and 50% of cases, respectively (Ball, Baer, & Otto, 1996).

Other rituals Opens in new window include counting; mental rituals such as repeating words, phrases, or prayers; seeking reassurance; hoarding objects; and insisting that things be put in a specific order or pattern.

Individuals with OCD commonly also exhibit passive avoidance or escape behaviors, as well as pathological doubt about whether they have performed tasks or actions correctly (or at all), despite objective evidence to the contrary.

Passive avoidance behaviors (e.g., avoiding using the stove) are seen across the range of anxiety disorders and are functionally similar to active avoidance behaviors such as compulsive rituals Opens in new window, in that both are aimed at reducing discomfort or anxiety.

Although a fear of uncertainty is present in other anxiety disorders, pathological doubt about one’s memory for actions performed (e.g., unreasonable doubt that one has adequately checked the stove to ensure that it is turned off) appears to be unique to OCD (Tolin, Abramowitz, Brigidi, & Foa, 2003).

The central role of anxiety in this syndrome explains why DSM-IV-TR classified OCD as an anxiety order. DSM-5 later introduced a separate chapter titled “Obsessive-Compulsive and Related Disorders” immediately after its chapter on anxiety disorders. However, regardless of the classification, researchers continue to refer to OCD as an “anxiety disorder”, mainly because of the central role of anxiety in OCD (Abramowitz & Jacoby, 2014).

People with OCD have some recognition that their obsession and compulsions are exaggerated and unrealistic. However, this recognition waxes and wanes during the illness, and in some cases it may rarely be present. Even when individuals have insight into the senselessness of their obsessions and compulsions, they find themselves unable to stop the intrusive obsessive thoughts and feel driven to perform the rituals.

OCD may persist in patients for years before they present for treatment. Some patients feel compelled to perform rituals Opens in new window for hours at a time, which interfere with their ability to fulfill social roles, such as work obligations and marital or other interpersonal relationships (Riggs, Hiss, & Foa, 1992).

Many avoid situations that provoke obsessive thoughts, and some patients become homebound. Often patients involve other family members in their compulsive behaviors:

As a result, OCD is associated with high rates of disability and a lowered quality of life. Approximately 38% of those with OCD are unable to work at some time, due to the severity of their disorder; 22% are unemployed, and 24% live a substandard socioeconomic class (Mancebo et al., 2008).

For a detailed description of OCD, refer to the current diagnostic criteria for OCD Opens in new window (DSM-5: 681; c.242).