Obsessions
Obsessive-compulsive disorder (OCD) is an anxiety disorder characterized by
intrusive thoughts that produce uneasiness, apprehension, fear, or worry; by
repetitive behaviors aimed at reducing the associated anxiety; or by a
combination of such obsessions and compulsions. Symptoms of the disorder include
excessive washing or cleaning; repeated checking; extreme hoarding;
preoccupation with sexual, violent or religious thoughts; relationship-related
obsessions; aversion to particular numbers; and nervous rituals, such as opening
and closing a door a certain number of times before entering or leaving a room.
These symptoms can be alienating and time-consuming, and often cause severe
emotional and financial distress. The acts of those who have OCD may appear
paranoid and potentially psychotic. However, OCD sufferers generally recognize
their obsessions and compulsions as irrational and may become further distressed
by this realization.
Obsessive–compulsive disorder affects children and adolescents, as well as
adults. Roughly one third to one half of adults with OCD report a childhood
onset of the disorder, suggesting the continuum of anxiety disorders across the
life span.
The phrase obsessive–compulsive has become part of the English lexicon, and
is often used in an informal or caricatured manner to describe someone who is
excessively meticulous, perfectionistic, absorbed, or otherwise fixated.
Although these signs are present in OCD, a person who exhibits them does not
necessarily have OCD, but may instead have obsessive–compulsive personality
disorder (OCPD), an autism spectrum disorder, disorders where perseveration is a
possible feature (ADHD, PTSD, bodily disorders or habit problems), or no
clinical condition.
Despite the irrational behaviour, OCD is sometimes associated with
above-average intelligence. Its sufferers commonly share personality
traits such as high attention to detail, avoidance of risk, careful planning,
exaggerated sense of responsibility and a tendency to take time in making
decisions. Multiple psychological and biological factors may be involved in
causing obsessive–compulsive syndromes. Standardized rating scales such as
Yale–Brown Obsessive Compulsive Scale can be used to assess the severity of OCD
symptoms
Obsessions are thoughts that recur and persist despite efforts to ignore or
confront them. People with OCD frequently perform tasks, or compulsions, to
seek relief from obsession-related anxiety. Within and among individuals, the
initial obsessions, or intrusive thoughts, vary in their clarity and vividness.
A relatively vague obsession could involve a general sense of disarray or
tension accompanied by a belief that life cannot proceed as normal while the
imbalance remains. A more intense obsession could be a preoccupation with the
thought or image of someone close to them dying or intrusions related to
"relationship rightness." Other obsessions concern the possibility that
someone or something other than oneself—such as God, the Devil, or disease—will
harm either the person with OCD or the people or things that the person cares
about. Other individuals with OCD may experience the sensation of invisible
protrusions emanating from their bodies, or have the feeling that inanimate
objects are ensouled.
Some people with OCD experience sexual obsessions that may involve intrusive
thoughts or images of "kissing, touching, fondling, oral sex, anal sex,
intercourse, incest and rape" with "strangers, acquaintances, parents, children,
family members, friends, coworkers, animals and religious figures", and can
include "heterosexual or homosexual content" with persons of any age. As
with other intrusive, unpleasant thoughts or images, most "normal" people have
some disquieting sexual thoughts at times, but people with OCD may attach
extraordinary significance to the thoughts. For example, obsessive fears about
sexual orientation can appear to the person with OCD, and even to those around
them, as a crisis of sexual identity. Furthermore, the doubt that
accompanies OCD leads to uncertainty regarding whether one might act on the
troubling thoughts, resulting in self-criticism or self-loathing.
People with OCD understand that their notions do not correspond with reality;
however, they feel that they must act as though their notions are correct. For
example, an individual who engages in compulsive hoarding might be inclined to
treat inorganic matter as if it had the sentience or rights of living organisms,
while accepting that such behavior is irrational on a more intellectual level.
In severe OCD, obsessions can shift into delusions when resistance to the
obsession is abandoned and insight into its senselessness is lost.
Primarily obsessional
Primarily Obsessional OCD
OCD sometimes manifests without overt compulsions. Nicknamed
"Pure-O", or referred to as Primarily Obsessional OCD, OCD without overt
compulsions could, by one estimate, characterize as many as 50 percent to 60
percent of OCD cases. Primarily obsessional OCD has been called "one of the
most distressing and challenging forms of OCD." People with this form of OCD
have "distressing and unwanted thoughts pop into head frequently", and
the thoughts "typically center on a fear that you may do something totally
uncharacteristic of yourself, something ...potentially fatal...to yourself or
others." The thoughts "quite likely, are of an aggressive or sexual
nature."
Rather than engaging in observable compulsions, the person with this subtype
might perform more covert, mental rituals, or might feel driven to avoid the
situations in which particular thoughts seem likely to intrude. As a result
of this avoidance, people can struggle to fulfill both public and private roles,
even if they place great value on these roles and even if they had fulfilled the
roles successfully in the past. Moreover, the individual's avoidance can
confuse others who do not know its origin or intended purpose, as it did in the
case of a man whose wife began to wonder why he would not hold their infant
child. The covert mental rituals can take up a great deal of a person's time
during the day.
Compulsions
Compulsive behavior
Some people with OCD perform compulsive rituals because they inexplicably
feel they have to, others act compulsively so as to mitigate the anxiety that
stems from particular obsessive thoughts. The person might feel that these
actions somehow either will prevent a dreaded event from occurring, or will push
the event from their thoughts. In any case, the individual's reasoning is so
idiosyncratic or distorted that it results in significant distress for the
individual with OCD or for those around them. Excessive skin picking (i.e.,
dermatillomania) or hair plucking (i.e., trichotillomania) and nail biting
(i.e., onychophagia) are all on the Obsessive-Compulsive Spectrum. Individuals
with OCD are aware that their thoughts and behavior are not rational, but
they feel bound to comply with them to fend off feelings of panic or dread.
Some common compulsions include counting specific things (such as footsteps)
or in specific ways (for instance, by intervals of two), and doing other
repetitive actions, often with atypical sensitivity to numbers or patterns.
People might repeatedly wash their hands or clear their throats, make sure
certain items are in a straight line, repeatedly check that their parked cars
have been locked before leaving them, constantly organize in a certain way, turn
lights on and off, keep doors closed at all times, touch objects a certain
number of times before exiting a room, walk in a certain routine way like only
stepping on a certain color of tile, or have a routine for using stairs, such as
always finishing a flight on the same foot.
The compulsions of OCD must be distinguished from tics; movements of other
movement disorders such as chorea, dystonia, myoclonus; movements exhibited in
stereotypic movement disorder or some people with autism; and the movements of
seizure activity. There may exist a notable rate of comorbidity between OCD
and tic-related disorders.
People rely on compulsions as an escape from their obsessive thoughts;
however, they are aware that the relief is only temporary, that the intrusive
thoughts will soon return. Some people use compulsions to avoid situations that
may trigger their obsessions. Although some people do certain things over and
over again, they do not necessarily perform these actions compulsively. For
example, bedtime routines, learning a new skill, and religious practices are not
compulsions. Whether or not behaviors are compulsions or mere habit depends on
the context in which the behaviors are performed. For example, arranging and
ordering DVDs for eight hours a day would be expected of one who works in a
video store, but would seem abnormal in other situations. In other words, habits
tend to bring efficiency to one's life, while compulsions tend to disrupt
it.
In addition to the anxiety and fear that typically accompanies OCD, sufferers
may spend hours performing such compulsions every day. In such situations, it
can be hard for the person to fulfill their work, family, or social roles. In
some cases, these behaviors can also cause adverse physical symptoms. For
example, people who obsessively wash their hands with antibacterial soap and hot
water can make their skin red and raw with dermatitis.
People with OCD can use rationalizations to explain their behavior; however,
these rationalizations do not apply to the overall behavior but to each instance
individually. For example, a person compulsively checking the front door may
argue that the time taken and stress caused by one more check of the front door
is much less than the time and stress associated with being robbed, and thus
checking is the better option. In practice, after that check, the person is
still not sure and deems it is still better to perform one more check, and this
reasoning can continue as long as necessary.
intrusive thoughts that produce uneasiness, apprehension, fear, or worry; by
repetitive behaviors aimed at reducing the associated anxiety; or by a
combination of such obsessions and compulsions. Symptoms of the disorder include
excessive washing or cleaning; repeated checking; extreme hoarding;
preoccupation with sexual, violent or religious thoughts; relationship-related
obsessions; aversion to particular numbers; and nervous rituals, such as opening
and closing a door a certain number of times before entering or leaving a room.
These symptoms can be alienating and time-consuming, and often cause severe
emotional and financial distress. The acts of those who have OCD may appear
paranoid and potentially psychotic. However, OCD sufferers generally recognize
their obsessions and compulsions as irrational and may become further distressed
by this realization.
Obsessive–compulsive disorder affects children and adolescents, as well as
adults. Roughly one third to one half of adults with OCD report a childhood
onset of the disorder, suggesting the continuum of anxiety disorders across the
life span.
The phrase obsessive–compulsive has become part of the English lexicon, and
is often used in an informal or caricatured manner to describe someone who is
excessively meticulous, perfectionistic, absorbed, or otherwise fixated.
Although these signs are present in OCD, a person who exhibits them does not
necessarily have OCD, but may instead have obsessive–compulsive personality
disorder (OCPD), an autism spectrum disorder, disorders where perseveration is a
possible feature (ADHD, PTSD, bodily disorders or habit problems), or no
clinical condition.
Despite the irrational behaviour, OCD is sometimes associated with
above-average intelligence. Its sufferers commonly share personality
traits such as high attention to detail, avoidance of risk, careful planning,
exaggerated sense of responsibility and a tendency to take time in making
decisions. Multiple psychological and biological factors may be involved in
causing obsessive–compulsive syndromes. Standardized rating scales such as
Yale–Brown Obsessive Compulsive Scale can be used to assess the severity of OCD
symptoms
Obsessions are thoughts that recur and persist despite efforts to ignore or
confront them. People with OCD frequently perform tasks, or compulsions, to
seek relief from obsession-related anxiety. Within and among individuals, the
initial obsessions, or intrusive thoughts, vary in their clarity and vividness.
A relatively vague obsession could involve a general sense of disarray or
tension accompanied by a belief that life cannot proceed as normal while the
imbalance remains. A more intense obsession could be a preoccupation with the
thought or image of someone close to them dying or intrusions related to
"relationship rightness." Other obsessions concern the possibility that
someone or something other than oneself—such as God, the Devil, or disease—will
harm either the person with OCD or the people or things that the person cares
about. Other individuals with OCD may experience the sensation of invisible
protrusions emanating from their bodies, or have the feeling that inanimate
objects are ensouled.
Some people with OCD experience sexual obsessions that may involve intrusive
thoughts or images of "kissing, touching, fondling, oral sex, anal sex,
intercourse, incest and rape" with "strangers, acquaintances, parents, children,
family members, friends, coworkers, animals and religious figures", and can
include "heterosexual or homosexual content" with persons of any age. As
with other intrusive, unpleasant thoughts or images, most "normal" people have
some disquieting sexual thoughts at times, but people with OCD may attach
extraordinary significance to the thoughts. For example, obsessive fears about
sexual orientation can appear to the person with OCD, and even to those around
them, as a crisis of sexual identity. Furthermore, the doubt that
accompanies OCD leads to uncertainty regarding whether one might act on the
troubling thoughts, resulting in self-criticism or self-loathing.
People with OCD understand that their notions do not correspond with reality;
however, they feel that they must act as though their notions are correct. For
example, an individual who engages in compulsive hoarding might be inclined to
treat inorganic matter as if it had the sentience or rights of living organisms,
while accepting that such behavior is irrational on a more intellectual level.
In severe OCD, obsessions can shift into delusions when resistance to the
obsession is abandoned and insight into its senselessness is lost.
Primarily obsessional
Primarily Obsessional OCD
OCD sometimes manifests without overt compulsions. Nicknamed
"Pure-O", or referred to as Primarily Obsessional OCD, OCD without overt
compulsions could, by one estimate, characterize as many as 50 percent to 60
percent of OCD cases. Primarily obsessional OCD has been called "one of the
most distressing and challenging forms of OCD." People with this form of OCD
have "distressing and unwanted thoughts pop into head frequently", and
the thoughts "typically center on a fear that you may do something totally
uncharacteristic of yourself, something ...potentially fatal...to yourself or
others." The thoughts "quite likely, are of an aggressive or sexual
nature."
Rather than engaging in observable compulsions, the person with this subtype
might perform more covert, mental rituals, or might feel driven to avoid the
situations in which particular thoughts seem likely to intrude. As a result
of this avoidance, people can struggle to fulfill both public and private roles,
even if they place great value on these roles and even if they had fulfilled the
roles successfully in the past. Moreover, the individual's avoidance can
confuse others who do not know its origin or intended purpose, as it did in the
case of a man whose wife began to wonder why he would not hold their infant
child. The covert mental rituals can take up a great deal of a person's time
during the day.
Compulsions
Compulsive behavior
Some people with OCD perform compulsive rituals because they inexplicably
feel they have to, others act compulsively so as to mitigate the anxiety that
stems from particular obsessive thoughts. The person might feel that these
actions somehow either will prevent a dreaded event from occurring, or will push
the event from their thoughts. In any case, the individual's reasoning is so
idiosyncratic or distorted that it results in significant distress for the
individual with OCD or for those around them. Excessive skin picking (i.e.,
dermatillomania) or hair plucking (i.e., trichotillomania) and nail biting
(i.e., onychophagia) are all on the Obsessive-Compulsive Spectrum. Individuals
with OCD are aware that their thoughts and behavior are not rational, but
they feel bound to comply with them to fend off feelings of panic or dread.
Some common compulsions include counting specific things (such as footsteps)
or in specific ways (for instance, by intervals of two), and doing other
repetitive actions, often with atypical sensitivity to numbers or patterns.
People might repeatedly wash their hands or clear their throats, make sure
certain items are in a straight line, repeatedly check that their parked cars
have been locked before leaving them, constantly organize in a certain way, turn
lights on and off, keep doors closed at all times, touch objects a certain
number of times before exiting a room, walk in a certain routine way like only
stepping on a certain color of tile, or have a routine for using stairs, such as
always finishing a flight on the same foot.
The compulsions of OCD must be distinguished from tics; movements of other
movement disorders such as chorea, dystonia, myoclonus; movements exhibited in
stereotypic movement disorder or some people with autism; and the movements of
seizure activity. There may exist a notable rate of comorbidity between OCD
and tic-related disorders.
People rely on compulsions as an escape from their obsessive thoughts;
however, they are aware that the relief is only temporary, that the intrusive
thoughts will soon return. Some people use compulsions to avoid situations that
may trigger their obsessions. Although some people do certain things over and
over again, they do not necessarily perform these actions compulsively. For
example, bedtime routines, learning a new skill, and religious practices are not
compulsions. Whether or not behaviors are compulsions or mere habit depends on
the context in which the behaviors are performed. For example, arranging and
ordering DVDs for eight hours a day would be expected of one who works in a
video store, but would seem abnormal in other situations. In other words, habits
tend to bring efficiency to one's life, while compulsions tend to disrupt
it.
In addition to the anxiety and fear that typically accompanies OCD, sufferers
may spend hours performing such compulsions every day. In such situations, it
can be hard for the person to fulfill their work, family, or social roles. In
some cases, these behaviors can also cause adverse physical symptoms. For
example, people who obsessively wash their hands with antibacterial soap and hot
water can make their skin red and raw with dermatitis.
People with OCD can use rationalizations to explain their behavior; however,
these rationalizations do not apply to the overall behavior but to each instance
individually. For example, a person compulsively checking the front door may
argue that the time taken and stress caused by one more check of the front door
is much less than the time and stress associated with being robbed, and thus
checking is the better option. In practice, after that check, the person is
still not sure and deems it is still better to perform one more check, and this
reasoning can continue as long as necessary.
