psychiatric disorders
Obsessive Compulsive Disorder (OCD)
Symptoms and Signs of OCD
Obsessionsare unwanted, intrusive thoughts, urges, or mental images, the presence of which usually causes marked distress or anxiety. The dominant themes of the obsessions include harm (eg, fears of harm to self or others), cleaning or contamination (eg, patients may obsess about becoming contaminated with dirt or germs), forbidden or taboo thoughts (eg, aggressive or sexual obsessions), and the need for symmetry. The obsessions are not pleasurable. Thus, patients usually try to ignore and/or suppress them, or they try to neutralize them by performing a compulsion. Compulsions(often called rituals) are excessive, repetitive, purposeful behaviors that people feel they must do to prevent or reduce the anxiety caused by their obsessive thoughts or to neutralize their obsessions. Examples are Washing (eg, handwashing, showering) Checking (eg, that the stove is turned off, that doors are locked) Counting (eg, repeating a behavior a certain number of times) Ordering (eg, arranging tableware or workspace items in a specific pattern) Most rituals, such as handwashing or checking locks, are observable, but some mental rituals, such as silent repetitive counting or statements muttered under the breath, are not. Typically, the compulsive rituals must be done in a precise way according to rigid rules. The rituals may or may not be connected realistically to the feared event. When connected realistically (eg, showering to avoid being dirty, checking the stove to prevent fire), the compulsions are clearly excessive—eg, showering for hours each day or always checking the stove 30 times before leaving the house. In all cases, the obsessions and/or compulsions must be time-consuming (ie, they take up an 1 hour a day or often much more) or cause patients significant distress or impairment in functioning; at their extreme, obsessions and compulsions may be incapacitating. The degree of insight varies. Most people with obsessive-compulsive disorder (OCD) recognize to at least some degree that the beliefs underlying their obsessions are not realistic (eg, that they really will not get cancer if they touch an ashtray). However, occasionally, insight is completely lacking (ie, patients are convinced that the beliefs underlying their obsessions are true and that their compulsions are reasonable). Because people with this disorder may fear embarrassment or stigmatization, they often conceal their obsessions and rituals. The time, distress, or poor functioning associated with the obsessions and compulsions may cause relationships to be disrupted and performance in school or at work to decline. Many people with OCD have coexisting past or current psychologic disorders, including Overview of Anxiety Disorders (76%) ( Overview of Mood Disorders (63%; the most common is Obsessive-Compulsive Personality Disorder (OCPD) (23 to 32%) ( Almost 50% of people with OCD have suicidal thoughts at some point, and about 10% attempt suicide (see Suicidal Behavior ) ( 1.Pallanti S, Grassi G, Sarrecchia ED, et al: Obsessive-compulsive disorder comorbidity: Clinical assessment and therapeutic implications.Front Psychiatry21;2:70, 2011. doi: 10.3389/fpsyt.2011.00070 2.Ruscio AM, Stein DJ, Chiu WT, et al: The epidemiology of obsessive-compulsive disorder in the National Comorbidity Survey Replication.Mol Psychiatry15(1):53-63, 2010. doi: 10.1038/mp.2008.94 3.Coles ME, Pinto A, Mancebo MC, et al: OCD with comorbid OCPD: A subtype of OCD?J Psychiatr Res42(4):289-296, 2008. doi: 10.1016/j.jpsychires.2006.12.009 4.Pellegrini L, Maietti E, Rucci P, et al: Suicide attempts and suicidal ideation in patients with obsessive-compulsive disorder: A systematic review and meta-analysis.J Affect Disord276:1001-1021, 2020. doi: 10.1016/j.jad.2020.07.115 5.American Psychiatric Association:Diagnostic and Statistical Manual of Mental Disorders, 5th ed. Text Revision (DSM-5-TR). Washington, DC, American Psychiatric Association, 2022. 