What is OCD?
Obsessive-compulsive disorder (OCD) is a mental health condition that can impact individuals of any age and is characterized by two types of symptoms – obsessions and compulsions. Those with OCD experience recurrent and persistent thoughts, images or urges that are unwanted and intrusive (these are called obsessions). In addition, OCD is characterized by repetitive behaviors or mental rituals that the individual feels driven to perform (these are called compulsions), typically in response to their obsessions and according to certain OCD-related rules.
People with OCD experience significant levels of anxiety and distress related to the content and intrusiveness of their obsessions. This distress then triggers compulsive behaviors, also known as rituals. Compulsions and rituals serve a function – they temporarily alleviate the distress that is caused by obsessions. However, in OCD, the obsessions inevitably return which then leads to more compulsions, all of which results in the recurring and reinforcing cycle of OCD symptoms. Anxiety disorders and OCD are similar in some ways, but OCD is different from typical worries and anxiety because the obsessions and compulsions are excessive, persistent, and interfere with day-to-day life.
While the particular themes and content of obsessions and compulsions vary among individuals, certain themes are common in OCD.
Common OCD themes include:
Cleaning/hygiene concerns
- Obsessions about contamination from dirt, germs, gross/sticky things, and bodily fluids
- Cleaning compulsions such as excessive cleaning, excessive wiping or excessive washing
- Avoiding possible triggers of contamination
A persistent need for symmetry, exactness and/or perfection
- Needing to organize items so that they are equal or symmetric
- Doing things a certain number of times or until they look, sound or feel “just right”
- Reading or writing until it feels “perfect”
Forbidden or taboo themes
- Intrusive thoughts or images related to aggressive, sexual, and religious themes that are unwanted and not within someone’s personal values or beliefs that lead to high levels of distress
- Needing to confess, repeatedly asking for reassurance, or repeatedly checking that nothing bad has happened or doing something to “undo” the content of the obsessions
Harm themes
- Intrusive fears and worries that one might cause harm to themselves or to others when they have no real desire to do so
- Checking and confessing rituals where the individual feels driven to be sure that no harm has befallen anyone
- Repeating certain actions or thinking certain thoughts or prayers to “undo” or prevent feared things from happening.
- “Good luck” rituals that have to be done to prevent bad things from happening in the future
Excessive collecting or saving
- Intrusive thoughts and worries that they might lose or discard important items
- Fear that harm will come to an individual or their loved ones if they discard or lose certain items.
While many people can experience an occasional intrusive thought or image, this is not OCD. Instead, a diagnosis of OCD requires the presence of obsessions and/or compulsions (almost always both, and almost always accompanied by intense distress). The obsessions and compulsions of OCD take up a significant amount of time in a person’s life, often causing difficulties in relationships, in functioning at school or at work, and other important activities of daily life. If this description of OCD and these symptoms and experiences sound familiar to you or your child, we invite you to take our survey here.
What exactly are obsessions?
Obsessions are recurring thoughts, images, or urges that are intrusive and unwanted. They cause significant distress and are typically outside of the actual values and desires of the person who is experiencing them. Because of this, individuals with OCD find their obsessions to be anxiety-provoking. Those with OCD often recognize that their obsessions do not make sense or are extreme, but they still cause high levels of anxiety. Common feelings that may arise with these intrusive thoughts can include fear, disgust, and an internal sense of “wrongness.” Obsessions can take up multiple hours of an individual’s day and impair a person’s ability to interact with their loved ones, friends, classmates/co-workers and to complete their daily activities and responsibilities.
While in everyday life we may hear the word “obsession” used in a positive way – for example, related to being drawn to something pleasurable (a good movie, a favorite song, a special person, a delicious food, etc.), an “obsession” in OCD is unwanted, persistent, and not pleasurable at all.
What exactly are compulsions?
Compulsions, the second component of OCD, are repetitive behaviors or mental rituals that a person feels compelled to do, usually according to certain rules. Those with OCD use compulsions as a way to (temporarily) eliminate or decrease the distress that comes from their obsessions. Some people may call their compulsions “rituals” or “safety behaviors”. Avoidance is another example of a compulsion. This is when the individual with OCD tries to avoid anything that may trigger their obsessions. Like obsessions, compulsions are time-consuming, interfere with personal and school/work relationships, and cause disruptions in daily functioning.
There are repetitive behaviors that people engage in that are not actual compulsions. For example, many people, of all ages, have bedtime or morning routines that involve repeated actions and are considered aspects of a healthy daily routine. The context and emotions behind the repeated action are important differentiators between compulsions of OCD and regular daily routines. For example, a librarian arranges and organizes books all day according to certain rules. This would not be considered a compulsion, since this activity is an expected component of a librarian’s job, and they are not organizing books due to distress and anxiety. Individuals with OCD engage in compulsions to relieve their distress. While the compulsions may decrease their worries for the time being, the obsessions/worries return due to the cycle of OCD.