ONE OVERViEW AND EVALUATiON

Introduction

Overview of Obsessive Compulsive Disorder

Obsessive Compulsive Disorder (OCD) is characterized by obsessions and/or compulsions. Obsessions are repetitive, intrusive thoughts that are difficult to suppress. Compulsions are repetitive mental or physical rituals that are undertaken either in a stereotyped way (according to rigid rules) or in response to intrusive thoughts. While intrusive thoughts (e.g., “Did I lock the front door?”) and compulsions (e.g., double-checking the front door is locked) are fairly common in the background population, in OCD these thoughts and actions occupy at least an hour each day and detract from the ability of the person to engage fully in their daily lives.

People with OCD often only seek help after suffering from the disorder for many years, in some cases being ashamed of their experiences or fearing that they will not be sensitively understood by healthcare professionals. In addition, healthcare professionals do not always screen for OCD and so many are left undiagnosed. This is unfortunate because OCD is treatable, yet chronically untreated symptoms not only are more ingrained (treatment resistant), but also lead to other conditions (e.g., depression).

The most common symptoms in OCD are contamination-related obsessions and cleaning/washing compulsions, but many other types of symptoms exist (see Table 1.1). The variety of symptoms that occur in OCD can present a challenge to clinicians in terms of diagnosis and treatment, there being some evidence that symptoms vary in terms of response to psychological and pharmacological treatments.

TABLE 1.1 Examples of Common Symptoms in OCD

Symptom type

Examples

Obsessions

Contamination-

Fear that one may be contaminated:

- by infections (e.g., sexually transmitted diseases)
- by body fluids (urine, semen, feces)
- by environmental factors (radiation leakage, dirt on the floor, cleaning products, gasoline)

Sex-related

Recurrent thoughts about:

- sexuality (homosexuality, bestiality)
- perverse thoughts or impulses (sex acts involving children or family members, sexual violence)

Religion-related

Thoughts about:

- heaven/hell, offending god, blasphemy
- morality

Control-related

Fears regarding:

- acting on impulses (e.g., throwing the baby in boiling water; jumping in front of a train)
- shouting out swear words or insults
- disturbing intrusive images

Harm-related

Concerns regarding:

- being responsible for a terrible outcome (e.g., murder)
- endangering loved ones or friends due to lack of care (e.g., dropping the baby)

Perfectionism-

Intrusive thoughts about:

- the need for exactness and symmetry
- the need to remember important information
- the need for hoarding items that “may some day be useful”

TABLE 1.1 Continued

Symptom type

Examples

Superstition-

Concerns about:

- some colors, numbers, or items being “lucky” or “unlucky”

Compulsions

Washing/

cleaning-related

Repetitive:

- hand-washing
- bathing (showers/using the bath)
- other cleaning (cleaning one’s teeth, trimming one’s nails)
- house chores such as polishing, decontaminating surfaces, or vacuuming

Checking-related

Repeated checking:

- that nothing terrible happened (e.g., one didn’t kill a pedestrian while driving)
- that one did not make a critical mistake
- that nothing was forgotten (list writing and checking)
- that a particular body part is “okay”

Repetition-related

Recurrent stereotyped:

- reading
- routines (including sequences of actions being completed a certain number of times in order to be “just right”)
- body movements / tapping items
- collecting of useless items
- confessions to others (including healthcare professionals)

Mental

compulsion-

- counting (e.g., to complete a task or prevent some horrible outcome)
- praying
- canceling out words

OCD is a serious and often disabling psychiatric condition that is under-diagnosed and under-treated. Errors are also made even when treatment is given: one study found that less than half of OCD patients treated with medication received appropriate doses of medication. Left untreated, or treated sub-optimally, OCD is associated with profound impairments in quality of life and functioning, affecting family and home life, relationships, scholastic achievements, and work.

Although some people may experience episodes of OCD that last for a year or two that remit and possibly reappear years later, most individuals, if untreated, have a chronic course of the illness.