MD - Psychiatry
Obsessive Compulsive Disorder (OCD) is an anxiety disorder that affects about 2 to 3% of the population. People with OCD experience both obsessions and compulsions.
Obsessions are unwanted and disturbing thoughts, images, or impulses that suddenly pop into the mind and cause a great deal of anxiety or distress.
Compulsions are deliberate behaviours (e.g. washing, checking, ordering) or mental acts (e.g. praying, counting, repeating phrases) that are carried out to reduce the anxiety caused by the obsessions.
What do “Obsessions” Look Like?
There are many different types of obsessions, and many people with OCD will have more than one type of obsession. Some examples of common obsessions are:
Fear of contamination
This obsession involves a fear of coming into contact with germs, getting sick, or making others sick, from touching “dirty” or “contaminated” items, sticky substances, or chemicals. For example, “I will be contaminated by germs if I pick up this pen off the floor”, or “I can be poisoned by lead if I come into contact with paint.”
Thoughts of doubt
This obsession involves constant doubt about whether you’ve done something wrong or made a mistake. For example, “Did I turn off the stove?”, “I think I made a spelling error on the email I just sent.”, “I think I threw away something important”, or “I might not have answered that question clearly and precisely enough.”‘ Did i drop something”
Fear of accidentally harming self or others:
Adults with these obsessions are afraid of harming themselves or others through carelessness. For example, “If I don’t make sure that the door is locked at night, the apartment might get broken into and I might be robbed and murdered”, “If I don’t immediately change out of my work clothes and wash them with bleach, I might bring outside germs home and cause my whole family to be sick.”
Need for symmetry/exactness:
Adults with this obsession feel a need to have objects placed in a certain order or position, or tasks or events to be completed in a set way. For example, “I need to sort all my clothes by colour and have them face the same direction. Otherwise, it just does not feel right!”; “I just scratched my right arm twice and now I need to balance it out by scratching my left arm twice.” David Beckham is said to arrange his bottles in the refrigerator in order of height.
Repugnant means disgusting. These kinds of obsessions include unwanted thoughts, images, or impulses of doing something horrible to a loved one (e.g., throwing your baby off a balcony, kicking your elderly grandmother; jumping off a bridge); sexual obsessions (e.g., thoughts of touching someone sexually against his/her will, images of molesting one’s baby, doubts about one’s sexuality); and obsessions that violate religious beliefs (e.g., swearing in temple/church, images of having sex with a god). Repugnant obsessions can also take the form of doubts, for example, “Did I run over someone without realizing?”, “Did I become sexually aroused while bathing my baby?”,These kinds of obsessions are particularly unwanted and people with them would never want to act on them. Having them DOES NOT mean you are crazy, dangerous, or evil deep down inside!
What do “Compulsions” Look Like?
Some examples of common compulsions are:
o Washing hands excessively
o Rituals and rules for cleaning the bathroom or kitchen, washing laundry, etc.
o Grooming/teeth brushing rituals (for example, brushing your teeth in a particular order)
o Showering rituals (such as washing a specific part of the body first)
These behaviours are performed in an attempt to stop something bad from happening. However, repeated checking often makes people feel even less sure that they have successfully prevented the bad event from happening. Some examples include:
o Checking to make sure doors are locked, stoves are turned off, electrical outlets are unplugged, etc.
o Checking to make sure everyone is okay and not harmed. For example, calling family members repeatedly to “check” if they are safe.
o Checking to make sure that you haven’t made any mistakes. For example, re-reading emails over and over to “check” for spelling/grammar mistakes or visually checking the environment to make sure that you have not left anything important behind.
This category of compulsion involves arranging items in specific ways, such as clothes, books, shoes, etc. For example, you might line up all the clothes in the closet so that they are arranged according to colour, with all the hangers facing in the same direction. Adults with this compulsion will sometimes arrange things until it “feels right”. Some will do it to prevent bad things from happening; for example, “If I don’t arrange all the books and magazines in the house so that they face east, then someone in my family will die.”
These are compulsions that are performed in your head. For example, you might mentally repeat a prayer whenever you have thoughts about something bad happening, or you might replace a “bad” thought (e.g., mom dying) with a “good” one (e.g., mom smiling and in good health).
Need to ask or confess.
Some adults with OCD are afraid that they have done or thought something “bad”, and therefore feel a strong urge to confess all of their thoughts to friends or family (for example, telling a loved one that “I just had a thought about pushing someone into the street”). Most people who feel the need to confess will also seek repeated reassurance that everything is okay (for example, asking a loved one, “Do you still love me even though I had a bad thought?”).
Some adults with OCD have a very hard time throwing away things that seem to others useless or of limited value. Hoarding can lead to excessive clutter in the home and interfere with daily life. For example, some people are not able to throw away any receipts, financial documents, or old newspapers.
How do I know if I have OCD?
Everyone has thoughts that are upsetting or do not make a lot of sense from time to time; this is normal. Just having an unpleasant thought does not mean you have obsessions. Similarly, it is not uncommon for people to repeat certain actions, such as double-checking whether the door is locked. However, these behaviours are not always compulsions.
When is it an obsession?
1. Obsessions occur frequently, even when you try very hard not to have them. People with OCD often say that their obsessions are intrusive and out of control.
2. Obsessions are time consuming. People with OCD spend at least one hour a day thinking about their obsessions.
3. Obsessions cause a lot of anxiety or distress and interfere with life.
4. Obsessions often lead to compulsions. People who have normal unwanted thoughts will not engage in compulsive or ritualistic behaviours to “fix” or “undo” the obsession.
When is it a compulsion?
1. Compulsions are related to obsessions. For example, if you have obsessions about being contaminated by germs, you will compulsively wash your hands to reduce the fear of being contaminated by touching something “dirty”.
2. Compulsions are repetitive. They are often done repeatedly and in an excessive and very specific way (e.g., washing each finger carefully, using only hot water). If the compulsions are not performed “correctly” or are interrupted, you might need to perform the entire compulsion again. Once is never enough!
3. Compulsions are also time consuming. People with OCD often spend at least one hour a day carrying out their compulsions.
4. Compulsions are deliberate. Although people with OCD describe their obsessions as being unwanted thoughts that “pop” into their heads uninvited, compulsions are carried out deliberately, because compulsions reduce anxiety in the short-term. While obsessions cause anxiety, performing a compulsion reduces that anxiety. For example, if you have an obsession about being contaminated by germs, you will probably feel anxious. However, if you then start compulsively washing your hands, your anxiety will probably diminish.
5. Compulsions cause a lot of anxiety in the long-run. Although people with OCD perform compulsions to “deal with” their obsessions, they often find that they become “slaves” to their compulsions. That is, they need to carry out the compulsions so often that they feel that they have no control over them.
In summary, you have OCD if:
A. You spend a lot of time thinking about (or avoiding) your obsessions and/or performing your compulsions.
B. You feel quite anxious or nervous most of the time.
C. Your daily life is significantly affected by it. For example, your OCD might cause you to take hours to do a small task (e.g., writing a casual email), get in the way of spending time with your family and friends, or prevent you from meeting work deadlines or even getting out of the house