OCD – What is Obsessive Compulsive Disorder? Part 1/6

Obsessive compulsive disorder is a mental health issue which is distressing to sufferers and impairs their ability to function in daily life. OCD is characterised by persistent thoughts, ideas, images, doubts or impulses (obsessions) that are experienced as disturbing, along with repetitive behaviour or mental rituals (compulsions) aimed at reducing anxiety.

Obsessions stimulate anxiety and are intrusive, unwanted and distressing. They are often experienced as irrational to the person experiencing them.

Common obsessions include;

  • Fear of contamination (by dirt, germs, bodily waste, chemicals or other substances)
  • Fear of illness, harm or death (to the self or significant others)
  • Aggressive obsessions (fear of hurting the self or others, violence, fear of being responsible for something terrible happening)
  • Sexual obsessions (“forbidden” sexual thoughts, such as incest or involving children, homosexuality or aggressive sexual behaviour)
  • Religious or moral obsessions (worry about thinking or saying something blasphemous, being consumed with always doing the right thing)
  • Number obsessions (safe numbers, bad numbers etc.)
  • Symmetry or exactness obsessions (alignment, perfection etc.)

Compulsions are repetitive behaviour or mental rituals that an individual feels compelled to perform in response to experiencing an obsession. The purpose of the compulsions is to alleviate or reduce the anxiety and distress created by the preceding obsession. The more successful the compulsion is at reducing the anxiety the more powerful and difficult to resist it becomes.

Common compulsions include;

  • Checking (things are locked, turned off, that somebody isn’t hurt or sick, something bad hasn’t happened, that a mistake hasn’t been made)
  • Repeating (rereading or rewriting, repeating activities)
  • Counting (counting and recounting)
  • Symmetry, ordering or arranging (straightening or arranging items)
  • Washing or cleaning
  • Touching
  • Excessive prayer
  • Avoidance of objects, substances or situations
  • Repetitive reassurance seeking

Obsessive-compulsive related disorders include body dysmorphic disorder (body image related obsessions and compulsions), hoarding disorder, trichotillomania (hair pulling disorder), excoriation (skin picking) disorder, and body-focused repetitive behaviour disorder (including nail biting, lip biting and cheek chewing).

OCD is a common mental health issue that impairs the functioning of a large number of people. The life time prevalence for OCD is estimated to be 2-3% of the population. However, some researchers argue this is an underestimate and that many cases of OCD go undiagnosed and untreated. People who suffer from OCD tend to experience impairment in several areas of life including occupational performance, academic achievement, and social functioning. The severity of OCD symptoms tends to wax and wane over time relative to the amount of stress a person experiences, even when the person has engaged in treatment. It can be a chronic and debilitating condition if not treated. Sometimes OCD symptoms can also change over time. For example the subject of obsessions may differ or the compulsions used to reduce anxiety may change.

Most people who suffer from OCD recognise that their fears and rituals are irrational and excessive. Because they have this level of insight they are more often than not distressed by their own thoughts and behaviour. Nonetheless, they feel almost powerless to stop them.

The onset of OCD is usually gradual and tends to manifest during adolescence or early adulthood. However, childhood onset or later life onset is not uncommon. Stressful life experiences such as family illness, death of a significant other, marital problems, divorce, sexual difficulties, or pregnancy often precipitate the onset of OCD.

Sherry-Lee Smith Perth Psychologist Home Page