What is OCD and Do I have it?

Obsessive-Compulsive Disorder (OCD) is an anxiety disorder that is characterized by obsessions and/or compulsions.  Typically, a person with OCD experiences unwanted threatening obsessional thoughts and engages in compulsive behaviors or mental activity in order to diminish the thoughts and anxiety The OCD brain generates a faulty “danger!” signal in response to a benign automatic thought.  In order to cope with the scary thought, a person struggling with OCD engages in a behavior or mental activity that sometimes quiets the obsession and relieves the fear.  Unfortunately, relief is short-lived, and if the person continues to rely on compulsions to cope with obsessions, both become stronger and more frequent over time.

To summarize, the OCD brain randomly misfires “danger!”, the OCD sufferer engages in a compulsions to achieve momentary relief, and the OCD symptoms worsen over time

Types of OCD

Responsibility OCD

People with Responsibility OCD, feel panicked or guilty due to thoughts or images of harming, killing, or molesting other people or children. The person fears that s/he could lose control at any moment or that s/he might have harmed someone in the past but cannot remember it. There is no substantial evidence to support these claims (only anxiety and uncertainty!).

Common rituals include:

  • Seeking reassurance from other people that you are not dangerous
  • Mentally checking memories of the past in order to verify that you could not be a dangerous person.  (By the way, while these rituals are motivated by the desire for relief, they often uncover ambiguous evidence that increases your anxiety.)
  • People with Responsibility OCD pay careful attention to their bodily sensations (e.g., a contraction of the bicep, a heart palpitation) as cues that they might become dangerous.
  • Avoidance: People with Responsibility OC try to escape situations, such as sleeping in the same bed as one’s spouse or holding a child, that provoke vague sensations, that could indicate that s/he is on the verge of losing control. S/he may hide potential weapons and avoid the kitchen.

Relationship OCD

Relationship OCD, also described as “Relationship Substantiation,” involves a compulsive search for emotional confirmation that one should stay in a relationship with one’s partner.

Common Rituals:

  • Your mind notices insignificant details about your partner (e.g., he wears pleated shorts, she pronounces her vowels in an odd manner, when I look at him I’m not sure if I experience a strong enough feeling of attraction),
  • You experience extreme discomfort or panic, and you need relief from this emotional state.
  • You ask others for reassurance that you should stay in the relationship,
  • You demand that your partner change to accommodate  your perceptions, or you end the relationship.

Unfortunately, these compulsive behaviors can erode relationships or prevent you from being willing to stay in long-term relationships.

Scrupulosity OCD

Also identified as Religious OCD, those suffering with  Scrupulosity OCD,  feel guilty, ashamed, or panicked in response to thoughts that they have offended God or another deity due to a subtle but “wrong” behavior or automatic thought.  Obsessions include the worry that you will go to Hell or die as a result of this violation.  Alternatively, you might have a similar reaction to thoughts that you violated a moral or ethical code or mistreated another person, thus indicating that you are a bad person. (Also called “Character Assassination.”)

Common Rituals:

  • Reciting perfect prayers,
  • Over-apologizing to others,
  • Confessing your “bad” thoughts or behaviors to loved ones or your therapist,
  • Superstitious behaviors (e.g., avoiding cracks in sidewalks, walking in a specific pattern, touching or tapping objects a certain number of times or in a specific manner).
  • You might avoid Shul or church, friends, or other situations that trigger these fears.

Checking OCD

Those with Checking OCD become panicked by the thought that the failure to retrace steps and check something will result in some type of disaster involving serious harm to other people and/or destruction of property.  For example, one may repeatedly check electrical plugs, stove knobs, and water faucets before leaving home in order to make sure that a fire or flood doesn’t kill the family or other people in the vicinity of your home or ruin the property of others or yourself.

Common Rituals include:

  • Repeatedly checking the lock on your front door, even returning home during your lunch break at work, in order to quiet the threatening thought that an intruder will break into your home and harm your family or steal your possessions.
  • Thoughts about harm to others or yourself, you ritualize by retracing actions either literally or in your memory, you employ others to take responsibility for potentially dangerous routine tasks
  • Avoiding putting yourself in situations that provoke these thoughts.

Contamination OCD (a.k.a., Washers)

With this type of OCD, you are grossed out by the dirtiness or ickyness of the environment or you fear the possibility of being infected by germs.  When you come into contact with parts of the environment that seem dirty or dangerous, you feel contaminated, disgusted, and/or terrified.

Common Rituals:

  • Incessantly check your hands for signs of “ick” or disease,
  • You wash your hands or shower until you feel clean and calm,
  • You do everything possible to avoid coming into contact with feared surfaces in the future.

Ordering OCD

Orderers are preoccupied with arranging or placing specific objects in an exact manner.  They might be preoccupied with placing their computer on the desk “just right” or with having clothes in their closet arranged “just so.”   They are often obsessed with a need for symmetry.  Orders repeatedly adjust objects until they feel at ease, rather than using logical perception as a guide for their ordering behavior.  Because ordering compulsions are driven by anxiety rather than logic, the homes of orderers  may appear disorderly, or messy, even though the items with which they are preoccupied are arranged in a precise manner.  Orders need their items to be arranged before they can move forward with their day, and they become anxious and distressed when others move their possessions.  The ordering compulsion can be a reaction to a sense that their world is out of control, or they can be employed to neutralize a thought that a loved one might be harmed (in the latter case, an argument can be made for the overlap of the constructs of Ordering, Checking, and Responsibility OCD).

Hoarding OCD

Hoarders are extremely resistant to throwing away items in their possession.  Unlike perfectionists (i.e., people with Obsessive-Compulsive Personality Disorder), who hold onto possessions in order to preserve collections or save items of sentimental value, hoarders feel terrified about discarding garbage and other useless or irrelevant items due to feeling out of control.

Pure Obsessional OCD (a.k.a., “Pure-O”)

Pure-O involves obsessional mental activity without observable behavioral compulsions.  Pure-O involves an endless pattern of mental obsessions-mental compulsions.  It is absolutely crucial to distinguish between mental obsessions and mental compulsions.  A mental obsession is an intrusive thought or image that enters your mind and causes distress.  It often comes in the form of a question:  “What if ____?!  Am I ____?!  In contrast, a mental compulsion is a conscious, effortful mental activity aimed at diminishing an obsession and relieving the anxiety associated with it. In effect, in “Pure-O” the obsession and compulsion are both in the mind, locking the person up from a more productive life.

If you think you might suffer from OCD, why not contact us for an appointment and assessment?