All About OCD

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OCD, Obsessive Compulsive Disorder

In the latest Diagnostic and Statistics Manual of Mental Disorders (DSM-5) OCD was relabeled not as an anxiety disorder, but as obsessive compulsive or related disorder. OCD is characterized by the presence of obsessions and compulsions.

Obsessions

According to DSM-5, obsessions are defined as both of the following:

“Recurrent and persistent thoughts, urges or images that are experienced, at some time during the disturbance, as intrusive, unwanted, and that in most individuals cause marked anxiety or distress.”
“The individual attempts to ignore or suppress such thoughts, urges, or images, or to neutralize them with some thought or action (i.e., by performing a compulsion).”

Compulsions

Repetitive behaviors that you feel driven to perform in response to an obsession, or in accordance to a set of rigid rules.
- hand washing
- ordering checking
- praying
- counting
- repeating words silently
The repeated behaviors are usually out of your control.
The behaviors are meant to reduce your distress, but only wind up temporarily alleviating some of your anxiety.
The compulsive behaviors are out of proportion or not realistically related to the source of your distress.

How OCD functions

The obsessions and/or compulsions usually take up so much time and effort (minimum of one hour per day) that it impedes with:

Your regular ability to function and complete tasks.
Your social life.
Your work performance.

The obsessions can also cause a significant amount of distress that is not otherwise related to any other health condition, mental disorder or drug usage.

Mild OCD

With good to fair insight, you may experience milder symptoms of OCD as you may be able to recognize that your obsessive compulsive beliefs may not be, probably aren’t, or definitely aren’t true. You may be able to reject the impulse to perform compulsions.

Medium OCD

With little to no insight, you may feel that your OCD beliefs are probably true and so follow through with your compulsions.

Severe OCD

With no insight you believe that all of your obsessive compulsive beliefs are absolutely true and follow through with your compulsions rigidly.

Tics

People with OCD are also commonly diagnosed with an anxiety disorder or tic disorder. Some tics involve small muscle movements like blinking, grimacing or shrugging. Or there are vocal tics like throat clearing, sniffing or grunting.

Obsessive Compulsive Disorder Causes

The exact cause of OCD is still unknown, however there are several risk factors that can lead to a diagnosis.

Genetics- first degree relative like a parent or sibling increases your chances although medical professionals are unsure of which gene is linked to OCD
Biology and your brain- the frontal cortex and subcortical structures of the brain are in control of your impulse control and behaviors. There is thought to be a link between these two and different biological pathways in your body that contribute to your OCD.
Temperament- if you are reserved, experience a lot of negative emotions and were either depressed or anxious as a child, your likelihood of an OCD diagnosis increases.
Childhood Trauma- there has been a discovered correlation between OCD and childhood trauma, however more research is needed to better understand how these are related.

Types of OCD

Experts don’t readily recognize every subtype of OCD, but here is a list of types of OCD to give you a better understanding of how OCD may present in your, or your loved one’s life.

Contamination OCD

The most famous form of OCD where you worry about becoming sick, or getting a loved one sick. Compulsions are:

Repeatedly washing your hands
Repeatedly cleaning your home or environment
Avoiding people (you care about) to avoid getting or passing off infections

“Just Right” OCD

What you commonly see on TV. Can also be known as Symmetry OCD. Compulsions may involve:

Repeating an action like opening or closing a door
Repeatedly organizing, ordering or arranging items
Repeatedly changing wording in emails/text messages
Ensuring things are symmetrical

Pure-O or Obsessional OCD

One of the more highly debated subtypes of OCD as the compulsions aren’t as ‘visible’ but still exist. The types of Pure-O OCD may not present with the same types of compulsions commonly associated with the following:

Sexual OCD
Harm OCD
Religious OCD
Romantic OCD
Health OCD
Existential OCD

Sexual OCD

The distress involved in this type of OCD can be extreme given peoples’ attitudes towards homosexuality and the moral implications of pedophilia.This type of OCD can be characterized by:

Questioning your sexuality and which gender you’re attracted to
Questioning your sexuality and if you you are a pedophile
- It isn’t likely that a person experiencing this type of OCD or POCD is actually a pedophile, but they become significantly worried that they are or could become a pedophile.

Harm OCD

Where a person becomes deeply disturbed by common violent thoughts people may experience and is unable to shake off the effects these impulses have on them. Compulsions may include:

Avoiding potentially harmful situations real or imagined
Hiding all potential weapons
Repeatedly checking to make sure no violent act has been committed by themselves

Religious OCD

You may feel compelled to perform religious rituals or behaviors in order to stave off a feared punishment with this type of OCD. Religious scrupulosity can leave you in fear of committing any minor infraction, intentional or accidental. Compulsions may include:

Ritualistic praying
Feeling a deep need to make sure all your actions follow your ascribed religion’s guidelines
Feeling compelled to make sure others follow your ascribed religion’s guidelines

Romantic OCD

Another form of the ‘just right’ type of OCD where you constantly check the well-being or ‘rightness’ of your relationship. Compulsions may include:

Repeatedly taking relationship quizzes
Comparing your relationship to others
Parsing over your relationship to determine how happy you really are

Health OCD

With this subtype you may feel an outsized fear of any interaction with potential germs/bacteria or of any minor health issue. Compulsions may include:

Checking your health or that of your loved ones repeatedly
Avoiding places you perceive to be ‘threatening’ to your health
Repeatedly seeking assurance that you and your loved ones are healthy

Existential OCD

You may be obsessed with the meaning of life with this subtype of OCD which may also be referred to as moral OCD. Compulsions may include:

Repeatedly questioning the reason for your existence
Repeatedly worrying over whether or not you’ve lived a moral enough life
Repeatedly checking if you’ve lived in a ‘worthy enough’ way by comparing yourself to others or seeking constant approval

Somatic OCD or Sensorimotor OCD

Where you become fixated on an aspect of your natural living processes and wonder if you’ll ever not notice those processes. Fixations may include:

Blinking
Swallowing
Breathing

Postpartum OCD

In this type of OCD, you may feel an extreme amount of fear over harm coming to your baby through your deliberate actions or by accident. Fears include:

Accidentally dropping or drowning your baby
(Not) Administering or seeking appropriate medical care
Intentionally hurting your baby
Sexually abusing your child

Real Event OCD

When you recall a past event and go over your behavior and wonder if you did the right thing or not.

Tourettic OCD

A comorbid type of tic disorder that has been found to be so intertwined with OCD and tic disorders that the effects of which are difficult to distinguish between the three. Treatments usually involve OCD treatments as well as treatment for a tic disorder. Features include:

An instigating physical sensation of discomfort that can only be relieved by performing a physical movement or vocalizing a word or phrase
“Compulsions” (clinically referred to as ‘impulsions‘) are more complex than a simple tic and often need to be performed in a ‘correct’ way and a certain amount of times
“Compulsions” are not anxiety based but are derived from the initial physical discomfort experienced

Waste OCD

This type of OCD usually results in hoarding. Individuals feel an intense need to be surrounded by items that may or may not have use or value.

Body OCD

Clinically referred as body dysmorphic disorder, individuals with this type of OCD may feel an intense obsession with their appearance or specific physical features and will engage in behaviors to either hide or compare what they perceive to be defects. Features of Body OCD may include:

Skin picking
Mirror gazing
Seeking reassurance
Excessive camouflaging of defects
Avoiding social situations and intimacy
Use of alcohol or illicit substances to endure interaction and intimacy (common also in Social Anxiety)

Counting OCD

This type of OCD is seen as an expression of arithmomania where you try to make sense of your world through numbers. Compulsions include:

Obsessive counting
Obsessive ordering and rearranging of numbers to make better sense of them
Obsessive need to make mathematical calculations

Dealing with OCD

Types of OCD intrusive thoughts

Sometimes OCD thoughts can derail your day and that is why OCD is a documented mental disorder. The way your thoughts can be become fixated on an obsession gets in the way of your ability to function and become very distressing. Types of OCD intrusive thoughts may center around:

If you’re clean enough or if you/your environment is passing around unwanted bacteria
If your relationship is really the right relationship for you and what would happen if you committed to the ‘wrong’ person
Committing sexual acts or an intense fixation on sex
If you are attracted to people of the same sex or not
If you are attracted to children or not
If you are a violent person
If you committed a violent act you can’t remember
If you prayed correctly or made a small mistake that violated your religion’s guidelines
If you organized things correctly and what would happen if things are not arranged in the perfect way
If you are getting sick
Being sick
If you got someone you love sick
Having enough money or things to protect you
If your existence matters
If you’ve lived a moral enough life
If you will accidentally hurt your child
If you look normal
If others notice your imperfections

Obsessive Compulsive Disorder Treatment

Cognitive Behavioral Therapy

The “gold standard” CBT for OCD is considered to be Exposure and Response Prevention Therapy. In this type of therapy you will be exposed to things that trigger your obsessions and/or compulsions and be left without an avenue to perform your compulsions. An example of this is someone with contamination disorder being left in a room with a dirty object and no way to wash their hands.

Exposures are meant to start out small and gradually increase to develop a better stress response to the stimuli you struggle with.

Journaling

For those who struggle to get to therapy, sometimes understanding how you think, and how it affects your emotional or mental state, as well as your ability to function socially and at work or around loved ones is a helpful place to start. Journaling can help you to organize the thoughts that lead to your obsessions and compulsions and how you react to them.

Analyzing

Next you can analyze how realistic your OCD thoughts are or how likely you are to follow up on an impulse that is causing you distress. Most of the time, OCD beliefs aren’t realistic and there are ways to remind yourself that you don’t need to perform compulsions or give in to your obsessions/obsessive thought patterns. It may take time to retrain yourself to better gauge your thoughts, and that’s normal.

Ask for Support/Feedback

Maybe you’re feeling unsure if your thoughts are realistic enough. Find a safe person to talk through your beliefs with and take time to reconsider if you are living with rules that aren’t necessary or helpful to your well-being. Ask for feedback about how your compulsions can be slowly reduced or ask for help to navigate tougher situations.

Conclusion

There are many types of OCD out there and your struggle with OCD may be cyclical over the course of your lifetime, with you experiencing several different subtypes of OCD throughout your struggle. This is normal. You will be okay. Don’t forget to seek help and try to reassess the way you think.

If you have a loved one with OCD and want to help them, remember to consider that their OCD is a process. They may need help working through what is realistic or not and will need a trustworthy friend to help them through their struggles. Remember to be patient and encouraging for any amount of progress made.

May God Bless and Keep You.