Anxiety: A Very Short Introduction - Daniel Freeman, Jason Freeman 2012

What is obsessive-compulsive disorder?
Obsessive-compulsive disorder

Have you ever left the house and then hurried back, maybe several times, to check that you’ve locked the front door or turned off the cooker? Have you ever found yourself unpacking your bag yet again on the way to the airport just to be sure that you haven’t forgotten your passport? And do you sometimes feel the need to wash your hands repeatedly after going to the toilet or touching something dirty?

How about strange thoughts that pop into your mind as if from nowhere? Do you ever find yourself thinking, for example, that you’re about to hit someone? Or shout or swear in the most inappropriate situations — at a funeral, perhaps, or in a library?

If you’ve answered yes to any of these questions, don’t worry. Virtually everyone experiences impulses like this occasionally. And they can sometimes seem quite bizarre. Here’s a selection volunteered by members of the general public:

• Impulse to push someone in front of a train.

• Wishing a person would die.

• Thought of throwing a baby down the stairs.

• Image of being in a car accident, trapped under water.

• Thoughts of catching a disease from touching a toilet seat.

• Idea that dirt is always on my hand.

• Impulse to say something hurtful.

• Thought of blurting out something in church.

• Thoughts of ’unnatural’ sexual acts.

• Idea of electrical appliances catching fire while I’m out.

• Idea of my home being broken into.

• Thought that I haven’t applied my car’s handbrake properly and that the car will crash into traffic while I’m away.

What is obsessive-compulsive disorder?

For a small proportion of people, these normal thoughts and urges can spiral out of control, dominating their life and developing into an extremely powerful and distressing set of worries and rituals that is termed obsessive-compulsive disorder (OCD).

The word ’obsession’ is often used to denote a keen interest in something, but it has a specific and quite different meaning here. Obsessions in OCD are upsetting and unwanted thoughts, images, and impulses that constantly recur, sometimes throughout the day and night. So distressing are they that people with OCD use a variety of elaborate and time-consuming rituals to try to make them disappear, or to prevent the harm they seem to predict. These rituals are called compulsions and they can be actions (checking that your home is spotlessly clean, for example) or thoughts (for instance, repeating a particular ’neutralizing’ phrase in your mind).

(Incidentally, the name ’obsessive-compulsive disorder’ is the result of a compromise. When the German psychiatric term Zwangvorstellung, literally ’irresistible thoughts’, was translated into English, the British opted for ’obsession’ and the Americans for ’compulsion’.)

A person is likely to be diagnosed with OCD if:

• They have regular unwanted and inappropriate thoughts, impulses, or images.

• These thoughts, impulses, or images are distressing, and are not simply exaggerated worries about real-life problems.

• They try to ignore or suppress the thoughts.

• They recognize that the thoughts are the product of their own mind.

• They engage in repetitive and ritualistic actions or thoughts (i.e. compulsions) in response to their obsessions.

• The compulsions aim to reduce the distress caused by the obsessions, or prevent some dreaded event, but are excessive and unrealistic.

• They have recognized that the obsessions or compulsions are unreasonable (this recognition often comes and goes, depending on how the person is feeling).

• The obsessions or compulsions cause significant distress, take up more than an hour a day, or have a major impact on the person’s normal life.

In its severest form, OCD can have a devastating effect, taking up so much of the person’s time that they’re unable to carry on normal life. It’s not uncommon for someone with fears about contamination, for example, to spend many hours washing and showering each day. You can get a sense of the potential seriousness of OCD from the fact that it’s the anxiety disorder most likely to cause hospitalization.

Sometimes there’s a logical connection between a compulsion and an obsession (for example, constant washing resulting from a fear of catching a disease). In other cases, there’s no obvious rhyme or reason (for example, a person might perform counting rituals to prevent their loved ones coming to harm). The vast majority of people with obsessions also have compulsions, but they can each occur independently.

OCD is a pretty heterogeneous category, encompassing a very broad range of anxieties and symptoms. In an effort to clarify that diversity, scientists have identified five ’dimensions’:

Despite this effort to impose order, debate over exactly what should be classified as OCD continues. Some experts, for example, have argued that hoarding is a distinctive form of illness in its own right. Others have argued that certain religious obsessions should be regarded not as a type of OCD but as ’scrupulosity disorder’.