What is Obsessive-Compulsive Disorder?

Obsessive-compulsive disorder (OCD) is an illness that affects thoughts and actions but is believed to be rooted in a chemical imbalance of the brain. OCD is classified as an anxiety disorder in the Diagnostic and Statistical Manual of Mental Disorders - Fourth Edition (DSM-IV), the main diagnostic reference of Mental Health professionals in the United States, published by the American Psychiatric Association in 1994. This puzzling illness is characterized by recurrent and disturbing thoughts (called obsessions) and/or repetitive, ritualized behaviors that the person feels driven to perform (called compulsions). Obsessions can also take the form of intrusive images or unwanted impulses.

Common types of obsessions include concerns with contamination (e.g., fear of dirt germs, or illness), safety/harm (e.g., being responsible for a fire), unwanted acts of aggression (e.g., unwanted impulse to harm a loved one), unacceptable sexual or religious thoughts (e.g., sacrilegious images of Christ), and the need for symmetry or exactness.

Common compulsions include excessive cleaning (e.g., ritualized hand washing), checking, ordering and arranging rituals, counting, repeating routine activities (e.g., going in/out of a doorway), and hoarding (e.g., collecting useless items). While most compulsions are observable behaviors (e.g., hand washing), some are performed as unobservable mental rituals (e.g., silent recitation of nonsense words to vanquish a horrific image).

The majority of patients have both obsessions and compulsions, but a minority have obsessions alone (about 20%) or compulsions alone (about 10%). The person with OCD usually tries to actively dismiss the obsessions or neutralize them by engaging in compulsions or avoiding situations that trigger the obsessions. In most cases, compulsions serve to alleviate anxiety. However, it is not uncommon for the compulsions themselves to engender anxiety, especially when they become very demanding.

A hallmark of OCD is that the person recognizes that his/her thoughts or behaviors are senseless or excessive. However, the drive can be so powerful that the person caves in to the compulsion even though he/she knows it makes no sense. One woman spent hours each evening sifting through the household trash to ensure that nothing valuable was being discarded. When asked what she was looking for, she chuckled and said, "I have no idea, I don't own anything valuable." Some people who have had OCD for a long time may stop resisting their compulsive drives because they feel it's just easier to give in to them.

Most OCD sufferers have multiple types of obsessions and compulsions. Someone with OCD may complain primarily of obsessive-compulsive symptoms involving asbestos contamination, but a detailed interview may disclose that he silently counts floor tiles and hoards junk mail.