Obsessive-compulsive disorder (OCD) is a brain disorder, and more specifically, an anxiety disorder. OCD is manifested in a variety of forms, but is most commonly characterized by a subject's obsessive drive to perform a particular task or set of tasks, compulsions commonly termed rituals.
OCD should also be distinguished from the similarly named but notably different obsessive-compulsive personality disorder, which psychiatric guidelines define as a personality characteristic rather than an anxiety disorder.
The phrase "obsessive-compulsive" has worked its way into the wider English lexicon, and is often used in an offhand sense to describe someone who is meticulous or absorbed in a cause. Such casual references should not be confused with obsessive-compulsive disorder. It is also important to distinguish OCD from other types of anxiety, including the routine tension and stress that appear throughout life. A person who shows signs of infatuation or fixation with a subject, or displays traits such as perfectionism, is not necessarily stricken with OCD, a specific and well-defined disorder.
Modern research has revealed that OCD is much more common than previously thought. An estimated two to three percent of the population of the United States is thought to have OCD or display OCD-like symptoms. Because of the condition's personal nature, and the lingering stigma that surrounds it, there may be many unaccounted-for OCD sufferers, and the above percentages could be even higher.
The typical OCD sufferer performs tasks (or compulsions) to seek relief from obsessions. To others, these tasks may appear simple and unnecessary. But for the sufferer, such tasks can feel critically important, and must be performed in particular ways for fear of dire consequences and to stop the stress build up. Examples of these tasks: repeatedly checking that one's parked car has been locked before leaving it; turning lights on and off a set number of times before exiting a room; repeatedly washing hands at regular intervals throughout the day.
OCD rituals are often bound up with intricate detail — detail that may seem arbitrary to outsiders. A smoker with OCD, for instance, may argue with him/herself that quitting cigarettes is possible only on the 13th or 27th of a month, and only when (s)he has possession of four cigarettes at noon.
Obsessions are thoughts and ideas that the sufferer cannot stop thinking about. Common OCD obsessions include fears of acquiring disease, getting hurt or causing harm to someone. Obsessions are typically automatic, frequent, distressing, and difficult to control or put an end to by themselves. A sufferer will almost always obsess over something which he or she is most afraid of. People with OCD who obsess over hurting themselves or others are actually less likely to do so than the average person.
Compulsions refer to actions that the person performs, usually repeatedly, in an attempt to make the obsession go away. For an OCD sufferer who obsesses about germs or contamination, for example, these compulsions often involve repeated cleansing or meticulous avoidance of trash and mess. Most of the time the actions become so regular that it is not a noticeable problem. Common compulsions include excessive washing and cleaning; checking; hoarding; repetitive actions such as touching, counting, arranging and ordering; and other ritualistic behaviors that the person feels will lessen the chances of provoking an obsession. Compulsions can be observable — washing, for instance — but they can also be mental rituals such as repeating words or phrases, or counting.
Most OCD sufferers are aware that such thoughts and behavior are not rational, but feel bound to comply with them to fend off fears of panic or dread. Because sufferers are consciously aware of this irrationality but feel helpless to push it away, OCD is often regarded as one of the most vexing and frustrating of the major anxiety disorders.
People who suffer from the separate and unrelated condition obsessive compulsive personality disorder are not aware of anything abnormal with them; they will readily explain why their actions are rational, and it is usually impossible to convince them otherwise. People who suffer with OCPD tend to derive pleasure from their obsessions or compulsions. Those with OCD do not derive pleasure but are ridden with anxiety. This is a significant difference between these disorders.
Equally frequently, these rationalisations do not apply to the overall behaviour, but to each instance individually,: for example, a person compulsively checking their front door may argue that the time taken and stress caused by one more check of the front door is considerably less than the time and stress associated with being burgled, and thus the check is the better option. In practice, after that check, the individual is still not sure, and it is still better in terms of time and stress to do one more check, and this reasoning can continue as long as necessary.
Not all OCD sufferers engage in compulsive behavior. Recent years have seen increased diagnoses of Pure Obsessional OCD, or "Pure O." This form of OCD is manifested entirely within the mind, and involves obsessive ruminations triggered by certain thoughts. These mental "snags" can be debilitating, often tying up a sufferer for hours at a time. At this writing (2004), headway continues to be made by specialists. It is believed by many that pure-o OCD is in fact more prevalent than other types of OCD, although it is likely the most underreported as it is not visibly apparent, and sufferers tend to suffer in silence. In pure-o, the sufferer tries to "disprove" the anxious thoughts through logic and reasoning, yet in doing so becomes further entrapped by the obsessions. Pure-o OCD is thought to be the most difficult form of OCD to treat.
OCD is different from behaviors such as gambling addiction and overeating. People with these disorders typically experience at least some pleasure from their activity; OCD sufferers do not actively want to perform their compulsive tasks, and experience no tangible pleasure in doing so.
OCD is placed in the anxiety class of mental illness, but like many chronic stress disorders it can lead to depression over time. The constant stress of the condition can cause sufferers to develop a deadening of spirit, a numbing frustration, or sense of hopelessness. OCD's effects on day-to-day life — particularly its substantial consumption of time — can produce difficulties with work, finances and relationships.
However, some people still maintain successful careers and relationships as many do find they can hide or suppress their obsessive-compulsive behaviour due to feeling unnecessarily ashamed of this debilitating disorder.
Lisa Angelettie, M.S.W., is a psychotherapist, author, and an online advice expert. She has been helping people make smarter life choices since 1998. Visit her for Advice & Counseling, or take a free Depression Screening today.
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