Individuals with Obsessive-Compulsive Disorder (OCD) typically experience
repetitive, intrusive, unwanted ideas, images, or impulses (called
obsessions) and/or an urge to perform repetitive behaviors (a
compulsion) in an attempt to relieve the discomfort or anxiety caused by
the obsession. Obsessive thoughts often seem nonsensical or silly and
may come out of the blue. They are often extremely difficult to ignore
or push away. Common obsessions might include themes related to losing
control, becoming contaminated, sex, violence, or religion. Although
most people (80-90%) report experiencing intrusive, unwanted thoughts,
these thoughts typically occur less often, for shorter duration, and are
associated with less distress than the obsessions of a person with OCD.
Compulsions are repetitive and often ritualistic behaviors performed to reduce the anxiety caused by the obsessions. For example, a person with obsessions
about dirt, germs, or contamination may perform numerous and lengthy
washing and cleaning rituals in an attempt to keep themselves or their
surroundings clean at all times. Compulsions often feel irresistible
(compelling), despite the fact that they may be nonsensical or even
harmful. For example, people with contamination obsessions may wash their hands so often that they become raw, cracked, or bloody.
Although it is possible to receive a diagnosis of OCD by having either obsessions or compulsions, the vast majority of people with OCD (approximately 90%) have both obsessions and compulsions. OCD is roughly equally common in men and
women. Although it is more common than schizophrenia, bipolar
depression, and even panic disorder, it can still often be overlooked by
mental health and medical professionals.
Either obsessions or compulsions:
- Obsessions: Obsessions are unwanted ideas, images, or impulses that repeatedly come to mind and feel inappropriate or intrusive. Obsessions tend to be intrusive, unpleasant, and produce a high degree of anxiety. The person with obsessions often attempts to ignore or suppress them, or to neutralize them with a thought or action. Common ideas include persistent fears that harm may come to self or a loved one, or an unreasonable concern with becoming contaminated. Sometimes the obsessions are of a violent or a sexual nature, or concern illness.
- Compulsions: Compulsions are repetitive or ritualistic behaviors. They are often performed in an attempt to decrease the anxiety caused by an obsession, or to try to prevent some dreaded event or situation. Some people with OCD have regimented rituals while others may have complex rituals that often change. Performing rituals may give the person some relief from their distress or anxiety, but it is often only temporary. The most common compulsions are washing and checking (e.g., making sure the gas is off for the oven). Other compulsive behaviors include counting (often while performing another compulsive action such as hand washing), repeating, hoarding, and endlessly rearranging objects in an effort to keep them in precise alignment with each other. Cognitive problems, such as mentally repeating phrases, list-making, or checking, are also common.
At some point during the disorder the person recognizes that the obsessions or compulsions are excessive or unreasonable. Note: In children, this feature may be absent.
Symptoms cause significant distress or impairment in social, occupational, or other important areas of functioning.
The obsessions or compulsions are not caused solely by another psychological disorder.
Symptoms are not caused by the physiological effects of a substance (e.g., drug, medication) or a medical condition (e.g., hyperthyroidism).
American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders, fourth edition. Washington, DC: American Psychiatric Association.