Obsessive Compulsive Disorder (OCD) is a condition characterized by obsessions, which are typically experienced as intrusive and bothersome, and/or compulsions, which are performed in response to obsessive thinking, and/or with the aim of reducing distress. In those with OCD, obsessions and compulsions are time-consuming, typically cause significant distress, and lead to impairment in major areas of everyday functioning (e.g., relationships, occupation, self-care). In a given year, approximately 1.2% of the United States population will meet the criteria for an OCD diagnosis. Females are affected at a slightly higher rate than males during adulthood, whereas males have a slightly higher rate during childhood (DSM-V, 2013).
Obsessions and compulsions can be unique and varied, but generally fall into one of several broad categories (Leckman et al., 2010):
1) Symmetry/Ordering
2) Contamination/Cleaning
3) Over-Responsibility, Harm/Checking
4) Aggression, Religious, Sexual
Examples of types of obsessions and compulsions appear below.
Symmetry/Ordering
Individuals with obsessive thoughts about attaining symmetry or ordering items in their environment often are worried that some negative outcome will arise if items are not arranged in a particular order. Some individuals report experiencing uncomfortable sensory phenomena and perform compulsions until they attain a “just-right” feeling or “complete” sensation.
Contamination/Cleaning
Individuals with obsessive thoughts about contamination tend to believe that they will become sick as a result of encountering contaminants in the environment. Cleaning is often a compulsive behavior that accompanies obsessions about contamination as the behavior may serve the purpose of reducing the risk of coming into contact with germs.
Over-Responsibility, Harm/Checking or Counting
Individuals experiencing intrusive thoughts related to responsibility or harm tend to believe that an action they have taken, or an action they might refrain from taking, might result in loss or harm to another individual. For example, a person might think they left the stove on, which could lead to others becoming injured if a fire were to start, or if the door were left unlocked their home might become burglarized. Others might have obsessive thoughts that a comment they made offended someone or if they stop an activity on a certain number another person will be harmed. Individuals with these types of thoughts tend to compulsively check their environment, may avoid certain numbers, or seek reassurance from others (e.g., return home to check that the stove is turned off, the doors are locked, eat 10 chips instead of 9 chips, apologize excessively).
Aggression, Religious, Sexual
Individuals who have obsessions in this domain tend to experience intrusive thoughts that they consider inappropriate, such as thoughts about explicit sexual acts, fear of being a pedophile, concerns about their sexual orientation, violence against others, and demeaning thoughts about others. Individuals experiencing these types of obsessions may engage in mental rituals to try and neutralize these thoughts.
It is important to note that a clear link between particular obsessions (e.g. encountering contaminants) and compulsive behavior (e.g., cleaning) is not always evident. For example, some individuals with OCD report engaging in compulsive cleaning but do not endorse experiencing intrusive thoughts about germs (Julien et al., 2006).
References
American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders,
5th ed. Washington, DC: American Psychiatric Publishing.
Julien, D., O’Connor, K. P., Aardema, F., & Todorov, C. (2006). The specificity of belief domains in obsessive-compulsive disorder. Personality and Individual Differences, 41, 1205-1216.
Leckman, J.F., Denys, D., Simpson, H.B., Mataix-Cols, D., Hollander, E., Saxena, S., Miguel,
E.C., Rauch, S.L., Goodman, W.K., Phillips, K.A., Stein, D.J. (2010). Obsessive-compulsive disorder: a review of the diagnostic criteria and possible subtypes and dimensional
specifiers for DSM-V. Depression and Anxiety 27 (6), 507–527.