OCD Disorder

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?

OCD Disorder: What is the diagnostic criteria? 

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. 

OCD Disorder: How do you Define Obsessions and Compulsions?

OBSESSIONS

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. 

  • These obsessions are not simply excessive worries about real life problems. The anxiety cannot be about things such as bills, or a real illness, or job stress which are not necessarily intrusive or inappropriate.
  • The person with these obsessions attempts to ignore or suppress the  thoughts, impulses, or images or to neutralize them. In order for obsessive compulsive disorder diagnosis to be made the person must be actively trying to avoid experiencing their anxiety.
  • The person must recognize the obsessions are a product of his mind .

COMPULSIONS

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.

  •  The behaviors or acts are aimed at preventing or reducing distress or preventing a dreaded event or situation. They are not connected in a realistic way with what they are designed to assist with or prevent, or, the behaviors are excessive. 

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 person with ocd disorder  has to recognize that the obsessions or compulsions are excessive or unreasonable (not required  if the person is a child).
  •  Additionally to make this diagnosis ,the obsessions or compulsions must cause distress, are time consuming or significantly interfere with the persons routine functioning or activities and relationships.
  • A person with and OCD disorder diagnosis must  not be functioning well across all domains of their life. Their behavior must interfere  with their happiness or success in some way.
  •  In order to have the obsessive compulsive disorder diagnoses, the person’s obsessions or compulsions cannot be better explained by another disorder. For example, a child may have a lot of anxiety about separating from their parent. If that child meets the criteria for  separation anxiety they would not have ocd.
  • The obsessions and compulsions cannot be caused by substance abuse or a medical condition.

Signs of OCD Disorder: Types of Obsessions

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.


SIgns of OCD Disorder: Compulsions 


 Compulsions

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.

 Checking Compulsions

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.

OCD Disorder: Obsessive Compulsive Disorder Statistics

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).

 Children

  • Conservative estimates indicate 1 in 200 young people at any time are suffering from OCD ( POTS 2004).
  • 1/3/ to ½ of adults develop OCD in childhood ( POTS 2004). The majority of children do not get the correct diagnosis of treatment ( POTS 2004).
  • In an NIMH sample boys are more likely to have an onset before puberty than girls ( March 1998).
  • Boys are more likely to have a family member with OCD or Tourettes Syndrome (March 1998).
  • Boys are more likely to have tic symptoms ( March 1998). Girls are more likely to have an adolescent onset and to have tic like symptoms (March 1998).
  • Parents often participate in their children’s compulsions, because they think it is helpful when it actually makes them sicker!
  • It is widely agreed upon that children with OCD benefit most from therapy or therapy and medication, but not medication alone.

 Random Facts

  • OCD disorder  Statistics indicate that 1-3 percent of the population suffers from it.
  • One study shows (20 percent) of patients referred to a dermatology clinic had an obsessive-compulsive disorder (OCD) and a resulting dermatological condition.( Lamburg 2007).
  • Sexual obsessions are common in people with OCD (Grant 2006).
  • Four in five people with OCD initially present to a physician other than a psychiatrist with other health conditions (Lamburg 2007).
  • There is debate in the field as to whether OCD is an anxiety disorder. Recent studies suggest that OCD patients have increased basal ganglia volume in their brain while people suffering from other anxiety disorders have decreased basal ganglia volume ( Joaquim 2010).
  • An implant in the brains of people with OCD called deep brain stimulation device ( DBS) stimulates laughter. OCD Patients with the DBS who had more laughter in this sample showed a decrease in symptoms of OCD(Haq 2010).
  • OCD patients are more likely to have musical hallucinations ( Hermesh 2004)!

 Genetics

  • During the past 40 years, family and twin studies have revealed that OCD disorder has a strong genetic component. Then several years ago, investigators linked the disorder to a region of chromosome 9 ( Treichel 2006).
  • OCD is five times more likely in first degree relatives of someone with ocd (Menzies 2008).
  • Scientists’ are currently making progress discovering which Gene is currently linked to OCD. Chromosome 9 has received the most attention.

 Facts Related to Other Mental Health Diagnoses

  • Some estimates put 30 percent of patients who have bipolar disorder as also having OCD ( Kaplan 2004).
  • Co morbid conditions in childhood include Adhd, other Anxiety Disorders and Major Depressive disorder (Piacinitni 2009).
  • It’s estimated that 75 percent of patients with OCD have a secondary or co morbid diagnosis (Kaplan 2004.)IF you have OCD you are likely to be struggling with something else.
  • 7.8 -25 percent of patients with schizophrenia have ocd and up to 60 percent of schizophrenic patients have ocd symptoms ( Kruger 2000).

 Medications

  • 40-60 percent of patients respond to a given trial of SRIS( Saxena 2009).
  • These people show a 40-50 percent reduction in symptoms (Saxena 2009).
  • OCD clients may need double the dose of an antidepressant as someone who is depressed.

Treatment

  • In children 60 -100 percent get significantly better with therapy.
  • OCD was once thought to be the most serious and severe of diseases and unresponsive to treatment (Kobak 2004).
  • ERP has been documented to be effective in treatment for OCD disorder for over two decades( Kobak 2004).

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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DISCLAIMER: The information provided is for educational and informational purposes only. This information should not replace the advice of a physician, psychiatrist or health care provider. Before taking any action, please consult with a physician, psychiatrist or health care provider. Please see Terms of Use for more information.

References

American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders: DSM-IV-TR. Washington, DC: American Psychiatric Association.

Arehart-Treichel,J Scientists Home In On Gene Linked to OCD.Psychiatric News, Aug 2006; 41: 26 - 32.

Haq IU, Foote KD, Goodman WG, Wu SS, Sudhyadhom A, Ricciuti N, Siddiqui MS, Bowers D, Jacobson CE, Ward H, Okun MS. Smile and laughter induction and intraoperative predictors of response to deep brain stimulation for obsessive-compulsive disorder. Neuroimage. 2010 Mar 10. [Epub ahead of print]

Hermesh H, Konas S, Shiloh R, Dar R, Marom S, Weizman A, Gross-Isseroff R. Musical hallucinations: prevalence in psychotic and nonpsychotic outpatients. J Clin Psychiatry. 2004 Feb;65(2):191-7.

Joaquim Radua; Odile A. van den Heuvel; Simon Surguladze; David Mataix-Cols.Meta-analytical Comparison of Voxel-Based Morphometry Studies in Obsessive-Compulsive Disorder vs Other Anxiety Disorders.

Arch Gen Psychiatry. 2010;67(7):701-711. Kaplan, A. and Hollander, E. A Review of Pharmacologic Treatments for Obsessive-Compulsive Disorder. F O C U S Summer 2004, Vol. II, No. 3 461 Focus, Jul 2004; 2: 454 - 461.

Kobak, Kenneth A., Greist, John H., Jefferson, James W., Katzelnick, David J., Henk, Henry J. Behavioral Versus Pharmacological Treatments of Obsessive Compulsive Disorder: A Meta-Analysis.Focus 2004 2: 462-474.

Kruger, Stephanie, Braunig, Peter, Hoffler, Jurgen, Shugar, Gerald, Borner, Ingrid, Langkrar, Julia. Prevalence of Obsessive-Compulsive Disorder in Schizophrenia and Significance of Motor Symptoms. J Neuropsychiatry Clin Neurosci 2000 12: 16-24

Lamberg,L. OCD Patients May Seek Help From Dermatologists Psychiatric News, Mar 2007; 42: 18 - 27.

Grant JE, Pinto A, Gunnip M, Mancebo MC, Eisen JL, Rasmussen SA. 2. Sexual obsessions and clinical correlates in adults with obsessive-compulsive disorder.Compr Psychiatry. 2006 Sep-Oct;47(5):325-9. Epub 2006 Apr 21.

March, John (1998). OCD in Children and Adolescents: A Cognitive-Behavioral Treatment Manual. New York: Guilford Press.

Menzies, Lara, Williams, Guy B., Chamberlain, Samuel R., Ooi, Cinly, Fineberg, Naomi, Suckling, John, Sahakian, Barbara J., Robbins, Trevor W., Bullmore, Ed T. White Matter Abnormalities in Patients With Obsessive-Compulsive Disorder and Their First-Degree Relatives Am J Psychiatry. 2008 Oct;165(10):1308-15. Epub 2008 Jun 2.

Piacentini, P. A. (2009, October 10). Treating children and adolescents with OCD. Power Point Lecture. BTTI TRAINING . San Diego, Ca.

Saxena. (2009, October 10). Psychopharmacology of Obsessive-Compulsive Disorder. Powerpoint Lecture. BTII Conference . San Diego, Ca.

The Pediatricc OCD Treatment Study (POTS) Team. Cognitive-Behavior Therapy, Sertraline, and Their Combination for Children and Adolescents With Obsessive-Compulsive Disorder: The Pediatric OCD Treatment Study (POTS) Randomized Controlled Trial JAMA. 2004;292(16):1969-1976.


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