Obsessive-Compulsive-Disorder

What is OCD?

A condition characterised by obsession and/or compulsive behaviour. Obsessions are cognitive, whereas compulsions are behavioural.

What is behavioural?

Ways in which people act.

What is emotional?

Related to a person’s feelings or mood.

What is cognitive?

Related to a person’s feelings or mood.

What is cognitive?

Refers to the process of ‘knowing‘, including thinking, reasoning, remembering and believing.

What does the DSM system recognise?

A range of related disorders, all of which include repetitive behaviour accompanied by obsessive thinking:

• OCD.

• Trichotillomania - compulsive hair pulling.

• Hoarding disorder - the compulsive gathering or possessions and the inability to part with anything, regardless of its value.

• Excoriation disorder - compulsive skin-picking.

What are the behavioural characteristics of OCD?

• Compulsions are repetitive.

• Compulsions reduce anxiety.

• Avoidance.

How are compulsions repetitive?

Typically, people with OCS feel compelled to repeat a behaviour, a common examples is handwashing, as well as counting, praying, tidying/ordering groups of objects such as CD collections or containers in a food cupboard.

How do compulsions reduce anxiety?

Around 10% of people with OCD show compulsive behavioural alone - they have no obsessions, just a general sense of irrational anxiety. However, for the vast majority, compulsive behaviours are performed in an attempt to manage the anxiety produced by obsessions. For example, compulsive handwashing is carried out as a response to an obsessive fear of germs.

What is avoidance?

People with OCD tent to try and manage their OCD by avoiding situations that trigger anxiety. For example, people who wash compulsively may avoid coming into contact with germs. However, this avoidance can lead people to avoid very ordinary situations, such as emptying their rubbish binds, and this can in itself interfere with leading a regular life.

What are the emotional characteristics of OCD?

• Anxiety and distress.

• Accompanying depression.

• Guilt and disgust.

What is anxiety and distress?``

OCD is regarded as a particularly unpleasant emotional experience because of the powerful anxiety that accompanies both obsessions and compulsions. Obsessive thoughts are unpleasant and frightening, and the anxiety that goes with these can be overwhelming. The urge to repeat a behaviour (a compulsion) creates anxiety.

What is accompanying depression?

OCD is often accompanied by depression, so anxiety can be accompanied by low mood and lack of enjoyment in activities. Compulsive behaviour tends to bring some relief from anxiety, but this is temporary.

What is guilt and disgust?

As well as anxiety and depression, OCD sometimes involves other negative emotions such as irrational guilt, for example over minor moral issues, or disgust, which may be directed against something external like dirt or at the self.

What are the cognitive characteristics of OCD?

• Obsessive thoughts.

• Cognitive coping strategies.

• Insight into excessive anxiety.

What are obsessive thoughts?

For around 90% of people with OCD, the major cognitive feature of their condition is obsessive thoughts, ones that recur over and over again. These vary considerably from person to person,, but are always unpleasant. Examples of recurring thoughts are worries of being contaminated by dirt and germs, or certainty that a door has been unlocked and that intruders will enter through it, or impulses to hurt someone.

What are cognitive coping strategies?

Obsessions are the major cognitive aspect of OCD, but people also respond by adopting cognitive coping strategies to deal with the obsessions. For example, a religious person tormented by obsessive guilt may respond by praying or meditating. This may help manage anxiety but can make the person appear abnormal to others and can distract them from everyday tasks.

What is insight into excessive anxiety?

People with OCD are aware that their obsessions and compulsions are not rational, in fact, this is necessary for a diagnosis of OCD. If someone really believed their obsessive thoughts were based on reality, that would be a symptom of a quite different form of mental disorder. In spite of this insight, people with OCD experience catastrophic thoughts about the worst case scenarios that might result if their anxieties were justified. They also tend to be hypervigilant, ie they maintain constant alertness and keep attention focused on potential hazards.