Understanding Obsessions and Compulsions
The Diagnostic and Statistical Manual of Mental Disorders – fifth edition (DSM-5; APA, 2013) identifies obsessive–compulsive disorder (OCD) as being characterized by obsessions and/or compulsions. Obsessions are defined as:
1. Recurrent and persistent thoughts,
urges, or impulses that are experienced, at some time during the
disturbance, as intrusive and unwanted, and that in most individuals
cause marked anxiety or distress.
2. The individual attempts to ignore or
suppress such thoughts, urges, or images, or to neutralize them with
some other thought or action (i.e., by performing a compulsion).
Compulsions are defined as:
1. Repetitive behaviors or mental acts
that the individual feels driven to perform in response to an obsession
or according to rules that must be applied rigidly.
2. The behaviors or mental acts are aimed
at preventing or reducing anxiety or distress, or preventing some
dreaded event or situation; however, these behaviors or mental acts are
not connected in a realistic way with what they are designed to
neutralize or prevent, or are clearly excessive.
DSM-5 also specifies that in order for an individual to be diagnosed
with OCD, these obsessions or compulsions must be time-consuming (e.g.,
take more than 1 h per day) or cause clinically significant distress or
impairment in social, occupational, or other important areas of
functioning; cannot be attributable to the physiological effects of a
substance or another medical condition; and cannot be better explained
by the symptoms of another mental disorder. Traditionally, OCD has been
classified as an anxiety disorder; however, in the most recent version
of the DSM, OCD was moved to a newly created category of
obsessive–compulsive and related disorders (OCRD) (APA, 2013).Understanding Obsessions and Compulsions
Currently, OCD can be diagnosed if the individual experiences either obsessions or compulsions (APA, 2013), however, it is rare for patients to only experience obsessions in the absence of compulsions, or compulsions in the absence of obsessions (Williams et al., 2011). The obsessions and compulsions characteristic of OCD are heterogeneous, meaning that individuals with OCD can present with many different kinds of symptom presentations. Recent research suggests that there are five main symptom subtypes (Williams et al., 2011) and one of these subtypes, comprised of compulsive acquiring and difficulty discarding, is now subsumed under an independent disorder (Hoarding Disorder) in DSM-5 (APA, 2013). Below, we will describe the four remaining symptom subtypes of OCD.
Harming
The harming cluster includes obsessions that focus on harm coming to the patient or to others, generally resulting in subsequent checking compulsions. Common obsessions include concerns about fire from leaving appliances on, burglary/theft from leaving doors unlocked, being responsible for hit and run accidents, harm coming to loved ones and pets, etc. Checking compulsions (including checking of appliances, doors, faucets, emergency brake, the route the patient has driven, etc.) are generally performed to prevent harm coming to themselves or others.
Contamination
The contamination cluster includes obsessions with themes of dirt, germs, and contamination; with subsequent washing and cleaning compulsions. Patients often present with emotional distress relating to contamination from dirt/germs, bodily waste/secretions (such as urine, feces, sweat, semen, and blood), environmental contaminants (mold, asbestos, and lead) or chemicals, solvents, and cleaners. This distress may manifest as either fear or disgust (Olatunji et al., 2007) and washing/cleaning compulsions (for example, excessive hand washing/sanitizing, showering, or excessive cleaning of household items) are often performed to reduce distress caused by the contamination obsessions.
Unacceptable thoughts
The unacceptable thoughts cluster includes individuals with unwanted and unacceptable aggressive, sexual or religious intrusive thoughts and mental and repeating compulsions. Individuals with these obsessions often perform mental or covert compulsions (mental acts that serve to neutralize anxiety caused by obsessions, e.g., reciting a silent prayer, mentally reviewing past actions or conversations, replacing ‘bad’ thoughts or images with ‘good’ thoughts or images, counting, etc.). Repeating behaviors can also be used as a way to reduce anxiety by patients with unacceptable thoughts and may include repeating routine tasks such as dressing, walking up stairs or through doorways, or repeating chores in response to the unwanted thought.
Symmetry
This cluster tends to include individuals with obsessions relating to symmetry and subsequent ordering compulsions. Obsessions in this domain tend to be associated with the need to know or remember, the need for exactness in behavior, and the need for symmetry in the environment. Emotional distress accompanying these obsessions may be more likely to manifest as feelings of ‘incompleteness’ or things being ‘not just right,’ rather than fear (Summerfeldt, 2004). The compulsions seen in this subtype can include physically ordering and arranging items such as books, CDs or DVDs, or clothing.
Demographics of Obsessive–Compulsive Disorder
Symptoms of OCD have been documented for at least 500 years (Burton, 1989) and the disorder can be seen across all ethnic groups (World Health Organization, 2002). OCD is a relatively common condition, with a prevalence rate of approximately 1.2% (Ruscio et al., 2010). Symptom onset tends to occur during adolescence to early adulthood (Ruscioet al., 2010); however, it is not uncommon to see a much younger childhood onset (Gelleret al., 2001). Most individuals with OCD develop symptoms by the age of 20 (Angst et al., 2004), and symptom onset rarely occurs in late adulthood (Fireman et al., 2001), unless caused by neurological trauma (Carmin et al., 2002).
This excerpt was taken from the article Obsessive–Compulsive Disorder by B.M. Wootton and D.F. Tolin. Read the rest of the article to learn about treatment and measurement of OCD here!
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