More on OCD…
The Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5) contains the descriptions for all known mental health disorders. This is how the manual summarizes Obsessive-Compulsive Disorder (OCD).
“OCD is characterized by the presence of obsessions and/or compulsions. Obsessions are recurrent and persistent thoughts, urges, or images that are experienced as intrusive and unwanted, whereas compulsions are repetitive behaviors or mental acts that an individual feels driven to perform in response to an obsession or according to rules that must be applied rigidly.”
First of all, we can notice that OCD includes obsessions and/or compulsions so it is possible to be diagnosed with OCD and have one or the other, but not necessarily both. Secondly, we can see that compulsions can be repetitive behaviors (for example, hand washing, checking to make sure the stove is off multiple times, or rearranging items in a neat line) but they can also be mental acts (such as counting, praying, or repeating certain words). This is important to note because although our culture many times depicts OCD as a very “quirky” and visible disorder many times people are suffering completely inside their own mind without outward or visible signs of OCD.
The content and themes of obsessions and compulsions varies among individuals, but there are some themes that are common, such as contamination obsessions and cleaning compulsions, concerns with symmetry, repeating, ordering, and counting, as well as fear of taboo thoughts, such as violent, sexual, or religious obsessions and compulsions, as well as fear of harming oneself or others are all common themes in OCD.
As clinicians, we specify if someone has good or fair insight, poor insight, or absent insight/delusional beliefs. This is determined by whether the individual recognizes that their beliefs are probably not true or logical. It’s important to note that the large majority of individuals diagnosed with OCD have good insight and recognize that their obsessions and/or compulsions are not logical, don’t make sense, or aren’t keeping them safe, but feel compelled to do them anyway.
This can often lead the person to feel defeated by their disorder, however, certain types of cognitive-behavioral therapy (CBT) such as exposure and response prevention (ERP) has been shown to be clinically effective in treating individuals with OCD (Abramowitz, 2006). In a relatively short amount of time, the prognosis for treating individuals with OCD has gone from poor to very good as a result of ERP and related therapies.
If you or your child is struggling with obsessions or compulsions, I would be happy to work with you to find a treatment that works for you. Please contact me at [email protected]
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596
Abramowitz, J. S. (2006). The Psychological Treatment of Obsessive—Compulsive Disorder. The Canadian Journal of Psychiatry, 51(7), 407–416. https://doi.org/10.1177/070674370605100702