Dr. Angela Hanford
”Did I lock the door”
“Did the garage door go down?”
“Did I turn the flat iron off?”
These are not uncommon thoughts, so when do they cross the line into an obsession? When do people develop an uncontrollable urge to do certain behaviors, such as turning the car around during their morning commute to check the flat iron every morning?
What is Obsessive-Compulsive Disorder?
Obsessive-Compulsive Disorder (OCD) is defined in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) (APA, 2013). As the name suggests, OCD is diagnosed when someone has obsessions and/or compulsions that interfere significantly with life or are time-consuming. Obsessions can be thoughts, images, or urges that are intrusive and persistent.
Compulsions are behaviors that are repetitive, such as checking to see if something is unplugged, or repetitive mental acts, such as counting. Compulsions are often done in response to an obsession and performing the behavior or mental act is done to reduce distress or prevent something bad from happening.
These obsessions and compulsions are not wanted and result in distress. It is hard for someone with Obsessive-Compulsive Disorder to stop the obsessions or compulsions because of the associated anxiety or distress that occurs when trying to suppress the symptoms. For example, a person with the compulsive behavior to wash their hands and sanitize their surroundings may, at first, touch a railing outside of the grocery store.
Their thoughts might include: “I am going to get sick from these germs,” “I have probably picked up a virus,” or “This place is disgusting.” This person then feels the emotions of disgust and fear. These emotions lead them to decide to use the hand sanitizer in their bag or car.
However, compulsive behaviors take this decision further. Hand sanitizer is now not enough. The person must go home and wash their hands for 10 minutes with different soaps, shower, and dress in clean clothes to rid themselves of the disgust and fear – as well as the original thoughts.
Unfortunately, cleaning and sanitizing are only temporary relief. (**Note: This is in the absence of a real threat and/more extreme than would be expected for the threat level. For example, it is reasonable with COVID-19 or the flu to wash hands and maintain appropriate hygiene. This is different from constantly fixating on the germs and washing one’s hands until they are raw.)
OCD tends to develop and become noticeable during late childhood and then later teen and young adult years, although symptoms can develop at anytime throughout the lifespan. Although the exact causes of OCD are not known, research is suggesting that genetic and physiological factors likely play a role.
Common Examples of OCD in Real Life
Here are several more examples of what Obsessive-Compulsive Disorder can look like:
- People who clean and sanitize. Probably the most well-known sign of obsessive-compulsive behavior is the urge to rid surfaces and items of germs beyond a standard cleaning. This can lead to ritualistic handwashing, sanitizing processes, and deep-cleaning routines that interfere with a person’s life and relationships. For example, the person may feel the need to miss work or social events if they have not completed their cleaning regimen.
- People who check, double-check, and recheck things. Going back to check the stove or coffeemaker, the locked door, or the gas hot water tank multiple times could be a sign of compulsive behavior. Thinking about the locked doors and appliances obsessively and then changing the expected behavior to check on these things are examples of OCD behaviors. The action becomes more than a habit, but a powerful urge fueled by fear.
- People who obsessively count numbers or objects, sometimes needing to reach a certain number that seems right.
- Repeating certain phrases or words over and over.
- People may need to do behaviors in a routine or a certain number of times, with the underlying fear that if this is not accomplished something bad could happen. For example, someone with OCD may have a bathroom routine that must be followed because missing one step or doing something out of order creates anxiety and fear. Another classic example is someone who turns on and off a light switch over and over until it “feels right”.
- Scrupulosity is a type of OCD that involves obsessions and compulsions about religious or moral factors (International OCD Foundation, 2010). For example, someone with scrupulosity may be very fearful of blasphemy to the point that it becomes extremely distressful and takes on the tone of OCD. This person may then continually confess sins and seek reassurance from religious leaders that they are not condemned to hell. Sometimes prayer can take on an OCD flavor, such as someone praying the same thing over and over fearing that if a certain prayer sequence is not completed then something bad will happen. These acts are distinct from religious practices in that they are extreme and do night line up with religious teaching.
- People who obsessively worry about losing control of themselves or hurting someone else. For example, someone may constantly obsess about being afraid of killing themselves but are not wanting to die. Another person may obsessively worry about hurting someone accidentally, such as not cleaning up a spill adequately, and then someone slips. These individuals fixate on imagined scenarios that cause extreme distress and are not likely to occur.
As you can see, the symptoms of OCD can take over a person’s life. Although they may receive temporary relief from succumbing to the OCD behavior, the actions create stress and anxiety, and frustration within their relationships.
Treatment for OCD
Although Obsessive-Compulsive Disorder can be very distressing and debilitating, there is treatment available. Treatment for OCD is often a combination of Cognitive-Behavioral Therapy and medication. Specifically, exposure and response prevention (ERP) is the treatment of choice for OCD because it has the most empirical support. ERP is basically what it sounds like…a therapist guides you in learning to confront and prevent the OCD symptoms.
This may sound scary, but a therapist will help you to learn tools to cope with distressing emotions that emerge during this process. A medical evaluation is also typically suggested to rule out underlying contributors to symptoms. For example, a medical condition known as PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections) can create a sudden onset of OCD symptoms.
Again, the good news is that effective treatment is available. If you or a loved one shows signs of OCD, know that we are here to evaluate and help you moved toward healing.
The Interactional OCD Foundation – http://www.ocfoundation.org
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.
International OCD Foundation (IOCDF) (2010). Scrupulosity. https://iocdf.org/wp-content/uploads/2014/10/IOCDF-Scrupulosity-Fact-Sheet.pdf. Retrieved on 5/28/21.
“Blurred Vision”, Courtesy of Christopher Ott, Unsplash.com, CC0 License; “Mountain River”, Courtesy of Kazuend, Unsplash.com, CC0 License; “Hand Washing”, Courtesy of Melissa Jeanty, Unsplash.com, CC0 License; “Pink Flowers”, Courtesy of Richard Loader, Unsplash.com, CC0 License