Obsessive Compulsive Disorder (OCD) Symptoms

The main characteristics of obsessive-compulsive disorder are persistent obsessions or compulsions that cause a significant amount of distress or impairment and that take up at least an hour in a person’s day1.  The individual with these symptoms recognizes (or has recognized at some point) that they are extreme; however this is not expected in young children with obsessive-compulsive disorder symptoms1.  Obsessions are repeated thoughts, images, or impulses that interfere with normal functioning and cause a great amount of anxiety1.  The content of the obsessions often may seem uncontrollable and unlike anything the individual would expect to think, but they are still believed to be created by his or her own mind1.  Here is a list of the most common obsessions1:

·         Contamination: recurrent thoughts about germs.

·         Doubts: frequent uncertainty about whether the door was locked or appliances turned off, or qualms about whether own thoughts caused a mishap.

·         Order: a strong need to have things in certain order.

·         Horrific impulses: frequent aggressive or shocking impulses of hurting someone or saying something inappropriate.

·         Sexual imagery: repeated pornographic images.

These thoughts, images, and impulses are not just exaggerated day-to-day concerns and they are often unrelated to daily worries1.  Obsessions tend to be so unpleasant and anxiety-provoking, that individuals who experience them regularly try to suppress them or to neutralize them with another thought or behavior.  Often these behaviors reduce the anxiety and distress and they may therefore be reinforced and repeated over and over again, thus being termed compulsions. 

Compulsions are repeated acts, either physical (such as hand-washing, checking appliances, etc.) or mental (such as counting, repeating certain words, or praying)1.  Compulsions are generally carried out because they reduce the anxiety caused by obsessions1.  Sometimes, individuals with OCD follow a rigid sequence of behaviors with intricate rules yet they might not be able to explain why they engage in the compulsion1.  Such behaviors can become part of their daily routine as they are usually reinforced by reducing the level of distress experienced by obsessions.  Here is a list of the most common compulsions1:

·         Washing and cleaning

·         Counting

·         Checking

·         Requesting or demanding assurances

·         Repeating actions

·         Ordering

Like other anxiety disorders, the most common age of onset for OCD is adolescence or early adulthood; however, OCD may begin in childhood, as young as 5 years of age or earlier2.  The rate of OCD in children is twice as high in boys as girls, because OCD is more likely to have an earlier onset in males in general3, 4.  This difference in rates seems to disappear or even switch such that women have a slightly higher rate than men in adulthood4, 5.

The majority of individuals who experience OCD symptoms acknowledge that their actions are excessive or unreasonable; however, some individuals may consider their fears to be rational and are said to have “poor insight”6.  In those cases, individuals may become so wrapped up in their obsessions that they might overestimate the likelihood of their thoughts and images to be true7, 8.  There seems to be a large variation in the level of insight among individuals with OCD9 and only few believe their obsessions to be completely senseless, particularly when they are experiencing high levels of anxiety10.

References

1.       American Psychiatric Association.  (2000).  Diagnostic and statistical manual of mental disorders (4th ed., text revision).  Washington, DC: Author.

2.       Jenike, M. A., Baer, L., Minchiello, W. E., Schwartz, E. E., Y Carey, R. J. (1986).  Concomitant obsessive-compulsive disorder and schizotypal personality disorders.   American Journal of Psychiatry, 143, 306-311.

3.       Bellodi, L., Sciuto, G., Diaferia, G., Ronchi, P., & Simeraldi, E. (1992).  Psychiatric disorders in the families of patients with obsessive-compulsive disorder.  Psychiatry Research, 42, 111-120.

4.       Rasmussen, S. A., & Eisen, J. (1990).  Epidemiology andn clinical features of obsessive-compulsive disorder.  In M. A. Jenike, L. Baer, & W. E. Minichiello (Eds.), Obsessive-compulsive disorders: Theory and management.  Chicago: Year Book Medical.

5.       Weissman, M. M., Bland, R., Canino, G., Greenwald, S., Hwo, H., Lee, C., Newman, S., Oakley-Browne, M., Rubio-Stipek, M., Wickramaratne, P., Wittchen, H., & Eng-Kung, Y. (1994).  The cross national epidemiology of obsessive compulsive disorder.  Journal of Clinical Psychiatry, 55, 5-10.

6.       Barlow, D. H. (2002).  Anxiety and its disorders: The nature and treatment of anxiety and panic (2nd ed.). New York: Guilford Press.

7.       Foa, E. B. (1979).  Failure in treating obsessive-compulsives.  Behaviour Research and Therapy, 17, 169-176.

8.       McKenna, P. J. (1984).  Disorders with overvalued ideas.  British Journal of Psychiatry, 145, 579-585.

9.       Foa, E. B., & Kozak, M. J. (1995).  DSM-IV field trial: Obsessive-compulsive disorder.   American Journal of Psychiatry, 152, 90-96.

10.   Kozak, M. J., & Foa, E. B. (1994).  Obsessions, overvalued ideas, and delusions in obsessive-compulsive disorder.  Behaviour Research and Therapy, 32, 343-353.