The phrase 'obsessive-compulsive' has worked its way into the wider English lexicon, and is often used in an offhand manner to describe someone who is meticulous or absorbed in a cause. Such casual references should not be confused with Obsessive-Compulsive Disorder (OCD). It is also important to distinguish OCD from other types of anxiety, including the routine tension and stress that appear throughout life. A person who shows signs of infatuation or fixation with a subject/object, or displays traits such as perfectionism, does not necessarily have OCD, a specific and well-defined condition.

To be diagnosed with Obsessive-Compulsive Disorder, one must have either obsessions or compulsions alone, or obsessions and compulsions, according to the DSM-IV-TR (2000) diagnostic criteria. The Quick Reference to the diagnostic criteria from DSM describes these obsessions and compulsions:-

 

Obsessions are defined by:-

• 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.
• The thoughts, impulses, or images are not simply excessive worries about real-life problems.
• The person attempts to ignore or suppress such thoughts, impulses, or images, or to neutralize them with some other thought or
  action.
• The person recognizes that the obsessional thoughts, impulses, or images are a product of his or her own mind, and are not based in
  reality.
• The tendency to fixate on small details that the person is unable to fix or change in any way.

 

Compulsions are defined by:-

• Repetitive behaviours or mental acts that the person feels driven to perform in response to an obsession, or according to rules that
  must be applied rigidly.
• The behaviours or mental acts are aimed at preventing or reducing distress or preventing some dreaded event or situation; however,
  these behaviours or mental acts either are not connected in a realistic way with what they are designed to neutralize or prevent or are
  clearly excessive.

 

In addition to these criteria, at some point during the course of the disorder, the sufferer must realize that his/her obsessions or compulsions are unreasonable or excessive. Moreover, the obsessions or compulsions must be time-consuming (taking up more than one hour per day), cause distress, or cause impairment in social, occupational, or school functioning (Quick Reference from DSM-IV-TR, 2000). OCD often causes feelings similar to that of Depression.

 

Symptoms and prevalence

OCD is manifested in a variety of forms.
 

Community studies have placed the prevalence between 1 and 3%, but the prevalence of clinically recognized OCD is much lower, suggesting that many individuals with the disorder are unaccounted for clinically. The fact that many individuals do not seek treatment may be due in part to stigma associated with OCD.

The typical OCD sufferer performs tasks (or compulsions) to seek relief from obsession-related anxiety. To others, these tasks may appear odd and unnecessary. But for the sufferer, such tasks can feel critically important, and must be performed in particular ways to ward off dire consequences and to stop the stress from building up. Examples of these tasks: repeatedly checking that one's parked car has been locked before leaving it; turning lights on and off a set number of times before exiting a room; repeatedly washing hands at regular intervals throughout the day.

Symptoms may include some, all, or perhaps none of the following:

• Repeated hand-washing.
• Specific counting systems - e.g. counting in groups of four, arranging objects in groups of three, grouping objects in odd/even
  numbered groups, etc. (One serious symptom which stems from this is 'counting' your steps - eg: you must take twelve steps to the
  car in the morning.)
• Perfectly aligning objects at complete, absolute right angles, etc. This symptom is shared with Obsessive-Compulsive Personality
  Disorder and can be confused with this condition unless it is realized that in OCPD it is not stress-related.
• Having to 'cancel out' bad thoughts with good thoughts. Eg: Imagining harming a child, and having to imagine a child playing happily to
  cancel it out.
• Sexual obsessions, or unwanted sexual thoughts. (Two classic examples are fear of being homosexual or fear of being a paedophile.
  In both cases, sufferers will obsess over whether or not they are genuinely aroused by the thoughts.)
• A fear of contamination; some sufferers may fear the presence of human body secretions such as saliva, sweat, tears, or mucus, or
  excretions such as urine or faeces. Some OCD sufferers even fear that the soap they're using is contaminated.
• A need for both sides of the body to feel even. A person with OCD might walk down a sidewalk and step on a crack with the ball of
  their left foot, then feel the need to step on another crack with the ball of their right foot. Also, if one hand gets wet, the sufferer may feel very uncomfortable if the other is not.

There are many other possible symptoms, and one need not display those above to suffer from OCD. Formal diagnosis is performed by a mental health professional. Furthermore, possessing the symptoms above is not an absolute sign of OCD.

Most OCD sufferers are aware that such thoughts and behaviour are not rational, but feel bound to comply with them to fend off feelings of panic or dread. Because sufferers are consciously aware of this irrationality but feel helpless to push it away, untreated OCD is often regarded as one of the most vexing and frustrating of the major anxiety disorders.

 

In an attempt to further relate the immense distress that those afflicted with this condition must bear, David Barlow & Mark Durand (2006) use the following example. They implore readers not to think of pink elephants. Their point lies in the assumption that most people will immediately create an image of a pink elephant in their minds, even though told not to do so. The more one attempts to stop thinking of these colourful animals, the more one will continue to generate these mental images. This phenomenon is termed the 'Thought Avoidance Paradox', and it plagues those with OCD on a daily basis, for no matter how hard one tries to get these disturbing images and thoughts out of one's mind, feelings of distress and anxiety inevitably prevail. Although everyone may experience unpleasant thoughts at one time or another, these are usually warranted concerns that are short-lived and fade after an adequate time period has lapsed. However, this is not the case for OCD sufferers. (K Carter 2006).

People who suffer from the separate condition Obsessive Compulsive Personality Disorder are not aware of anything abnormal about themselves; they will readily explain why their actions are rational, and it is usually impossible to convince them otherwise. People who suffer from OCPD tend to derive pleasure from their obsessions or compulsions, while those with OCD do not feel pleasure but are ridden with anxiety. OCD is ego dystonic, meaning that the disorder is incompatible with the sufferer's self-concept. Because disorders that are ego dystonic go against an individual's perception of his/herself, they tend to cause much distress. OCPD, on the other hand, is ego syntonic - marked by the individual's acceptance that the characteristics displayed as a result of this disorder are compatible with his/her self-image. Ego syntonic disorders understandably cause no distress (Carter 2006). This is a significant difference between these disorders.

Equally frequently, these rationalisations do not apply to the overall behaviour, but to each instance individually; for example, a person compulsively checking their front door may argue that the time taken and stress caused by one more check of the front door is considerably less than the time and stress associated with being robbed, and thus the check is the better option. In practice, after that check, the individual is still not sure, and it is still better in terms of time and stress to do one more check, and this reasoning can continue as long as necessary.

OCD is placed in the anxiety class of mental illness, but like many chronic stress disorders it can lead to clinical Depression over time. The constant stress of the condition can cause sufferers to develop a deadening of spirit, a numbing frustration, or sense of hopelessness. OCD's effects on day-to-day life - particularly its substantial consumption of time - can produce difficulties with work, finances and relationships.

The illness ranges widely in severity.

                                                                                                           Demographics
Obsessive-Compulsive Disorder tends to be slightly more common in females than in males. The lifetime prevalence of the disorder in women is 2.9%, versus 2.0% in men. However, in a 1980 study of 20,000 adults from New Haven, Baltimore, St. Louis, Durham, and Los Angeles, the lifetime prevalence rate of OCD for both genders was recorded at 2.5%.

Education also appears to be a factor. The lifetime prevalence of OCD is lower for those who have graduated high school than for those who have not (1.9% versus 3.4%). However, in the case of college education, lifetime prevalence is higher for those who graduate with a degree (3.1%) than it is for those who have only some college background (2.4%). As far as age is concerned, the onset of OCD usually ranges from the late teenage years until the mid-twenties in both genders, but the age of onset tends to be slightly younger in males than in females (Martin Antony, Fiona Downie & Richard Swinson 1998).

Violence is very rare among OCD sufferers, but the disorder is often debilitating and detrimental to their quality of life. Also, the psychological self-awareness of the irrationality of the disorder can be painful. For people with severe OCD, it may take several hours a day to carry out the compulsive acts. To avoid perceived obsession triggers, they also often avoid certain situations or places altogether.

It has been alleged that sufferers are generally of above-average intelligence, as the very nature of the disorder necessitates complicated thinking patterns, but this has never been supported by clinical data.

 

 

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