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Understanding what obsessive compulsive disorder is

I was washing my hands thinking about the act of washing my hand. I like to put the soap on my hand first and then wash it under the water. I have rituals like this, but they don’t consume my life. I wanted to research more about this topic of how a simple ritual is different from obsessive compulsive disorder.

What is Obsessive Compulsive Disorder (OCD)? (National Institute of Mental Health, Mayo Clinic)

As the name implies, people with OCD have a combination of obsessions (persistent, upsetting thoughts, images or impulses) and compulsions (use of rituals) to control various anxieties. Most of the time, the rituals end up controlling and consuming their life. Performing such rituals is not pleasurable although it may produce temporary relief from the anxiety created by obsessive thoughts.

Typical OCD obsessions revolve around:

  • Fear of contamination or dirt

  • Having things orderly and symmetrical

  • Aggressive or horrific impulses

  • Harming loved ones

  • Having thoughts prohibited by religious beliefs

OCD symptoms involving obsessions may include:

  • Fear of being contaminated by shaking hands or by touching objects others have touched

  • Doubts that you’ve locked the door or turned off the stove

  • Intense distress when objects aren’t orderly, lined up properly or facing the right way

  • Impulses to shout obscenities in inappropriate situations

  • Avoidance of situations that can trigger obsessions, such as shaking hands

  • Dermatitis because of frequent hand washing

  • Hair loss or bald spots because of hair pulling

Typical compulsions revolve around:

  • Washing and cleaning

  • Counting

  • Checking

  • Demanding reassurances

  • Repeating actions over and over

  • Arranging and making items appear orderly

OCD symptoms involving compulsions may include:

  • Washing hands until the skin becomes raw

  • Checking doors repeatedly to make sure they’re locked

  • Checking the stove repeatedly to make sure it’s off

  • Counting in certain patterns

It is important to understand that healthy people also have rituals, such as checking to see if the stove is off several times before leaving the house. The difference is that people with OCD perform their rituals even though doing so interferes with daily life and they find the repetition distressing. Although most adults with OCD recognize that what they are doing is senseless, some adults and most children may not realize that their behavior is out of the ordinary.

Although OCD was once thought to be a rare condition, it affects about 2.2 million American adults. Often the problem can be accompanied by eating disorders, other anxiety disorders, depression or substance abuse.

Diagnosing Obsessive Compulsive Disorder (Mayo Clinic)

A mental health professional can diagnose obsessive-compulsive disorder after a thorough evaluation. Although there aren’t any laboratory tests to diagnose OCD, your doctor may check for physical problems the condition may cause, such as dermatitis from frequent hand washing.

It’s sometimes difficult to diagnose obsessive-compulsive disorder because it may resemble generalized anxiety disorder or other mental conditions. To help diagnose obsessive-compulsive disorder, your doctor will ask you questions about your obsessions, compulsions and emotional well-being and may talk to your friends and relatives about your behavior.

To be diagnosed with obsessive-compulsive disorder, someone must meet the criteria spelled out in the Diagnostic and Statistical Manual of Mental Disorders (DSM). This manual is published by the American Psychiatric Association and is used by mental health professionals to diagnose mental conditions and by insurance companies to reimburse for treatment.

For OCD to be diagnosed, you must have either obsessions or compulsions, you must realize that these obsessions and compulsions are excessive or unreasonable, and they significantly interfere with your daily routine.

This is taken for the DSM-IV-TR Diagostic criteria section

A. Either obsessions or compulsions:

  • Obsessions as defined by (1), (2), (3), and (4)

    1. recurrent and persistent thoughts, impulses, or images that are experienced, at some time during the disturbance, as intrusive and inappropriate and that cause marked anxiety or distress

    2. the thoughts, impulses, or images are not simply excessive worries about real-life problems

    3. the person attempts to ignore or suppress such thoughts, impulses or images, or to neutralize them with some other thought or action

    4. the person recognizes that the obsessional thoughts, impulses, or images are a product of his or her mind (not imposed from without as in thought insertion)

  • Compulsions as defined by (1) and (2)

    1. repetitive behavior (ex. hand washing, ordering, checking) or mental acts (ex. praying, counting, repeating words silently) that the person feels driven to perform in response to an obsession, or according to rules that must be applied rigidly.

    2. the behaviors or mental acts are aimed at preventing or reducing distress or preventing some dreaded event or situation; however, these behaviors or mental acts either are not connected in a realistic way with what they are designed to neutralize or prevent or are clearly excessive.

B. At some point during the course of the disorder, the person has recognized that the obsessions or compulsions are excessive or unreasonable. However, this does not apply to children.

C. The obsessions or compulsions cause marked distress, are time consuming (take more than 1 hour a day), or significantly interfere with the person’s normal routine, occupational (or academic) functioning, or usual social activities or relationships.

D. If another Axis I disorder is present, the content of the obsessions or compulsions is not restricted to it (ex. preoccupation with food in the presence of an Eating Disorder; hair pulling in the presence of Trichotillomania; concern with appearance in the presence of Body Dysmorphic Disorder, preoccupation with drugs in the presence of a Substance Use Disorder; preoccupation with having serious illness int he presence of Hypochondriasis; preoccupation with sexual urges or fantasies in the presence of Paraphilia; or guilty ruminations in the presence of Major Depressive Disorder.

E. The disturbance is not due to the direct physiological effects of a substance (ex. a drug of abuse, medication) or a general medical condition. Specify if: with poor insight: if, for most of the time during the current episode the person does not recognize that the obsessions and compulsions are excessive and unreasonable

Theories around some causes of OCD Mayo Clinic causes (Mayo Clinic

  • Biology. OCD may be a result of changes in your body’s own natural chemistry.

  • Insufficient serotonin. An insufficient level of serotonin, one of your brain’s chemical messengers, may contribute to obsessive-compulsive disorder.

  • Family history.Although researchers haven’t identified the gene responsible for OCD, it is believed that having parents or other family members with the disorder can increase your risk of developing OCD.

  • Environment. Some researchers believe that OCD results from learned behavior habits over time.

  • Strep throat. Some studies suggest that some children develop OCD after infection with group A beta-hemolytic streptococcal pharyngitis — strep throat. This may due to the antibody developed against strep throat bacteria acting like a brain enzyme and interrupting communication between neurons in the brain.

  • Stressful life events. If you tend to react strongly to stress, your risk may increase.

More information:

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