OCD Disorder versus Obsessive Compulsive Personality Disorder
In popular culture the understanding of OCD Disorder has been distorted. People often will say " I am OCD " or I am "so OCD" when what they mean is that they are neat, orderly or precise that they need things to be just so. This is actually quite upsetting to people who suffer from OCD, a true affliction which causes great suffering.
Obsessive Compulsive Personality Disorder is also not OCD. This personality consists of a preoccupation with rules and order, perfectionism, and inflexiblity about morality,and rigidity.
So just what is OCD?
According to the Diagnostic and Statistical Manual of Mental Disorders-IV-TR (American Psychiatric Association, 2000) to meet the criteria for OCD disorder, the following must be true:
A person with OCD must have obsessions or compulsions (generally is it is now accepted that OCD always consists of both). Usually my clients who have OCD can suffer from them periodically throughout their lives. It may abate for a time and then later resurface with more intensity. How much their OCD is present depends on how much stress they have at any particular moment. The target of their OCD can also change and varies depending on the developmental stage that they are in, and what is important to them at any particular time.
Obsessions are defined as recurrent persistent thoughts, impulses, or images that are experienced as intrusive and inappropriate and cause marked anxiety or distress. People who have obsessions do not want to have them and struggle to get them out of their mind.
Compulsions are defined as repetitive behaviors or mental acts that the person feels driven to perform in response to an obsession or according to rigid rules. People with OCD engage in the compulsion because of the obsession.
For example the person with OCD disorder may feel that if they recite the alphabet three times every ten minutes, their spouse will not get in a car accident. In this case, reciting the alphabet is not at all related to whether their spouse gets into a car accident.
People with the obsessive compulsive disorder diagnosis do not check the stove once to ensure they don’t burn the house down. They check it three, or four, or fifteen times. Checking the stove once would be a normal thing to do and is related to a legititmate fear and is not considered obsessive.
Here are some other diagnostic criteria.
The types of obsession people who have OCD suffer from fall into specific categories and are broken down below.
Contamination obsessions include excessive concern with anything which can cause contamination. Touching others, germs, illness, and environmental contaminants are all obsessions in this category.
Aggressive obsessions include fear of harming self or others. A person with this kind of obsession may have violent images that are feared, fear of acting on unwanted impulses (such as stealing, or punching someone), or fear that they will be responsible for some terrible happening.
Hoarding and saving obsessions are fears related to keeping and not throwing away things.
Health related obsessions are related to excessive concern with illness disease, a particular aspect of appearance.
Religious or moral obsessions are concerns related to offending god with a thought or dead or excessive concern over morality
Magical obsessions have to do with lucky or unlucky numbers colors words.
Sexual obsessions have to do with upsetting thoughts, images, or impulses or obsessions about sexual orientation.
Less specific obsessions may include fear of embarrassment, fear of needing to remember insignificant things, fear of saying the wrong thing, or fear of intrusive thoughts and images sounds or words.
Compulsions are behaviors that people engage in that don’t make much sense, but they reduce anxiety that is connected to an obsession.
For example, if you have a fear of dirt and germs, you may engage in the compulsion of washing your hands over and over again.
There are certain categories of compulsions that are frequently seen in people with OCD, and these are highlighted below.
Washing and Cleaning Compulsions
One form of compulsions people with OCD may have are washing and cleaning compulsions. People with this kind of compulsions may have very elaborate showering, bathing and grooming rituals.
They may wash their clothes and sheets over and over again, clean things in their house excessively, and wash their hands 50 times a day or in a particular routine that takes a very long time.
These people may also refuse to touch people or objects that they feel could contaminate them.
People who have checking compulsions may check with others for reassurance about a particular obsession.
Checking compulsions can also be related to self harm or harm to others. For example people may check their body to make sure they haven’t harmed themselves, or consistently check with others to see if they are okay.
Children or students with OCD may check their homework over and over again. People with safety fears may check locks, stoves etc. People with fears about health may check their body temperature, or with doctors repeatedly to ensure they are not sick. As you can see, compulsions are connected with obsessions.
Repeating, Arranging, and Counting Compulsions
Repeating compulsions consist of repeating activities or routines. Some people may feel they need to turn a switch on and off or get up and sit down over and over again.
This can also be seen in the workplace and school in the form of rereading and rewriting work because of letters needing to be perfect.
Counting compulsions consist of a need to count things over and over. Arranging compulsions consist of ordering and straightening things over and over.
Symmetry compulsions are a form of arranging compulsions which consist of evening things up so sides are symmetrical.
Hoarding and Saving Compulsions and Superstitious Behavior
Hoarding and saving compulsions consist of not throwing things away. We see these compulsions in both children and adults.
Superstitious behaviors can also be compulsions if the person believes the behaviors will avoid something bad from happening. For example a person who won’t drive without a good luck medal or on a Thursday.
Compulsions Involving Other People
A person with OCD may also involve another person. We see this mostly with children. The child may ask for reassurance all the time about their fears or may make the parent engage in their rituals or compulsions. For example a child with an obsession about contamination may insist a parent wash their hands over and over again before making dinner.
Other more random compulsions include: excessive confessing, touching, tapping, rubbing, list making, arranging or touching things until they feel just right, or avoiding saying certain words.
Obsessive compulsive disorder statistics from the world global health organization indicate OCD is ranked ten among all diseases as a cause for disability. This includes physical diseases. To help give perspective, Osteoarthritis is ranked number 8 ( Saxena 2009).
Facts Related to Other Mental Health Diagnoses
7.8 -25 percent of patients with schizophrenia have ocd and up to 60 percent of schizophrenic patients have ocd symptoms ( Kruger 2000).
Treatment for Obsessive Compulsive Disorder consists of exposing the person gradually to the thing they are afraid of, and preventing them from engaging in the compulsion. In fact, treatment for almost all anxiety consists of this in some form. This is called exposure and response prevention (ERP) or exposure therapy for short. People who suffer from OCD disorder can learn that their obsessions and their compulsions do not really help them in any way, that they are unnecessary and even harmful to living fulfilling and happy life.
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