The Ultimate Guide to Understanding OCD: Symptoms and Overview

Obsessive Compulsive Disorder (OCD) is a mental health disorder marked by the presence of obsessions and/or compulsions. Contrary to the popular misconception, OCD is not limited to hyperfocus on cleaning and organizing; the symptoms of OCD are debilitating and significantly reduce the quality of life. 

Often, an individual suffering from OCD is preoccupied with navigating their obsessions and/or compulsions for the majority of the time which can cause major difficulties in daily functioning, interpersonal relationships, work, and other important areas of their life. 

Thankfully, OCD is a treatable condition. If you suspect that you may have some signs and symptoms of OCD, it is best to consult a clinical psychologist or a psychiatrist for evaluation and to understand treatment options. 

WHAT IS OCD? 

According to the Diagnostic and statistical manual of mental disorders (DSM-V), OCD is characterized by the “presence of obsessions and/or compulsions”. 

It is important to note that while DSM V is heavily referred to for diagnostic purposes, its conceptualization of mental health disorders is critiqued for being a mere list of signs and symptoms and not grounded in empirically supported conceptual models (Abramowitz & Jacoby, 2015). It means that while a person may show signs and symptoms of OCD, the diagnostic criteria may not fully capture their experience. This is why it is essential to work with a mental healthcare provider who can help explore the intricacies of the difficulties a person with OCD may be experiencing beyond a checklist. 

What are obsessions?

Obsessions are unpleasant, invasive, and unwanted thoughts that often come to a person’s mind. They are sudden, out of context, and cause significant emotional distress to the person who is experiencing them. Some examples of obsessions are:

• An excessive concern with dirt and germs 
• Recurrent thoughts of harming self or others (e.g., visualizing physically assaulting others with no real intention/plan)
• Fear of acting out on intrusive thoughts and impulses (e.g., incessant worry that one may hurt a loved one with no real intention/plan)
• Forbidden or perverse thoughts about sex (e.g., thoughts about incest, perpetuating sexual violence, etc. with no real intention/plan)
• Excessive concern with what is right vs. wrong (e.g., debilitating fear of offending god)

What Are Compulsions?

To seek relief from obsessive thoughts, a person may engage in compulsion - a repetitive act or behavior that they think will bring relief from the obsessions. This act may be conscious (intentional) or unconscious (automatic). 

However, such behaviors may not have any logical basis, can be harmful, and/ or their effects are overstated in the person’s mind.

For example, a person who fears contamination may wash their hands multiple times a day. They may have an irrational association with it - like, in every wash, need to spend 10 minutes cleaning their hands or they will fall sick. Here, while washing hands is a good hygiene practice, the impact of doing it for ten minutes is irrational, overstated, and can have health hazards (e.g., excessive pruning). It may also take a significant amount of time every day and cause a negative impact on daily functioning (e.g., they are late to work, unable to focus, stay present in social interactions, etc.).

Some examples of compulsions are: 

• Excessive or ritualized handwashing 
• Needing excessive check-ins and reassurance about not harming self or others
• Isolating self and avoiding social interactions so that one doesn't act on their harm-related obsessions
• Viewing self or sexual activities as “bad”. Abstaining or avoiding sex-related activities. 
• Excessive re-reading, re-counting, and rewriting to avoid mistakes
• Excessive praying, strictly following religious leaders/texts so that one does not offend god

The person may have varying levels of insight about their OCD symptoms where some people have an awareness of engaging in these acts while others may not. 

If you suspect that you are exhibiting signs and symptoms of OCD, it is best to make judgments about these symptoms along with a loved one who gets to observe your daily behavior. The person suffering from OCD is likely to underestimate or be unaware of the magnitude of their symptoms. Integrating information and insights from the client and an informant who lives in proximity makes a reliable foundation for assessment and treatment considerations. 

SIGNS & SYMPTOMS

A person may experience various types of obsessions and compulsions. While the specific content may vary, there are some general themes related to the OCD symptoms: 

• Cleaning: Fear of contamination that often leads to ritualized cleaning acts
• Symmetry: Wanting things to be in a particular order in response/to prevent obsessive thoughts (e.g., spending a lot of time arranging things in a particular order when anxious, ensuring things stay in a certain way, feeling something is “not right” if things deviate from preferred order, etc.)
• Forbidden or taboo thoughts: Aggressive, sexual, and religious obsessions and related compulsions
• Harm: Fear that one may harm oneself or others and repetitive checking/avoidance of the loved ones

The OCD symptoms can cause varying levels of anxiety within the individual, causing significant stress and difficulties in managing daily life. The person may spend a lot of time consumed by their anxious thoughts and enacting compulsive behaviors which may cause difficulties in work and relationships. 

For example, a person who is highly anxious about making mistakes may be prone to excessive rechecking, leading to reduced work efficiency and poor performance evaluations. 

It is a common experience for people with OCD symptoms to have varying levels of anxiety, shame, guilt, disgust, etc. about their challenges. If you suspect that you might be showing some signs and symptoms of OCD, please know that these thoughts are intrusive and not a true reflection of your belief system. It is helpful to reach out to a clinical psychologist or psychiatrist to get the help you deserve.  

OCD IN CHILDREN & ADULTS

The developmental course of OCD varies from person to person. The symptoms of OCD can be present from childhood or develop after a particular life stage/event. While the intensity of symptoms varies, if untreated, OCD symptoms can last or worsen over the course of a person’s life. 

In children, compulsions are relatively easier to spot because they are observable. Usually, children are more direct in sharing what is on their mind and are under the observation of multiple people who can spot if a behavior seems excessive (e.g., teachers, coaches, parents, etc.). 

The pattern of OCD symptoms varies in children and becomes stable in adults over a period of time. Regardless of age, most people experience both obsessions and compulsions. The nature of content may vary based on factors like age, social class, religion, etc. 

TREATMENT 

For OCD, a combination of psychiatric medications and psychotherapy works best. In India, you can consult a clinical psychologist or a psychiatrist to get a formal assessment and diagnosis. 

Medications are often the first line of treatment for OCD symptoms. It helps to manage the intensity of distress and create mental space for examining the nature of the obsessive and compulsive symptoms. 

A clinical psychologist can help you in:

1. Identifying and managing obsessions and compulsions
2. Identifying underlying dysfunctional belief systems that fuel OCD symptoms
3. Address the challenges that come with living with OCD
4. Facilitate a journey of self-reflection, growth, and healing

Some common psychotherapy treatments for OCD are:

• Exposure and Response Prevention (ERP),
• Cognitive Behavioral therapy (CBT), and 
• Acceptance and Commitment Therapy (ACT)

A clinical psychologist may use one or a combination of therapeutic modalities based on the client’s needs. Any specific questions about the relevance and efficacy of a particular OCD treatment option are best provided by your Mental Healthcare Provider. 

While living with OCD comes with a lot of challenges, it is important to know that it is a treatable condition. With the right care and treatment, people with OCD can live happy, purposeful, and fulfilling lives. 

If you are looking to consult a clinical psychologist for OCD-related symptoms, you can check out Mave Health’s Therapy Club! – India’s largest mental health platform that makes good mental health a priority. Find a professional who can meet your needs and start your mental health journey today. 

REFERENCES: 

Abramowitz, J. S., & Jacoby, R. J. (2015). Obsessive-compulsive and related disorders: A critical review of the new diagnostic class. Annual Review of Clinical Psychology, 11, 165-186.

American Psychiatric Association, D. S. M. T. F., & American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders: DSM-5 (Vol. 5, No. 5). Washington, DC: American psychiatric association.

SCALE, O. C. (2005). Yale-Brown Obsessive Compulsive Scale (Y-BOCS). Primary Care Tools for Clinicians: A Compendium of Forms, Questionnaires, and Rating Scales for Everyday Practice, 280.