What is OCD?

Obsessive-compulsive disorder, commonly referred to as OCD, is a commonly misrepresented mental disorder. What is the criteria for a diagnosis of OCD? What are the common myths associated with OCD? What is it actually like to have OCD? What are the available treatments?

Diagnostic Criteria for OCD

Obsessive-compulsive disorder is characterized by the presence of obsessions and/or compulsions.

Obsessions are persistent and recurrent thoughts, urges, or images that occur without volition and cause marked distress or anxiety (American Psychiatric Association, 2013). Individuals experiencing obsessions often try to ignore or suppress them or neutralize them with a compulsion.
Compulsions often follow obsessive thoughts as a way to relieve the anxiety or distress caused by the obsessions, or prevent an unwanted situation from occurring. Compulsions are repetitive and either not realistically connected to the situation attempted to be prevented, or excessive (American Psychiatric Association, 2013).

Common Themes:

The obsessions and compulsions vary based on the individual. However, there are four common themes. These themes include: cleaning (obsessions about contamination and compulsions about cleaning), symmetry (obsessions about symmetry and compulsions about repeating, ordering, and counting), taboo or forbidden thoughts (obsessions and compulsions related to aggression, sex, or religiosity), and harm (obsessions of harm to oneself or others and compulsions of checking).

Both obsessions and compulsions do not have to be present for a diagnosis of OCD, but are most commonly present together. An example of an obsession and compulsion is as follows: someone may have a persistent thought that their loved one will suddenly die (obsession) and flick on and off the light switch until it feels just right as an attempt to keep their loved one safe (compulsion).

The obsessions and/or compulsions take up more than one hour per day or cause marked distress or impairment in functioning (American Psychiatric Association, 2013).
The symptoms are not attributed to the effects of a substance or medical condition and cannot be better explained by another mental disorder.

Insight Related to OCD

The DSM-V also specifies the level of insight regarding the individual’s view of the accuracy of their obsessive-compulsive beliefs.

Many individuals with OCD have fair or good insight, highlighting that they believe their obsession is impossible or improbable to occur in the absence of the compulsion. For the example earlier, the person may feel that their loved one definitely will not, or will likely not, die if they do not flick on and off the light switch.
Individuals with poor insight may feel that their loved one will likely die if they do not flick on and off the light switch.
A small amount (4% or fewer) experience absent insight or delusional beliefs, and are convinced that the situation will occur if they do not perform the compulsion. For example, these individuals would be absolutely convinced that their loved one will die if they do not flick on and off the light switch.

The prevalence of OCD is 1.2% of the United States population. Females experience OCD at slightly higher rates in adulthood, while males tend to have an earlier age of onset. The average age for diagnosis of OCD is 19.5 years old, with a quarter of the cases beginning by 14 years old. Without treatment, OCD is often chronic (American Psychiatric Association, 2013).

Common Myths About OCD

Most of us have heard, or said, something like “I’m so OCD!” or “That’s just my OCD”. Many times, these statements are used to express a preference for cleanliness, orderliness, or organization. However, this is a misrepresentation of clinical OCD. As mentioned before, OCD goes beyond just wanting to be clean (and also may not have anything to do with cleanliness!), causing marked distress, anxiety, and impairment to functioning. In addition, saying something like “I am so OCD” is inherently inaccurate. We can have a mental disorder, but we cannot be a mental disorder.

While statements like these may be common, they can be harmful. Attributing cleanliness or orderliness to a mental disorder can minimize the difficulty experienced from someone who is dealing with clinical OCD. Moreover, the misrepresentation of OCD from these statements decreases clarity and understanding of the disorder.

What is it Actually Like to Have OCD?

While everyone’s experience with OCD is different, this is a typical day documented through the eyes of someone diagnosed with OCD:

What Are Available Treatments for OCD?

Cognitive behavioral therapy, or CBT, is the primary therapy modality for individuals experiencing OCD. CBT works to identify the distorted thoughts (obsessions) and modify the repetitive rituals (compulsions). Exposure response prevention (ERP) therapy is a form of CBT that is effective for treating OCD. ERP works to expose the individual to the feared stimuli without performing any compulsions. ERP is currently the first line of therapeutic treatment for OCD (Hezel & Simpson, 2019). Medications are also used for the treatment of OCD.

References:

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author.

Hezel, D. M., & Simpson, H. B. (2019). Exposure and response prevention for obsessive-compulsive disorder: A review and new directions. Indian journal of psychiatry, 61(Suppl 1), S85–S92. https://doi.org/10.4103/psychiatry.IndianJPsychiatry_516_18