Obsessive Compulsive Disorder – OCD

Dr Elaine Ryan
Written by Dr Elaine Ryan Psychologist and Founder of MoodSmith® Elaine obtained her Dr in Psychology from the University of Surrey and has worked in psychology for 20 years. Dr Ryan specialises in Intrusive Thoughts, OCD and anxiety-related conditions.

What Is OCD?

Obsessive-Compulsive Disorder, OCD, is a mental health condition that consists of obsessions, compulsions, or both which adversely interfere with your quality of life. OCD occurs in roughly 2 per cent of the general population worldwide (Sasson et al. 1997)1. However, this figure could be much higher as many people do not come forward for help and therefore remain undiagnosed.

Most people have heard of OCD or watched programs about it on television. People often think of it as hand washing or repeatedly having to perform some ritual where the handwashing is a compulsion that follows a thought that something is dirty or contaminated. However, OCD has more categories or subtypes than contamination.

According to Abramowitz et al. (2010) 2 the obsessions within OCD fall under several categories.

Regardless of the type of obsession, i.e. fear of contamination or obsessing that you have caused harm. All OCD follows a similar pattern; thoughts make you uncomfortable, and you perform a compulsion to make yourself feel better and try to prevent the feared thing from happening.

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Types Of OCD

When reading the following examples, the critical point is that these are the defined categories, but OCD can be related to any thought that is important to you.

Contamination, People Who Clean

With OCD, you may fear that you can somehow contaminate yourself or others or make people around you ill. You may obsess about germs and will try to ensure against the spread of germs by cleaning not only yourself but also surfaces and objects.

 

You may also have difficulty touching things as this would pass germs onto your hands that you have already washed. Even showering can be problematic. Once in the shower, it can be challenging to use shampoo or shower gel; you might find that you need to clean this as you go along or may also have to avoid touching the shower screen or clean it as well.

 

As you can see from this brief example, everyday things become complex and create extreme external anxiety. For people who do not have OCD, you are probably not aware of how often we touch things as we go about our day.

The alarm clock when we wake up. Door handle for the bathroom, all the objects in the bathroom. In our home, we can have some degree of control over this. Once we leave the house, however, there are door handles, toilets, people bumping into us, which for a person with OCD, can cause extreme anxiety, discomfort and fear.

Symmetry/completeness - feels right, just right.

image of person arranging pencils

 

People with OCD may obsess about symmetry and having things in order so that it feels right. 

 

This can include, for example, arranging cans with the labels facing the front. Having your home more than spick and span, putting your clothes in a certain way in your wardrobes.

 

This type of OCD can make it very difficult to have people in your home.

People who hoard

Note: Hoarding no longer falls under the general umbrella of OCD. In the latest edition of DSM 5, hoarding disorder is now under Obsessive-compulsive and related disorders.

Do you have difficulty throwing things out, and your home is so cluttered that it is difficult to move freely? Some people with OCD experience pain throwing things out and would experience a spike in anxiety.

You might need the things at some stage. Not being able to discard items can cause problems in relationships and your living environment as closets may be overflowing, work surfaces covered and piles of “stuff on the floor.” Again, this is a symptom of the underlying anxiety that OCD creates.

Responsibility for harm - People Who Check

Nearly every one of us experiences this to a certain degree. Leaving the house, only to return to verify that the alarm was on, you turned the oven off. 

However, if you “check” due to OCD, it can affect your quality of life. It becomes more complicated than just checking that the oven is off. You may have developed a routine that you check a certain number of times, only to leave the house, and wonder, “is it off?”

This thought causes your anxiety to spike, and your brain quickly learns that your stress decreases (albeit temporarily) when you return to the house and check again. This leads to on to:

People Who Repeat

With the oven example, you may have to check it a certain number of times or wash your hands. You might repeat certain words or phrases in your head.

All of the above examples, although different, have one big thing in common. They all exist to lower your anxiety for a while. You have the thought (obsession), carry out a compulsion, and stress goes down for a time.

 However, it does not stay down, and the cycle starts to repeat; only now, it takes more compulsions or rituals to help control your anxious thoughts.

Intrusive Thoughts

People mistakenly think that intrusive thoughts are not part of OCD in that the person does not carry out compulsions. They may believe they have Pure O, but the compulsions will be hidden from view.

Intrusive thoughts have their sub-themes as follows.

Regardless of how your OCD manifests itself, I always see one common factor. That somehow something terrible will happen, and it will be your fault. 

 

These thoughts may lead you to avoid children or other people, stay away from the knives in the kitchen, or remove them should you hurt someone. They are just thoughts. Alarming ones, yes, but thoughts all the same.

 

Everyone that I have worked with, with OCD has never carried out any of the scary thoughts they have in their head. Nor have they unwittingly caused harm to others. This can be problematic, as the person may believe that they have prevented something bad from happening by the rituals (compulsions) they perform and are very reluctant to stop doing them if something terrible happens.

 

But this is what people who have recovered from OCD achieve. Firstly by reducing and finally eliminating their compulsions and then seeing their thoughts for what they are – just mental activity in their brain. Cognitive Behavioral Therapy is what I mostly use to help people recover from OCD.

 

How do I know if I have OCD?

Many people suspect they have OCD but have not been diagnosed.
Before discussing how the condition is formally diagnosed, this section will discuss the typical symptoms that may alert you to OCD.

Signs and symptoms of OCD

Touching something and then scrubbing your hands is the typical presentation of OCD shown in the media, but this represents only a sub-type of the condition.

 

If you suspect you might have OCD, you will have both obsessions and compulsions; a thought and then feeling compelled to do something.

 

At its simplest, OCD is a thought which creates anxiety, followed by a ritual or compulsion which gives you temporary relief from the tension. The idea on its own will not lead to compulsion. The feeling of anxiety, shame, disgust, or guilt compels you to ritualise, which is a crucial point in treating OCD and the backbone of ERP. If you can manage the uncomfortable feeling without carrying out the compulsion, you are well on your way to breaking the cycle of OCD.

What are Obsessions?

Obsessions can be thoughts or images. They differ from other thoughts in that you fixate on them as they repulse, disgust or frighten you, and they result in a change in emotion, often leading to fear and anxiety.

 

People with OCD can go to great lengths to either

  • avoid these thoughts
    or
  • carry out elaborate or repetitive compulsions to cleanse the idea, reduce the emotion and prevent the thought from coming true.

 

Important. Having the thought does not mean that it is true. This is thought-action fusion.

What are Compulsions?

Compulsions develop to reduce the anxiety associated with obsessive thoughts and images.
Compulsions are, for example, feeling compelled to go back to the house and check the curling irons are turned off, unplugged and that you can see the plug is far away from the socket.

We all have compulsions or rituals to a certain degree.

For example, think about superstitions, throwing salt over the shoulder, not putting an umbrella up indoors, not walking under ladders or splitting a post or pole with a friend when out walking.

Do you think throwing salt over the shoulder will stop something from happening? Or you may lose a long term friendship because while out walking, you both walked either side of a post? Maybe not, but many of us do not risk it or “tempt fate” all the same.

However, it becomes problematic when the compulsions or rituals interfere with daily life.

How Is OCD Diagnosed?

Mental health professionals use a diagnostic handbook; The Diagnostic and Statistical Manual for Mental Disorder, Fifth Edition (DSM-5; American Psychiatric Association [APA], 2013)

Up until the new edition of The Diagnostic and Statistical Manual for Mental Disorder DSM in 2013, OCD fell under anxiety disorders, including other conditions such as panic disorder, social phobia, simple phobia, GAD, and post-traumatic stress disorder. The defining diagnostic criteria for OCD was anxiety when classified as an anxiety disorder.

OCD was given a separate category in 2013 with The Diagnostic and Statistical Manual for Mental Disorder DSM-5, known as obsessive-compulsive and related disorders. This change was significant as the defining diagnostic criteria for OCD are now obsessions and compulsions.

Having obsessions and compulsions, though, are not sufficient for a diagnosis of OCD. To be given a diagnosis, the mental health professional will be interested in how much the obsessions and compulsions impact your life, how much distress they cause you, and how much of your time they affect.

Treatment For OCD

The cornerstone of therapy is to help you reduce and eliminate your compulsions and stop having distressing thoughts and images. To achieve this, we work with your thought processes and help you reduce your overall anxiety levels.

 

When you are feeling calmer, you are then in an excellent position to start working towards reducing and finally eliminating your compulsions.

 

What to expect if you meet with a mental health professional.

People often start with a visit to their doctor, who will refer them to a psychologist or psychiatrist. I’m a psychologist and will give you a brief outline of what will happen if you attend a psychologist.

 

Assessment

Your first and maybe second appointments are used to undertake an assessment.  

In the assessmet, you will be asked questions about;

your obsessions (the unwanted thoughts and images) to identify the type of obsession (if any), how often they happen, and whether or not they interfere with your quality of life.

The psychologist will ask about what you do to help cope with the obsessions. The things that you do to manage are known as compulsions. Again, the psychologist will record the type of compulsion, how often you do this, how much it bothers you, and how much it interferes with your quality of life.

 

The psychologist will score your answers, and depending on your score; you will be told you do not have OCD or have mild, moderate or severe OCD.

All content on MoodSmith is written and researched by Dr Elaine Ryan and uses only peer-reviewed research on journals, government bodies, universities and professional bodies to support the article.

 

  1. Sasson Y, Zohar J, Chopra M, Lustig M, Iancu I, Hendler T. Epidemiology of obsessive-compulsive disorder: a world view. J Clin Psychiatry. 1997;58 Suppl 12:7-10. PMID: 9393390.
  2. Abramowitz JS, Deacon BJ, Olatunji BO, Wheaton MG, Berman NC, Losardo D, Timpano KR, McGrath PB, Riemann BC, Adams T, Björgvinsson T, Storch EA, Hale LR. Assessment of obsessive-compulsive symptom dimensions: development and evaluation of the Dimensional Obsessive-Compulsive Scale. Psychol Assess. 2010 Mar;22(1):180-98. https://doi: 10.1037/a0018260. PMID: 20230164.
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