Obsessive Compulsive Disorder

Obsessive-Compulsive Disorder (OCD) is an anxiety disorder that is characterized by repetitive/obsessive thoughts and recurrent/compulsive behaviors.

Obsessions are recurrent and persistent thoughts, urges and images that are experienced as intrusive and negative in nature and makes one feel uncomfortable. The person often attempts to ignore or suppress such thoughts, urges or images or neutralize them with some other thought or action….compulsions.

Examples of obsessions include, for example, a driver suddenly becoming convinced that, while checking his rear-view mirror, s/he ran over someone on the street; becoming convince that one’s clothes are not clean; believing that one has picked up germs after touching something or someone; fearing that the stove, somehow, is not turned off and could cause an explosion, etc.

Compulsions are behaviors or mental exercises that a person feels driven to perform in response to an obsession. These behaviors or mental exercises are meant to relieve the stress/anxiety the person feels due to the obsessions.  Sometimes, the person develops specific rules about the performance of the behaviors or mental exercises.

Examples of compulsions include: driving around the block repeatedly to see is someone is lying in the road after being hit and run over by a/your car, inspecting one’s clothes before putting them on, washing one’s hands repeatedly (to the point that they chaff and bleed), checking and rechecking the stove to see if it is off, praying, counting, repeating words silently, organizing, etc.

The obsessions and compulsions become increasingly time-consuming and cause significant impairment in the person’s ability to meet responsibilities in different areas of the person’s life, i.e., socially, occupationally, sexually, etc.

When working with someone who presents themselves complaining of being OCD, I’ll ask about the following:

Hand-washing:  After shaking a person’s hand or touching something, do they feel a strong need to wash their hands or feel they have been contaminated?

Does the person spend excessive amounts of time looking at/examining their body and/or body functions, i.e., blinking, swallowing, and breathing?

Over Cleaning: After typical cleaning activities for a home or apartment, does the person feel what they have done is not enough? Do they subsequently re-clean, doing the exact same cleaning procedures? Does not re-cleaning make them feel uncomfortable?

Checking and Re-checking:  Do they feel the need to recheck doors, windows, stoves, appliances?  Do they repeatedly perform an action associated with checking, i.e., lock and unlock and lock a door 4-5 times, turning on and off a light fixture repeatedly, etc.

Counting Compulsions: Does the person find themselves counting….anything?  Do they count and not realize that they have started counting? Also, do they fixate on certain numbers (when this is part of their counting or not), believing these numbers have special significance?

Perfectionism: Closely related to cleaning, the person with OCD struggles with trying to get everything or certain things perfect in their lives. This drive for perfectionism helps them avoid making mistakes and experiencing the anxiety associated with making mistakes.

Dwelling on Relationships: The person struggling with OCD will obsess over what they said/did with others. They will over-analyze what they and the other person said/did, look for hidden meanings in such and lament what they didn’t say/do.

Need for Reassurance: Does this person constantly ask for reassurance about decisions they have made, comment they have made, etc.? The motivation for the want for reassurance is to avoid making a mistake and dealing with the anxiety they feel over decisions/action they have already taken.

Trouble concentrating and failing to meet social/work obligations: This person is frequently distracted because they are obsessing about mistakes they have made or will make in the future; thus, they find it hard to focus on what is in front of them.  This causes them to waste time and subsequently be late in meeting work deadlines; or they will be late for work or social events because for example they must examine and re-examine their clothes for dirt or imperfections.

A lot of people have some of these traits.  Only a few have enough of these behaviors to warrant a diagnosis. Typically, the combination of (outpatient) talk therapy and medications help most people overcome the obsessions and compulsions.