What Is OCD and How is it Recognized?
Virtually everyone has experienced worries, doubts or fears at one time or another. It’s natural to worry about life issues such as your health or the well-being of someone you love, paying bills or what the future will bring. Everyone has also an occasional intrusive thought; it’s not even abnormal if you’ve had an intrusive “bad” thought. That’s not OCD.
OCD is diagnosed when obsessions and compulsions
- Consume excessive amounts of time (an hour or more each day)
- Cause significant distress
- Interfere with daily functioning at work or school, or with social activities, family relationships and/or normal routines.
OCD is characterized by obsessive thoughts, impulses, or images and compulsions (overt or mental rituals) that are difficult to suppress and take a considerable amount of time and energy away from living your life, enjoying your family and friends or even doing your job or school work.
When OCD symptoms are present, it’s important to consult a mental health professional who is knowledgeable about OCD for evaluation and treatment.
What are the Symptoms of OCD?
In some cases, compulsions are shaped by the nature of the obsessions. Compulsive washing, for example, is commonly performed in response to obsessive fears of contamination. Similarly, a fear of the house burning down may lead to excessive checking of the stove, oven and iron.
In other cases, obsessions and compulsions are paired in a way that defies explanation; the compulsive behavior is completely unrelated to the obsession. For example, a business man may feel compelled to tap his desk multiple times to prevent harm from coming to his family while he is at work..
It’s important to note that some people with OCD perform rituals not in response to a distinct obsession or fear but rather in response to certain sensory phenomena. Visual, auditory or tactile sensations may trigger a need for something to look, sound, or feel “just right.” Upon seeing a tile floor, for example, a person may experience a need to trace over each of the tiles mentally in a symmetrical fashion.
In other cases, external triggers are absent, but the individual has an inner feeling and/or perception of discomfort that causes him or her to repeat a behavior until the feeling is relieved; the behavior needs to be repeated until it feels “just right” or “complete.” In still other situations, repeating behavior is preceded neither by obsessions nor sensations but rather by a need or urge.
Below are some examples of the more common OCD symptoms. Obsessions are shown in italics, and rituals that are frequently associated with those obsessions are listed beneath them.
Fears of germs or contamination
- Repeatedly washing hands, using anti-bacterial wipes or hand-sanitizer
- “Protecting” what is perceived as “clean” space – personal desk or locker, other personal property
- Seeking reassurance from someone in the environment that others aren’t “sick” or “dirty”
- Avoiding touching “dirty” surfaces that others may have touched, including common-area objects such as doorknobs, desks, shared supplies, computer keyboards, soap, cafeteria trays, etc.
- Avoiding contact play or sports – either because of a fear of catching a disease or fear of contaminating others
- Avoiding the use of public washrooms
- Refusing to share items or supplies with others
- Refusing to eat in a cafeteria
- Avoiding certain products or surfaces because they may contain “poison” (for example, cleaning chemicals)
Fears that harm, illness, or death, will befall oneself or others; fear of causing harm to oneself or others, including violent or aggressive obsessions (fear of killing or injuring oneself or another person; fear of molesting a child)
Note: Individuals with OCD who have violent/aggressive thoughts neither have a history of violence nor act upon these urges or ideas.
- “Checking” behavior, such as making sure doors and/or windows are locked; checking to be sure that oven, stove, coffee pot, iron, curling iron are off
- Checking light switches or turning them on and off repeatedly
- Repeatedly checking to see if a child is still breathing during the night
- Reading a paragraph over and over again to prevent harm from coming to a loved one, pet, etc.
- Seeking reassurance from someone in the environment that the person (with OCD) is “safe”
- Avoiding leaving a “safe” zone (such as a cubicle, classroom); avoiding going into certain "unsafe" zones (for example, for lunch or recess areas)
- Avoiding open spaces, such as a gymnasium
- Unreasonable avoidance of colleagues or peers, for fear of causing them harm
Fears/feelings/urges related to numbers, e.g., "good" numbers, "bad" numbers, "magical" numbers
- “Counting” behavior such as counting, touching or saying words a certain number of times (believing there is a magical significance to certain numbers and, for example, using those numbers to “magically” keep harm from coming to another); counting the number of steps between locations and having to start over if interrupted
- Touching objects a certain number of times; not being able to move on unless this touching has been accomplished
- Reading words or pages a certain number of times, causing delays in completing work, assignments
- Going back and forth through doorways a certain number of times before it’s OK to enter the room
- Avoiding using certain numbers that are "unlucky" or "not safe"; only using numbers that are "safe" or "lucky."
Fears/feelings/urges related to discarding something (e.g., fears that something bad will happen if something is thrown away); feelings of incompleteness if something is discarded (e.g., need to document and preserve all life experiences); fears of contamination (excessive acquisition of items that cannot be touched due to contamination fears; buying items that a person has touched to avoid contaminating other people); need to buy items in multiples of a particular number; not discarding objects to avoid repetitive rituals such as washing or checking
Note: This form of hoarding is related to the obsessions and compulsions of OCD and is distinct from Hoarding Disorder (see Related Conditions).
- Saving useless items – scraps of paper, candy wrappers, bottle caps, broken items; being unable to part with things that are not needed any more
- Holding on to items for fear that they might be needed sometime in the future, such as books, newspapers, food, school papers
- Buying multiples of the same item (e.g., buying in multiples of 3 because its a person’s magic number)
- Buying every item in a grocery store that one may have touched (and therefore "contaminiated") to prevent others from being contaminated
- Accumulating items or objects in a particular area (e.g., desk drawer) because they are contaminated and cannot be touched
Excessive fear of violating religious or moral rules (scrupulosity)
- Apologizing or confessing that something was (or is thought to have been) wrong, such as breaking rules, including religious, office, classroom rules
- Constantly seeking reassurance that a task has been completed right or perfectly; seeking affirmation that a mistake was not made
- Saying prayers a certain number of times; excessive praying to atone for being “bad”; repeatedly confessing perceived “sins” or bad behavior
- Repetitive praying or confessing to neutralize or “undo” bad thoughts, intrusive sexual thoughts, or visions of acting badly, including cursing or blaspheming at work, school or church
- Avoiding answering questions for fear of telling a lie
Fears/feelings/urges related to symmetry or order
- Constantly “evening up” items or groups of items, such as books on a shelf or items on a desk; aligning edges to be “just right” or “even”
- Rearranging items to be in a certain order, for example, by color or alphabetical order
- Avoiding a particular room with square tiles (e.g., bathroom); seeing the tiles would necessitate tracing each of the edges with the eyes
Fears/feelings/urges/images related to sexual content
- Doubting one’s sexual orientation, even though there is no evidence to support this concern
- Excessive praying to atone for having inappropriate sexual thoughts or images
- Avoiding TV, magazines, books, DVDs, etc., for fear of seeing something sexually-related
Excessive doubting/dread of uncertainty
- Constantly rechecking to see if everything that should be in a brief case, backpack is actually there
- Leaving one’s work area to check something, e.g., to check that a car in a parking lot is actually locked
- Avoiding a school locker to prevent having to check the lock over and over again
Fears/feelings/urges related to having something "just right," "just so" or "perfect"
- Getting up and sitting down repeatedly at a desk, until the "just right" feeling has been achieved
- Repeatedly revising the way letters, words, numbers, or ones name is written to make them look "just right"; getting "stuck" writing the same letter or word over and over again
- Erasing words and rewriting over and over – sometimes until holes are rubbed in the paper
- Extreme slowness with work or school activities – making sure that everything looks "just right" or is done "just right," possibly in a certain order or pattern
- Repeating various actions over and over for no apparent reason
- Avoiding a hallway in which one must walk repeatedly until it feels "just right"
Symptoms of OCD vary widely, depending upon the individual and the situation. Adults and children experience many symptoms other than those mentioned above. Interestingly, the majority of people with OCD are able to function reasonably well, and friends or co-workers may not even suspect there’s a problem. But when symptoms escalate to the point that they interfere with functioning – excessive time is lost from work, an individual is unable to work, a student who normally receives good grades in school suddenly receives poor grades, uncontrollable fear and anxiety are severely straining a relationship – it’s time to get help.
Postpartum OCD (PPOCD)
Over the years, the condition experienced by many new mothers known as post-partum depression has received increased attention. Perhaps not as widely recognized, however, is that although reported figures vary, an estimated two to three percent of new mothers develop postpartum OCD (PPOCD). With this disorder, a woman may have obsessive intrusive thoughts about her baby’s safety. Symptoms include:
- excessively washing or sterilizing baby bottles
- excessively washing baby clothing, or washing other family members’ clothing repeatedly
- isolating the baby to keep family members or others from “contaminating” the baby
- constantly checking on the baby
- experiencing persistent and terrifying fears of harming the baby
Everyone from family members to friends expects a new mother to be joyful. But society doesn’t realize that PPOCD can leave a new mother feeling devastated and exhausted. Untreated PPOCD can have a negative impact a mother’s ability to care for her child and severely strain her marriage, friendships and other relationships.
Effective individualized treatment for both post-partum depression and PPOCD (which frequently occur together) is available, and can enable a new mom to manage her symptoms. As with other types of OCD, postpartum OCD usually responds to medications (serotonin reuptake inhibitors) and cognitive-behavioral therapy (CBT). Although serotonin reuptake inhibitors are effective treatments for OCD, their risks to the unborn and breast-feeding child are not yet well known. Many experts believe these medications probably pose no danger, but it’s important to discuss the possible risks with your doctor on an individual basis. A safer, yet more challenging treatment approach, is CBT, which has been demonstrated to be more effective than medications for non-postpartum OCD.