What is Obsessive-Compulsive Disorder?
Anyone can be affected by obsessive-compulsive disorder (OCD) regardless of race, gender, and background. OCD causes recurring unwanted thoughts or sensations known as obsessions. The obsessions are followed by compulsions, which result in the urge to do something repeatedly. These repetitive behaviours, along with the feelings of distress caused by OCD, are debilitating and can impede a person’s ability to go about their daily activities.
Obsessions result in distressing emotions such as anxiety and disgust and may revolve around a certain concern, for instance being exposed to germs, being harmed, or thoughts involving sex or religion. Some people with OCD are not aware that their obsessions are not true. However, these intrusive thoughts persist even if the person with OCD recognises that they are disproportionate or illogical.
Examples of obsessions include:
- Contamination, such as by germs, dirt, or body fluids.
- Unwanted sexual thoughts
- Losing control, for example acting on an impulse to harm oneself or others.
- Religious obsessions, where one is excessively concerned about morality or afraid of offending God.
- Harm, where one is afraid that something terrible will happen to oneself or others if one is not careful enough.
Compulsions are repetitive physical or mental actions that a person feels an urge to engage in, in order to inhibit or reduce a feared outcome or the distress caused by obsessions. Compulsions can bring temporary respite from the feelings of discomfort caused by the obsessions. However, since obsessions and compulsions are irrational, the person will again be affected by the obsession after some time, which leads to a cycle of obsessions and compulsions.
Some examples of compulsions are:
- Checking to reduce the fear of harming or endangering oneself or others, for instance by repeatedly checking that the door is locked.
- Cleaning to reduce the fear of contamination by germs or dirt, for instance by spending hours washing one’s hands or cleaning one’s environment.
- Ordering to reduce discomfort, for instance by arranging objects in a certain order or aligning them symmetrically.
- Hoarding to reduce the fear that something bad will happen if an item is thrown away.
- Mental compulsions in response to intrusive thoughts, for instance by repeating prayers or other phrases to prevent something bad from happening.
These are some of the most common examples of compulsions, and others may exist that are not included in this list. A person may not realise that they have compulsions if the compulsions are mental, such as mental counting, as this makes the compulsions unobservable by others. However, in the same way, these mental rituals serve to assuage the fears caused by obsessions. People with OCD may also feel the need to seek reassurance from others or may feel compelled to avoid things that trigger the obsessions.
How Do You Know If You Might Have OCD?
Only a professional can diagnose OCD. In order for OCD to be diagnosed, the person has to be experiencing obsessions and compulsive behaviours that take up much time and get in the way of important activities such as work, school, or spending time with loved ones.
There are many myths and misunderstandings surrounding OCD.
- Having OCD is not the same as having an “obsessive personality trait”. People with OCD are distressed by their obsessions and compulsions. In fact, an “obsessive personality trait” might be more closely linked to obsessive-compulsive personality disorder (OCPD).
- Many people experience intrusive thoughts from time to time; for instance, worrying about falling sick or worrying about the safety of a loved one. However, a diagnosis of OCD is only made when the irrational cycle of obsessions and compulsions, and the anxiety that comes along with it, is severe enough that it consumes a lot of time or impairs important areas of functioning.
According to the Singapore Mental Health Study (SMHS) conducted in 2016, the median time taken between the onset of OCD symptoms and seeking professional help is 11 years. Most people with OCD do not seek treatment despite experiencing comorbidity and loss of quality of life. Although the presence of some obsessive thoughts or compulsive behaviours does not always indicate the presence of OCD, when uncertain, it would be a good idea to consult a psychologist.
How Therapy Can Be Helpful
Exposure and Response Prevention (ERP), a type of Cognitive Behavioural Therapy, is commonly used to treat OCD. The therapist and client discuss ways to expose the client to the objects or situations which provoke their compulsions. When the choice to expose oneself to the obsession is paired with successful attempts not to engage in the compulsive behaviour, over time, the anxiety that arises in response to the obsessions will decrease.
- American Psychiatric Association. What is obsessive-compulsive disorder? Retrieved July 8, 2020, from https://www.psychiatry.org/patients-families/ocd/what-is-obsessive-compulsive-disorder
- BeyondOCD.org. Clinical definition of OCD. Retrieved July 8, 2020, from https://beyondocd.org/information-for-individuals/clinical-definition-of-ocd
- International OCD Foundation. What is OCD? Retrieved July 8, 2020, from https://iocdf.org/about-ocd/
- OCD-UK. What are compulsions? Retrieved July 8, 2020, from https://www.ocduk.org/ocd/compulsions/
- Psych Central. When to seek treatment for OCD. Retrieved July 8, 2020, from https://psychcentral.com/lib/when-to-seek-treatment-for-ocd/
- Subramaniam M, Abdin E, Vaingankar J, et al. Obsessive-Compulsive Disorder in Singapore: Prevalence, Comorbidity, Quality of Life and Social Support. Ann Acad Med Singapore. 2020;49(1):15-25.