The behavioural, emotional and cognitive characteristics of obsessive-compulsive disorder (OCD).
Characteristics of OCD
- Behavioural – compulsions usually decrease anxiety, avoid situations that trigger anxiety.
- Emotional – intense anxiety, depression, guilt and disgust.
- Cognitive – obsessive thoughts, cognitive strategies, e.g. prayer, and self-insight.
Obsessions are typically persistent and uncontrollable thoughts, images, impulses, worries, fears and doubts (or a combination of these). Additionally they are intrusive, unwanted, disturbing and significantly interfere with normal life, making them incredibly difficult to ignore.
Sufferers know that their obsessional thoughts are irrational, but they believe the only way to relieve the anxiety caused by them is to perform compulsive behaviours, often to prevent perceived harm happening to themselves or more often than not, to a loved one.
Instances of Obsessions
- worrying that you or something/someone/somewhere is contaminated.
- worrying that everything needs to be arranged symmetrically or at perpendicular angles so everything is ‘just right’
- worrying about causing physical or sexual harm to yourself or others
- unwanted or unpleasant sexual thoughts and feelings, including those about sexuality or fear of acting inappropriately towards children
- intrusive violent thoughts
- worrying that something terrible will happen unless you check repeatedly
- having the unpleasant feeling that you are about to shout out obscenities in public
When someone is affected by Obsessive-Compulsive Disorder the natural response is to fight these horrible obsessional thoughts with purposeful mental or physical rituals and behaviours – compulsions.
Compulsions are the repetitive physical behaviours and actions, or mental thought rituals, that are performed over and over again, in an attempt to relieve the anxiety caused by the obsessional thoughts. But unfortunately, any relief that the compulsive behaviours provide is only temporary and short lived, and often reinforces the original obsession, creating a gradual worsening cycle of the OCD.
These behaviours involve repeatedly performing purposeful and meaningful actions in a very rigid and structured routine, specifically in relation to the obsessional thoughts, usually in an attempt to prevent perceived danger or harm coming to themselves, or to a loved one.
In most cases the person recognises their compulsive actions are senseless and irrational, but none-the-less feels bound to carry them out. This is not for pleasure, but to feel they have ‘neutralised’ the perceived threat from the obsessional thought. Often a person with OCD will feel a heightened sense of responsibility to perform the neutralising behaviour, simply because they feel doing so will prevent harm coming to themselves or loved ones. What’s more they sometimes have an overwhelming urge to obtain that ‘just right’ feeling with no other reason than to feel comfortable.
Instances of Compulsions
- excessive washing of one’s hands or body
- excessive cleaning of clothes or rooms in the house
- checking that items are arranged ‘just right’ and constantly adjusting inconsequential items, such as pens on a table, until they are aligned to feel ‘just right’ as opposed to looking aligned
- mental rituals or thought patterns such as saying a particular phrase, or counting to a certain number, to ‘neutralise’ an obsessional thought
- avoiding particular places, people or situations to avoid an OCD thought
- repeatedly opening and sealing letters / greetings cards that one has just written, maybe hundreds of times
- constant checking of light switches, handles, taps, locks etc to prevent perceived danger from flooding, break in, gas leak or fire
- saying out loud (or quietly) specific words in response to other words
- avoidance of kitchen knives and other such instruments
A compulsion can either be overt (i.e. observable by others), such as checking that a door is locked or covert (an unobservable mental act), such as repeating a specific phrase in the mind.
OCD generally manifests itself in four different ways: checking, contamination, hoarding and intrusive thoughts. It is diagnosed when the behaviour consumes excessive time, causes distress and anxiety and interferes with a person’s ability to function adequately.
Checking often occurs so the person feels they are preventing something terrible happening. For example, checking appliances could be for fear of a house fire.
Contamination can be mental or physical. A person might compulsively brush their teeth for fear of mouth disease, or avoid public toilets to avoid people’s germs.Hoarding is the inability to discard useless or worn-out possessions.
Intrusive thoughts occur without the person wanting them, and are repetitive, disturbing and repugnant. People with intrusive thoughts are the least likely to act on them because the thoughts are so distressing. For example, a parent might have intrusive thoughts about abusing their child.