Obsessive Compulsive Disorder (OCD) is a disorder characterized by the recurrent and persistent appearance of intrusive thoughts, images or impulses (obsessions) that generate very intense anxiety or discomfort and lead the sufferer to perform a series of behaviors (compulsions, rituals or neutralization behaviors) to reduce such discomfort or to avoid the occurrence of some negative consequence.
When performing the avoidance behavior, the person unconsciously learns that the sensation of danger ceases when the anxiety decreases, so he or she tends to repeat the behavior in the long term, until it becomes a habit.
How to detect if we have OCD?
The main characteristic of OCD is the sudden appearance of unwanted thoughts or images or impulses that generate strong distress and give rise to a pressing need to do something to alleviate the discomfort or to prevent some disaster or feared event from occurring, either to oneself or to others.
The difference with the obsessive manifestations and compulsions (manias) of people without clinical problems is that in people with OCD they are more frequent, intense, disturbing and interfere in a significant way in their lives, since they require a lot of time and energy and end up causing personal, work and socio-familial deterioration.
In addition, people with OCD feel responsible for and enslaved by their obsessions. They usually know that they are irrational, senseless and exaggerated, but the moment they appear they hesitate and feel unable to distance themselves from them and continue with what they are doing.
They often consider that they are unacceptable and feel bad about themselves for not being able to control them, feeling that they are inadequate for having these thoughts and that they may mean something negative about themselves.
Difference between obsessions and compulsions
Obsessions are thoughts, images or impulses that spontaneously and persistently appear in the mind of the person, who considers them as intrusive and unwanted, and cause excessive discomfort or anxiety. The person tries to ignore them, suppress them or neutralize them by means of other thoughts or acts.
For their part, compulsions are the behaviors that the person performs in response to these obsessions or in accordance with certain rigid rules that must be applied to relieve anxiety or to prevent the occurrence of something feared. Usually the behavior performed is related to the content of the obsession, but sometimes it is not.
The most common obsessions are:
- Of contamination: they are characterized by an excessive fear of becoming infected by being in contact with some substance that they consider dangerous (virus, dirt, germs).
- Of repeated doubts and checking: excessive worry about whether the light has been left on, the door left unlocked or the faucet open.
- Symmetry/order: excessive need for symmetry, order or accuracy and intense discomfort with disorder or asymmetry.
- Moral: moral scrupulosity and guilt. Fear of having immoral thoughts or doing something unacceptable.
- Religious: concern or fear of having blasphemous thoughts, not complying with some religious rule or precept and being punished for it, thinking or doing something that goes beyond moral rectitude or not complying with the divine will.
- Aggressive content: excessive concern or fear of harming others or oneself. Very frequent is the fear of acting moved by involuntary impulses or harming others due to lack of care.
- Of sexual content: involuntary and intrusive thoughts, images or impulses of a sexual nature. There may also be an irrational fear of being homosexual and not knowing it.
- Of somatic content: excessive attention to some part of the body or some of its involuntary functions (blinking, breathing, etc.) or exaggerated concern about contracting a disease or about some aspect of physical appearance.
The most common compulsions are:
- Washing and cleaning: conscientious behaviors such as showering, washing hands, cleaning things or disinfecting. There is also a tendency to avoid touching something that may be contaminated or to use gloves or other behaviors to avoid picking up or touching something.
- Ordering, counting, repeating: the person is forced to order objects in a certain way, or to count things numerically (tiles in the street, tiles on a wall or books on a shelf). Moreover, it must do so in a specific way and a specific number of times.
- Safety, checking and checking: check again and again that everything is right (off, closed, well said or understood) so that something dreaded does not happen.
- Mental: thinking about something several times, mentally repeating certain words or thoughts, praying or counting to oneself. They usually serve to compensate for something they have seen, read or heard or simply to prevent something bad from happening.
- Superstitious” behaviors: these can be mental or external behaviors that the person performs to prevent something bad from happening (using something of a certain color, not stepping on the tiles or doing some kind of ritual). They often involve large amounts of time.
- Accumulation: storing, piling up and/or collecting useless objects.
However, in the latest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published in 2013 by the American Psychiatric Association (APA), hoarding disorder is included as a disorder in its own right within the category of “Obsessive-compulsive and related disorders,” not as a subtype of OCD, although the clinical manifestations are very similar.
What types of OCD are there?
Specific subtypes of OCD are established based on the subject matter of your obsessions/compulsions. The most common classifications are:
- of doubt and verification
- contamination and cleanliness
- of order and symmetry
- of sexual or religious content
- of aggressive content
- of somatic content
- of accumulation
Often people present obsessions and compulsions of different subtypes, although one in particular tends to predominate and to be maintained over time.
In addition, certain compulsions can be linked to different obsessions, for example, the compulsions of verification can be associated to obsessions of doubt and verification, but also to those of aggressive or religious character.
How is Obsessive Compulsive Disorder treated?
The psychological treatment that for years has shown its efficacy in obsessive compulsive disorder has as a central element the technique called Exposure with Response Prevention. It consists of gradually exposing the patient to the feared stimulus and teaching him/her cognitive, behavioral and emotional regulation techniques that help him/her to resist the impulse to perform compulsions or neutralization/avoidance behaviors to control anxiety or to avoid the occurrence of the feared stimulus.
To favor the effectiveness of the treatment, it is important to carry out a task of psychoeducation, where the patient understands well what the disorder consists of and the reason for the application of these techniques. In this way, we can help him/her to commit to change.
In the treatment of OCD, additional work with the family is often required, either at the pedagogical level or at the intervention level, as well as pharmacological treatment.
What other disorders are associated with Obsessive Compulsive Disorder?
The main disorders that have been found to be associated with obsessive-compulsive disorder are depressive disorders (especially major depressive disorder) and anxiety disorders.
Depressive disorder often appears as a consequence of OCD, while anxiety disorders often precede it.
Among the associated anxiety disorders, generalized anxiety disorder, social phobia, specific phobia and panic disorder are particularly prominent.
A certain rate of comorbidity has also been described with hypochondriasis, body dysmorphic disorder, sleep-wake disorders, excessive consumption of alcohol and other substances, eating disorders and obsessive-compulsive, avoidant and dependent personality disorder.