What Is OCD? Definition, Types, Symptoms & Causes

International OCD Foundation | What is OCD?

What Is OCD? Definition, Types, Symptoms & Causes

Obsessive compulsive disorder (OCD) is a mental health disorder that affects people of all ages and walks of life, and occurs when a person gets caught in a cycle of obsessions and compulsions.

Obsessions are unwanted, intrusive thoughts, images, or urges that trigger intensely distressing feelings.

Compulsions are behaviors an individual engages in to attempt to get rid of the obsessions and/or decrease his or her distress.

Most people have obsessive thoughts and/or compulsive behaviors at some point in their lives, but that does not mean that we all have “some OCD.” In order for a diagnosis of obsessive compulsive disorder to be made, this cycle of obsessions and compulsions becomes so extreme that it consumes a lot of time and gets in the way of important activities that the person values.

What exactly are obsessions and compulsions?

Obsessions are thoughts, images or impulses that occur over and over again and feel outside of the person’s control. Individuals with OCD do not want to have these thoughts and find them disturbing. In most cases, people with OCD realize that these thoughts don’t make any sense.

 Obsessions are typically accompanied by intense and uncomfortable feelings such as fear, disgust, doubt, or a feeling that things have to be done in a way that is “just right.” In the context of OCD, obsessions are time consuming and get in the way of important activities the person values.

This last part is extremely important to keep in mind as it, in part, determines whether someone has OCD — a psychological disorder — rather than an obsessive personality trait.

Unfortunately, “obsessing” or “being obsessed” are commonly used terms in every day language. These more casual uses of the word means that someone is preoccupied with a topic or an idea or even a person. “Obsessed” in this everyday sense doesn’t involve problems in day-to-day living and even has a pleasurable component to it.

You can be “obsessed” with a new song you hear on the radio, but you can still meet your friend for dinner, get ready for bed in a timely way, get to work on time in the morning, etc., despite this obsession.

In fact, individuals with OCD have a hard time hearing this usage of “obsession” as it feels as though it diminishes their struggle with OCD symptoms.

Even if the content of the “obsession” is more serious, for example, everyone might have had a thought from time to time about getting sick, or worrying about a loved one’s safety, or wondering if a mistake they made might be catastrophic in some way, that doesn’t mean these obsessions are necessarily symptoms of OCD.

While these thoughts look the same as what you would see in OCD, someone without OCD may have these thoughts, be momentarily concerned, and then move on.

In fact, research has shown that most people have unwanted “intrusive thoughts” from time to time, but in the context of OCD, these intrusive thoughts come frequently and trigger extreme anxiety that gets in the way of day-to-day functioning.

Common Obsessions in OCD [1]

  • Body fluids (examples: urine, feces)
  • Germs/disease (examples: herpes, HIV)
  • Environmental contaminants (examples: asbestos, radiation)
  • Household chemicals (examples: cleaners, solvents)
  • Dirt
  • Fear of acting on an impulse to harm oneself
  • Fear of acting on an impulse to harm others
  • Fear of violent or horrific images in one’s mind
  • Fear of blurting out obscenities or insults
  • Fear of stealing things
  • Fear of being responsible for something terrible happening (examples: fire, burglary)
  • Fear of harming others because of not being careful enough (example: dropping something on the ground that might cause someone to slip and hurt him/herself)
  • Concern about evenness or exactness
  • Concern with a need to know or remember
  • Fear of losing or forgetting important information when throwing something out
  • Inability to decide whether to keep or to discard things
  • Fear of losing things
  • Forbidden or perverse sexual thoughts or images
  • Forbidden or perverse sexual impulses about others
  • Obsessions about homosexuality
  • Sexual obsessions that involve children or incest
  • Obsessions about aggressive sexual behavior towards others
  • Concern with offending God, or concern about blasphemy
  • Excessive concern with right/wrong or morality
  • Concern with getting a physical illness or disease (not by contamination, e.g. cancer)
  • Superstitious ideas about lucky/unlucky numbers certain colors

Compulsions are the second part of obsessive compulsive disorder. These are repetitive behaviors or thoughts that a person uses with the intention of neutralizing, counteracting, or making their obsessions go away. People with OCD realize this is only a temporary solution but without a better way to cope they rely on the compulsion as a temporary escape. Compulsions can also include avoiding situations that trigger obsessions. Compulsions are time consuming and get in the way of important activities the person values.

Similar to obsessions, not all repetitive behaviors or “rituals” are compulsions.  You have to look at the function and the context of the behavior.

For example, bedtime routines, religious practices, and learning a new skill all involve some level of repeating an activity over and over again, but are usually a positive and functional part of daily life. Behaviors depend on the context. Arranging and ordering books for eight hours a day isn’t a compulsion if the person works in a library.

Similarly, you may have “compulsive” behaviors that wouldn’t fall under OCD, if you are just a stickler for details or to have things neatly arranged. In this case, “compulsive” refers to a personality trait or something about yourself that you actually prefer or .

In most cases, individuals with OCD feel driven to engage in compulsive behavior and would rather not have to do these time consuming and many times torturous acts. In OCD, compulsive behavior is done with the intention of trying to escape or reduce anxiety or the presence of obsessions

Common Compulsions in OCD [2]

  • Washing hands excessively or in a certain way
  • Excessive showering, bathing, tooth-brushing, grooming ,or toilet routines
  • Cleaning household items or other objects excessively
  • Doing other things to prevent or remove contact with contaminants
  • Checking that you did not/will not harm others
  • Checking that you did not/will not harm yourself
  • Checking that nothing terrible happened
  • Checking that you did not make a mistake
  • Checking some parts of your physical condition or body
  • Rereading or rewriting
  • Repeating routine activities (examples: going in or out doors, getting up or down from chairs)
  • Repeating body movements (example: tapping, touching, blinking)
  • Repeating activities in “multiples” (examples: doing a task three times because three is a “good,” “right,” “safe” number)
  • Mental review of events to prevent harm (to oneself others, to prevent terrible consequences)
  • Praying to prevent harm (to oneself others, to prevent terrible consequences)
  • Counting while performing a task to end on a “good,” “right,” or “safe” number
  • “Cancelling” or “Undoing” (example: replacing a “bad” word with a “good” word to cancel it out)
  • Putting things in order or arranging things until it “feels right”
  • Telling asking or confessing to get reassurance
  • Avoiding situations that might trigger your obsessions

Learn More About OCD

Who Gets OCD?
What Causes OCD?
How is OCD Diagnosed?
How is OCD Treated?
How Do I Find Help for OCD?
Related Disorders

Source: https://iocdf.org/about-ocd/

The 5 Types of Obsessive-Compulsive Disorder

What Is OCD? Definition, Types, Symptoms & Causes
Verywell / Emily Roberts

Although specific symptom types appear to be relatively stable over time, it is possible to experience a change in the nature and focus of your symptoms. Additionally, although the majority of your symptoms might be consistent with a particular symptom subtype, it is possible to experience symptoms of other types at the same time.

  1. Contamination Obsessions With Washing/Cleaning Compulsions: If you are affected by this symptom subtype, you will usually focus on feelings of discomfort associated with contamination and wash or clean excessively to reduce these feelings of distress.

    For example, you might feel that your hands are dirty or contaminated after touching a doorknob or worry that you will contaminate others with your germs. To get rid of these feelings, you might wash your hands repeatedly for hours at a time.

  2. Harm Obsessions With Checking Compulsions: If you experience this symptom subtype, you will often have intense thoughts related to possible harm to yourself or others and use checking rituals to relieve your distress. For example, you might imagine your house burning down and then repeatedly drive by your house to make sure that there is no fire.

    Or, you may feel that by simply thinking about a disastrous event, you are increasing the lihood of such an event actually happening.

  3. Obsessions Without Visible Compulsions: This symptom subtype often relates to unwanted obsessions surrounding sexual, religious, or aggressive themes.

    For example, you could experience intrusive thoughts about being a rapist or that you will attack someone. You may often use mental rituals such as reciting particular words, counting in your head or praying to relieve the anxiety you experience when you have these involuntary thoughts. Triggers related to obsessions are usually avoided at all costs.

  4. Symmetry Obsessions With Ordering, Arranging, and Counting compulsions: When experiencing this subtype, you feel a strong need to arrange and rearrange objects until they are «just right.» For example, you might feel the need to constantly arrange your shirts so that they are ordered precisely by color.

    This symptom subtype can also involve thinking or saying sentences or words over and over again until the task is accomplished perfectly. Sometimes these ordering, arranging, and counting compulsions are carried out to ward off potential danger. For example: «If I arrange my desk perfectly my husband won’t die in a car accident.» However, this is not always the case.

  5. Hoarding: Hoarding is now recognized as a distinct diagnosis in the DSM-5. Hoarding involves the collection of items that are judged to be of limited value by others such as old magazines, clothes, receipts, junk mail, notes, or containers. Often your living space becomes so consumed with clutter that it becomes impossible to live in.

    Hoarding is often accompanied by obsessional fears of losing items or possessions that may be needed one day and excessive emotional attachment to objects. People affected by the hoarding symptom subtype will tend to experience higher anxiety and depression than people with other subtypes and are often are unable to maintain steady employment. Importantly, compulsive hoarding can occur independently of OCD.

The DSM-5 included new definitions or moved these disorders to this category.

  • Skin Pricking Disorder (Excoriation): This disorder was also recognized as a distinct diagnosis in the DSM-5. It is persistent pricking at your skin that results in lesions, infections, and clinically significant distress. It is prevalent in approximately 1 to 2 percent of the population.
  • Hair-Pulling Disorder (trichotillomania): In this OCD-related disorder, you have a strong urge to pull the hair from your head, eyebrows, eyelashes, or elsewhere on your body. It is usually treated with habit-reversal training and cognitive-behavioral therapy.
  • Body Dysmorphic Disorder: This disorder is a «preoccupation with one or more perceived defects or flaws in appearance that are not observable or appear slight to others.

    » The criteria include that you have performed repetitive behaviors of grooming or checking your appearance or have mental acts such as constantly comparing your appearance to others. Muscle dysmorphia is a subtype of body dysmorphic disorder in which you think your body is too small or not muscular enough.

  • OCD and Related Disorders Induced By a Substance/Medication or Due to Another Medical Condition: Exposure to certain substances and medications can induce the development of OCD symptoms. There also are certain medical and neurological conditions that can be associated with the development of the disorder.

In addition, although it is not uncommon for new mothers to experience a wide array of emotions following the arrival of a new child, the postpartum period has long been known to be a time of increased risk for the appearance, worsening, or recurrence of mood and anxiety disorders. A number of studies have suggested that the postpartum period may also present a risk for the onset or worsening of OCD.

Although many people think of OCD as a disorder that affects only adults, a similar percentage of children are also affected. While there are many similarities between adult-onset and childhood-onset OCD, there are also many important differences—particularly with respect to treatment and the nature of symptoms.

Although we usually think of OCD as being caused by a combination of stress, genetic factors, and an imbalance of chemicals in the brain, there is growing evidence that a specific form of childhood OCD may actually be an autoimmune disorder.

 In pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS), children develop OCD or tic disorders suddenly after a strep infection (such as strep throat) or scarlet fever or have a worsening of already existing OCD symptoms.

Studies at the National Institute of Mental Health have shown that a strep infection can produce cross-reactive «anti-brain» antibodies that produce the symptoms of PANDAS in children between age 3 and puberty.

Choosing a course treatment for OCD depends on several factors, including:

  • What has worked in the past
  • Your attitudes toward medication
  • Your motivation to undergo exposure response prevention (ERP) or cognitive-behavioral therapy (CBT)
  • The severity of your symptoms
  • The presence of other disorders such as depression

In general, most OCD types respond to some combination of cognitive-behavior therapy, exposure-response prevention, and medication. An important exception may be hoarding, which does not seem to improve with medication but does seem to respond to psychotherapy.

Nevertheless, it may be useful for you to discuss with your psychologist or physician the ways in which ERP, CBT, and medication can be adjusted for maximum benefit your symptoms.

If you have symptoms of OCD or its related disorders, see your health care provider as there is treatment available. You are not the only person with one of these disorders. You will find support and get the help you need to relieve yourself of these symptoms.

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  1. Williams MT, Mugno B, Franklin M, Faber S. Symptom dimensions in obsessive-compulsive disorder: phenomenology and treatment outcomes with exposure and ritual prevention. Psychopathology. 2013;46(6):365–376. doi:10.1159/000348582

  2. Leckman JF, Bloch MH, King RA. Symptom dimensions and subtypes of obsessive-compulsive disorder: a developmental perspective. Dialogues Clin Neurosci. 2009;11(1):21–33. doi: 10.1007/0-387-23370-9_1

  3. Regier DA, Kuhl EA, Kupfer DJ. The DSM-5: Classification and criteria changes. World Psychiatry. 2013;12(2):92–98. doi:10.1002/wps.20050

  4. Pittenger C, Kelmendi B, Bloch M, Krystal JH, Coric V. Clinical treatment of obsessive compulsive disorder. Psychiatry (Edgmont). 2005;2(11):34–43. PMID: 21120095

  5. Forray A, Focseneanu M, Pittman B, McDougle CJ, Epperson CN. Onset and exacerbation of obsessive-compulsive disorder in pregnancy and the postpartum period. J Clin Psychiatry. 2010;71(8):1061–1068. doi:10.4088/JCP.09m05381blu

  6. Marazziti D, Mucci F, Fontenelle LF. Immune system and obsessive-compulsive disorder. Psychoneuroendocrinology. 2018;93:39-44. doi: 10.1016/j.psyneuen.2018.04.013

  7. Hezel DM, Simpson HB. Exposure and response prevention for obsessive-compulsive disorder: A review and new directions. Indian J Psychiatry. 2019;61(Suppl 1):S85–S92. doi:10.4103/psychiatry.IndianJPsychiatry_516_18

Additional Reading

  • PANDAS—Questions and Answers. National Institute of Mental Health.

  • American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition). Washington, D.C.: American Psychiatric Association; 2013.

  • da Rocha FF, Correa H, Teixeira AL. Obsessive-Compulsive Disorder and immunology: A Review. Progress in Neuro-Psychopharmacology & Biological Psychiatry 2008 32: 1139-1146.

  • Lomax CL, Oldfield VB, Salkovskis PM Clinical and Treatment Comparisons Between Adults With Early- and Late-Onset Obsessive-Compulsive Disorder. Behavior Research and Therapy 2009: 99-104.

  • Starcevic V, Brakoulias V. Symptom Subtypes of Obsessive-Compulsive Disorder: Are They Relevant for Treatment? Australian and New Zealand Journal of Psychiatry 2008 42: 651-661.

Source: https://www.verywellmind.com/what-are-the-different-types-of-ocd-2510663

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