Dr. Kimberly Riley
Do you have a friend or family member who says, “Wait, I need to check the door one more time,” or “I always wash my hands this many times before I eat” and you are confused about why?
Maybe you are the one who has a behavior that you have noticed you do often, but don’t really understand the drive behind it. Possibly you have thought that their behavior or even your behavior is an indication of a disorder often referred to by just three letters: OCD.
People tend to use that term for behavior that is repetitive or strange to them. A lot of times people will see someone who is very organized or likes to be clean and will say “They are so OCD,” as if OCD is is something a person can be instead of something they are struggling with symptoms from.
It is rare that a person uses the actual name of the disorder instead of the acronym. I don’t think people say, “She is always fixing things at my house, she is so Obsessive Compulsive Disorder.” Maybe because when the whole name is used, it doesn’t make sense anymore to label a person with a disorder where symptoms are misunderstood.It is likely that behaviors based on the symptoms a person is trying to manage from their diagnosis can appear odd to others, but all behaviors that are different from someone else’s does not point directly to OCD. In this article, some of the Obsessive Compulsive Disorder symptoms that are misunderstood will be explained, and hopefully will be helpful to those who are either questioning some of the symptoms they have or the symptoms of their loved ones.
What is Obsessive Compulsive Disorder (OCD)?
So, what is Obsessive Compulsive Disorder, anyway? Is it just a disorder that causes people to want their house to be clean all of the time? Is it something that forces people to want to reorganize random items every where they go? How about it being the main disorder behind people washing their hands all of the time? These are just some of the behaviors that I hear people attach the word OCD with.
It is beneficial if a person is curious about some of those behaviors in themselves because they are Obsessive Compulsive Disorder symptoms, but probably not a great idea to judge others and assume they are dealing with the symptoms of a disorder that is often not fully understood.
Obsessive Compulsive Disorder has several different sets of criteria that have to be met before it can be given as a diagnosis. There is more behind the diagnosis than behaviors. Thoughts matter as well.
Obsessive Compulsive Disorder Symptoms
A person is diagnosed with Obsessive Compulsive Disorder when they have these symptoms:
Unwanted recurrent thoughts, urges, or images that are experienced during the disturbances that often cause anxiety or distress.
Trying to ignore or suppress the thoughts (for example, contamination), urges (for example, to hurt someone), or images (for example, violent scenes) by having another thought or action (performing a compulsion).
Repetitive behaviors such as: hand washing, ordering, checking, or other mental acts like praying, counting, or repeating words silently that the person feels like they have to perform in response to their obsession;
The behaviors are to prevent or reduce anxiety, distress, or to prevent an event or situation, yet they are not connected in a realistic way to what they are trying to prevent.
Obsessions and Compulsions
The obsessions or compulsions are time-consuming, taking more than an hour a day, or are clinically distressing, impairing socially, occupationally, or in other areas of functioning. The obsessions or compulsions are not explained by the symptoms of another medical condition or mental disorder.
Common Misunderstood Symptoms
- As mentioned above, everyone is different. Some people may have behaviors that might seem like a clear indication of Obsessive Compulsive Disorder, but others may not. Certain content of obsessions and compulsions varies among individuals, but some symptoms are common in Obsessive Compulsive Disorder, such as cleaning (contamination and cleaning compulsions), symmetry (symmetry obsessions and repeating, ordering, and counting compulsion), taboo or forbidden thoughts (aggressive, religious, and sexual obsessions and compulsions), harm (fears of harm to oneself and others and related checking compulsions).
- Although it may seem as if a person who is acting out a compulsion is doing it for pleasure, it is really a response to an obsessive thought. The obsessive thoughts, urges, or images that people have are intrusive and unwanted, usually causing distress or anxiety. Most people who have Obsessive Compulsive Disorder have both obsessions and compulsions. The goal of the compulsive act in response to the obsession is to reduce the distress caused by the trigger or prevent a feared event. So, even though the compulsion isn’t done for pleasure, some individuals do experience relief from their anxiety or stress.
- Those who have Obsessive Compulsive Disorder will either have good or fair insight, poor insight, or no insight. If a person has good or fair insight they might believe that whatever it is they are worried about will more than likely be okay even if they do not do the compulsive act, a person with poor insight may believe that whatever it is they are worried about will probably happen if they don’t do the compulsive act, while a small amount (about 4% or less) has no insight or delusional beliefs and believe that whatever it is they are worried about will definitely happen.
- A number of individuals (up to 30%) have a lifetime Tic Disorder. Usually males who had an onset of Obsessive Compulsive Disorder during childhood will have different Obsessive Compulsive Disorder symptoms, comorbidity, course, and pattern of familial transmission than people who have a history of Tic Disorders.
- People with Obsessive Compulsive Disorder have a much harder time in situations where their obsessions and compulsions are triggered. They may experience anxiety that includes frequent panic attacks frequent or a feeling of disgust. While acting out the compulsion they might even have the feeling of incompleteness. Based on what it is that triggers someone, they might avoid other people, places, and things. Some places people who are concerned about contamination might avoid are public restrooms and restaurants.
- Often times as people investigate the cause of some behaviors they notice in themselves or others, they make assumptions based on what they believe to be true without knowing specific symptoms that might be different. Obsessive Compulsive Disorder has some differences in symptoms based on gender and age, so it is helpful to know what to look for in all people when deciding if the behaviors are in need of more care. It appears sometimes that mostly middle age adults are the ones living with Obsessive Compulsive Disorder symptoms, but really the mean age of onset is 19.5 years old with 25% of cases starting at age 14, and almost 25% of males have an onset before the age of 10. It is rare that people age 35 and older have an onset of symptoms, but it does occur.
- Onset in childhood can lead to a lifetime of Obsessive Compulsive Disorder symptoms, although 40% of those with onset in childhood may experience remission by adulthood. This means that we should be aware of signs and symptoms in children as well. Compulsions are more easily diagnosed in children than obsessions because compulsions are observable. Although, children do have both obsessions and compulsions.
It might make sense that a young child wants their parent to perform compulsive acts every evening before bed, like kissing them a certain amount of times on the cheek or checking the window to make sure it is locked several times in a row to provide safety when they are obsessed with danger and their parents’ acts are what they believe are keeping them safe.
Obsessive Compulsive Related Disorders Symptoms
Maybe after reading about Obsessive Compulsive Disorder you still have some questions about symptoms you are experiencing or noticing in others. Possibly you know that you have an obsession and compulsive response, but it is specifically related to one idea or thought. Well, there are several disorders that are very specific and fall under the category of obsessive compulsive related disorders. A few are described briefly here.
Body Dysmorphic Disorder
Preoccupation with one or more perceived flaw (such as hair thinning or face wrinkles) or defect in physical appearance (such as believing they are unattractive) that is not noticeable to others where at some point the person has performed some repetitive behavior (like mirror checking) or mental act (like comparing themselves to others) in response to their concerns about their appearance.
Persistent difficulty getting rid of (by ways like donating, recycling, or throwing away) possessions regardless of their value (items like: newspapers, mail, or old clothing) due to the perceived need to keep the items and distress associated with discarding them. The difficulty getting rid of possessions leads to clutter in active living spaces and the hoarding behavior then causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
Trichotillomania (Hair-Pulling) Disorder
Recurrent pulling of one’s hair resulting in hair loss (most often from places like the scalp or eyebrows) sometimes accompanied by rituals involving the hair (such as looking for certain texture or color of hair). Some individuals may have the urge to or does pull hair from other individuals (such as dolls, pets, sweaters, or carpets). Repeated attempts are made to stop the hair pulling and the hair pulling causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
Excoriation (Skin-Picking) Disorder
Recurrent skin picking (using things like fingernails, or tweezers) resulting in lesions (from places like face, arms, and hands) with repeated attempts to decrease or stop skin picking and the skin picking causes clinically significant distress or impairment in social, occupational, or other important areas of functioning. There can also be skin rubbing, squeezing, lancing, and biting in addition to the skin picking. Skin picking can be triggered by feelings of anxiety or boredom and may be preceded by tension and can lead to a sense of relief, immediate gratification, or pleasure.
These disorders all have some type of obsession, compulsion, or ritual that may either be observed by others while engaging in the behaviors or just known to others by seeing the outcome. People’s symptoms cause them to suffer greatly in social settings due to embarrassment and shame.It can be difficult to be in settings that are triggering and compulsions begin, allowing people to see the effects of hoarding by inviting them into your house, or exposing your body with scars from picking or hair loss from pulling, but people still try their best to live their lives in a world that may not fully understand.
People have a large range of thoughts and ideas that cause them to engage in behaviors that are comforting when they are feeling triggered, so it is a beautiful thing when we can be compassionate and understanding of others or even ourselves when suffering from symptoms associated with obsessive compulsive and related disorders. Knowledge is the key to being able to care for ourselves and others.
Where Do You Go From Here?
Maybe you have some compulsions or obsessions that keep you from fully enjoying life and you are curious about what you can do next. There are therapists here that can help you gain some freedom from the symptoms of Obsessive Compulsive and related disorders and support you as you stabilize your symptoms. You don’t have to journey alone anymore.
“Forest,” courtesy of Allef Vinicius, unsplash.com, CC0 License; “Stack of Books,” courtesy of Jan Mellstrom, unsplash.com, CC0 License; “Jenga,” courtesy of Michal Parzuchowski, unsplash.com, CC0 License; “Pray,” courtesy of Ben White, unsplash.com, CC0 License