Obsessive-compulsive disorder (or OCD) belongs to anxiety disorder featured by a pattern of uncontrollable, unwanted thoughts associated with repetitive behaviors a person feels compelled to take action in order to ease the thoughts. Its onset typically happens in early adolescence or young adulthood. OCD tends to be chronic. People with OCD might be aware of their situations, assuming that recurrently uncontrollable thoughts and repetitive acts are irrational. Yet, they find it difficult to resist such thoughts and behaviors.
Definitions of Obsessive-compulsive disorder
Obsessions mean that a person keeps holding thoughts, images, ideas, and impulses in one’s mind over and over again in most of the time. Due to frequent recurrence, these thoughts are so intrusive that they get occupied in one’s mind much more than other matters do. Although a person makes an effort to ignore or suppress them, it seems ineffective. More specifically, obsessions refer to thoughts that:
- Are persistent and distressing
- Are not simply excessive worries about real-life problems
Examples of common obsessive thoughts: thoughts related to sexuality (e.g, bisexual imagery), superstition (e.g, excessive focus on fortune and unfortunate), self-control (e.g, fear of losing control), violence (e.g, hitting someone), and uncertainty (wondering if one has turned off the lights before leaving room), etc
Compulsions are behaviors or mental acts that a person repeatedly performs to ease or prevent the stress or dread event caused by obsession. The behaviors are repetitive and ritualized. People with compulsions, for example, are likely to sweep and vacuum the house 3 times per day, whereas it is common for average people to clean up the house once or twice per week.
Examples of common mental acts: repeating words silently, wishing, counting and re-counting, praying, redoing something in one’s mind, etc.
Symptoms of OCD
Symptom A: either obsessions or compulsions
It is possible for obsessions and compulsions to occur separately; however, 96% of obsessions go with compulsions (Foa & Kozak, 1995). The fact that intrusive thoughts are common was confirmed in one study that 80% of undergraduate students reported to experience intrusive thoughts (Clark & Purdon, 2009).
It is of importance that obsession and excessive worries about daily problems are two different aspects. Obsessions involve more imagery than worries do.
Symptom B: obsessions or compulsions cause marked distress
The thoughts or behaviors are quite often time-consuming (take more than 1 hour/ day), or interference with daily functioning (including normal routine, occupational functioning, social activities, relationships)
Symptom C: Not due to the direct physiological effects of a substance
The effects are caused by a drug of abuse, medication, or other significant treatment.
- Contamination: excessive discomfort and distress with a belief that they are dirty and covered with germs. They tend to wash hands very frequently in order to get rid of the dirty feeling. In another Obsessive-compulsive disorder scenario, they concern that contamination will lead to harm and therefore, excessive hand washing will prevent harming themselves and others.
- Checking: repeated exposure to doubt if one has locked the door. The checking behavior is driven by aggressive obsession, and they always want to make sure to have something done perfectly. One checks whether or not all door cars, for example, are locked 15 times before entering a house.
- Hoarding: a strong tendency to store things or possession with a belief that they will need the objects in the future. People with hoarding OCD struggle hard to decide if something should be discarded. The problems associated with hoarders are very debilitating.
- Order/symmetry: an obsession in objects organization following criteria such as pattern, color, shape, material, texture, design, and so on. The objects are likely arranged in a particular manner that a person feels “right”.
Etiology (or Causes) of Obsessive-compulsive disorder
Regarding the cognitive perspective, OCD is a paradoxical effect of trying to suppress particular thoughts. Suppression of thoughts appears to accidentally increase the person’s frequency of behaviors. OCD is persistent due to the person’s maladaptive attempts to reduce such obsessional thoughts. Importantly, how people react to their instructive thoughts is a primary problem. For example, one employs thoughts of harming others, the person with OCD tends to assume: “Well… I am truly evil for thinking to harm others”. They also strongly believe that other people will be harmed due to their thoughts or at least, their thoughts increase the probability that others will get harmed such as “That man got hurt badly because I wished that. It was terribly guilty” or “I could hurt other people if having negative thoughts”.
From a psychodynamic perspective, Obsessive-compulsive disorder is believed to be a result of fixation at the anal stage of psychosexual development, which leads personality to develop in a too rigid or too obedient manner in adulthood, according to Freud. Feelings of inferiority, defined by Adler, is another cause of OCD involvement.
In terms of behaviorist view, obsessions are learned anxieties through classical and operant conditioning. Whereas, compulsions are reinforced through anxiety reduction.
Thought suppression explanation: the more you want to forget the thought, the more it comes to your mind.
Several of other contributors to Obsessive-compulsive disorder:
- Early life experiences and learning that some thoughts are toxic, intolerable, and maladaptive.
- Avoidance behaviors (e.g, being apart from others for fear of hurting them).
- Thought-action fusion is a tendency to combine thoughts and behaviors together and view them in a similar way.
- Neutralization, a behavior that a person wants to prevent, cancel, or undo the distress caused by an obsession.
Treatment of OCD
The first treatment provides a person with OCD an opportunity to think, act, and react to unhealthy thoughts and behaviors with an aim to replacing uncontrollable and unwanted thoughts with productive and healthy ones. ERP is also a talk therapy which is a specific form of CBT. During ERP, a person with Obsessive-compulsive disorder has exposure to matters originating his/ her anxiety and then the person involves in new responses in order to prevent repetitive and ritualized behaviors. Antidepressants could be used for OCD, but combination medication with CBT does not work as well as CBT alone.
1. Clark, D. A., & Purdon, C. (2009). Mental Control of Unwanted Intrusive Thoughts: A Phenomenological Study of Nonclinical Individuals, Special Section: Mental Control of Anxious and Depressive Cognitions. International Journal of Cognitive Therapy 2(3), 267-281. Doi: doi.org
2. Foa, E. B., & Kozak, M. J. (1995). DSM-IV field trial: Obsessive-compulsive disorder. The American Journal of Psychiatry, 152(1), 90–96.