Obsessive-Compulsive Disorder (OCD)

What is OCD

Have you ever heard the statement “oh she’s so OCD”? The idea that Obsessive-Compulsive Disorder (OCD) is simply a quirk or personality characteristic is a major misconception. OCD is a serious mental health disorder, often very distressing and debilitating, and affects individuals across all ages, cultures and genders.

OCD is characterised by a pattern of obsessions (unwanted thoughts, images and fears) and compulsions (repetitive behaviours which aim to ‘neutralise’ the unwanted thoughts/fears or act on the thoughts in a way where they prevent or de-escalate the distress of the obsession), which cause distress and impairment on one’s functioning.

Both obsessions and compulsions can interfere with daily life and often cause a lot of distress to the individual. Thus, while engaging with and completing the compulsions can often ease the distress of the obsession, this in turn creates and prolongs the cycle of OCD.

In summary:

Obsessions – unwanted thoughts, images and fears which are often intrusive and distressing in nature.

Compulsions – repetitive behaviours or thoughts which aim to neutralise the unwanted thoughts/fears and ease distress by getting rid of the obsessions until it feels “just right”.

DSM criteria:

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the criteria for an OCD diagnosis requires the following:

1. Presence of obsessions, compulsions, or both:

Obsessions are defined by (1) and (2):

1. 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.
   1. 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).

Compulsions are defined by (1) and (2):

• Repetitive behaviours (e.g., handwashing, 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 behaviours or mental acts are aimed at preventing or reducing anxiety or distress, or preventing some dreaded event or situation; however, these behaviours or mental acts are not connected in a realistic way with what they are designed to neutralize or prevent or are clearly excessive.

• The obsessions or compulsions are time-consuming (e.g., take more than 1 hour per day) or cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
• The obsessive-compulsive symptoms are not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition.
• The disturbance is not better explained by the symptoms of another mental disorder (e.g., excessive worries, as in generalized anxiety disorder).

OCD can often focus on themes such as contamination of germs, harm to loved ones, sexually natured ideology, checking and cleaning to name a few. Often, compulsions can take up a lot of time to perform, sometimes up to hours per day, greatly impacting on someone’s daily routine and wellbeing.

Let’s look at some examples:

Common Obsessions

• Responsibility: fears of being responsible for a terrible/catastrophic event or responsible over another person’s actions (i.e. a partner cheating).
• Sexually natured: intrusive and unwanted images and/or thoughts relating to sexual content and/or fears of acting on impulsive sexual thoughts or sexually harming behaviours.
• Contamination: fears of contamination via contact with various substances (i.e. bodily fluids and products, germs or diseases, or chemicals).
• Religious: Fears of being punished by or offending God or other religious figures, and concerns with morality.
• Harm to self or others: fears of harm coming to oneself or others due to acting on impulsive thoughts or not being careful enough.
• Perfectionism: fears of something not being perfect, even, correct or exact or making mistakes.

Common Compulsions

• Mental: thinking about images, thoughts, statements, counting or praying to prevent the distressing idea from happening or until it feels “just right”.
• Repeating: practicing activities or rituals over and over again (i.e. tapping, stepping, picking up and placing down items, blinking) until it feels “just right”, this can also occur in certain number patterns that feel “safe” or “right” (i.e. tying shoe laces three times, opening and closing a door 5 times).
• Ordering: Placing items or completing tasks in a certain order.
• Cleaning: cleaning/washing self or body parts a certain number of times or a certain way (i.e. washing hands with very hot water), or excessive cleaning of items, rooms or spaces to avoid contamination/sickness or until it feels “just right”.
• Checking: checking over and over that doors are locked, appliances are turned off, you have not harmed someone else or won’t harm yourself, that something bad hasn’t happened or won’t happen.
• Other: touching certain items, making religious gestures, rubbing hands or fingers together to avoid something bad from happening or until it feels “just right” or “safe”.

Ultimately, the goal of compulsions can often be to feel some sort of control over oneself, behaviour and distressing thoughts by taking action on preventative or remedial behaviours. So, completing compulsions until something feels “safe” or “just right” can provide a sense of relief and control for the person so they can try and move along in their day. However, both OCD obsessions and compulsions often occur multiple times a week, day or hour, and can therefore not only increase distress, but be incredibly time consuming and debilitating for the person, often interfering with school, work or other areas of functioning.

How is OCD Diagnosed

In order to get a diagnosis, you’ll need to see a trained mental health professional (such as a psychologist) who can diagnose OCD. Usually, they will ask questions to better understand your symptoms and determine whether your symptoms meet the criteria for an OCD diagnosis.

What is the treatment for OCD

According to research, the most effective treatments for OCD are therapy, such as Cognitive Behavioural Therapy (CBT) with Exposure and Response Prevention (ERP) and Acceptance and Commitment Therapy (ACT), and medication. Therapy can help someone experiencing OCD to improve insight and awareness of their thoughts and actions. This can help to better manage their symptoms to feel a sense of control and not allow the symptoms to determine or control their life. This can lead to less distress and debilitation and better quality of life overall.

How do I find help for OCD?

Usually the best place to start looking for help with OCD is your doctor, otherwise jumping on to a search engine and looking for psychologists who are experienced with OCD is a good way to begin too. You can read more on finding a psychologist here: Finding a psychologist

Our team here at Mind Life Psychology are highly experienced working with OCD and other anxiety disorders.

Frequently Asked Questions about OCD

How are compulsions different from rituals?

Typically, rituals (i.e. a repetitive bedtime ritual – shower, brush teeth, read, go to bed), tend to be done without much intense thought and don’t usually cause distress for someone. However, compulsions aim to reduce distress or avoid something ‘bad’ happening. Thus, if someone is unable to complete a compulsion, we usually see an increase in the distress that they feel, often debilitating, and a significant struggle or even inability to continue on with their day or tasks until they can complete the compulsion. Whereas, as stated in the example above, for someone who does not struggle with OCD, not being able to read before bed is unlikely to cause significant distress or debilitation, nor will they worry about something bad happening or stopping distressing thoughts if they cannot read before bed.

Who can experience OCD?

OCD can affect anyone of all ages, races, genders, and backgrounds. Risk factors include a family history of OCD (i.e. parents or family who also have OCD), stressful life events or trauma, and other mental health disorders, as OCD can co-occur with other presentations and conditions (such as Generalised Anxiety Disorder and Major Depressive Disorder (depression)).

Does OCD appear at a certain age?

No, OCD can emerge at any time across the lifespan. However, research does suggest that it can commonly start to occur at two stages of life, between late childhood and early adolescence, and early adulthood.

What causes OCD?

While the exact cause of OCD is unknown, it’s believed to be a combination of genetic, environmental (i.e. learned or taught behaviours) and biological (i.e. body and brain chemistry/functions/changes) factors. Research indicates that there is no single cause for OCD, especially as different people develop OCD for different reasons. The good news is that treatment for OCD can be very effective and helpful regardless of the cause of OCD.

How many adults have OCD?

According to research, globally, OCD affects 1-3% of the population. In Australia it is estimated to affect 3% of people, 1.2% of adults in the USA, 1% of people in Canada, and 1.2% of the population in the UK.

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