Obsessive Compulsive Disorder
Obsessive Compulsive Disorder (OCD) is a mental health disorder that affects up to 2.3% of the population. Individuals diagnosed with OCD experience unwanted recurrent thoughts, urges or images that cause marked anxiety or distress. In an effort to reduce anxiety or distress, individuals with OCD engage in behaviors called compulsions or rituals.
Prevelance
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OCD typically emerges between the ages of 8-12 years old or in late adolescence/early adulthood.
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OCD can affect any person regardless of gender, race, ethnicity, religion, or nationality.
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Current estimates suggest that approximately 1 in every 100 adults has OCD and at least 1 in 200 children have OCD. This amounts to roughly 2-3 million adults and 500,000 children.
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The prevalence of OCD is likely under-estimated due to low self-reporting and lack of awareness of what symptoms qualify as OCD.
Symptoms
Obsessions
Obsessions are recurrent and persistent thoughts, urges, or images that are experienced, at some time during the disturbance, as intrusive and unwanted, and that in most individuals cause marked anxiety and distress. The individual attempts to ignore or suppress such thoughts, urges, or images, or to neutralize them with some other thoughts or actions (i.e., by performing a compulsion).
Compulsions
Compulsions are repetitive behaviors (e.g., hand washing, ordering, checking) or mental acts (e.g., praying, counting, repeating words silently) the individual feels driven to perform in response to an obsession or according to a rule that must be applied rigidly. The behaviors or mental acts are aimed at preventing or reducing anxiety or distress, or preventing some dreaded event or situation; however, these behaviors or mental acts are not connected in a realistic way with what they are designed to neutralize or prevent, or are clearly excessive.
*Although most people experience some form of intrusive thoughts and compulsive behaviors during their lifetime individuals with OCD experience obsessions and/or compulsions as time-consuming (e.g., take more than 1 hour per day) or cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
Assessment
Yale Brown Obsessive-Compulsive Scale
The Yale Brown Obsessive Compulsive Scale (YBOCS) is a semi structured clinician administered assessment utilized to diagnose OCD in children, adolescents, and adults. The assessment utilizes a symptom checklist to determine the type and presence of obsessions and compulsions in the following way:
Obsessions
Contamination Obsessions: excessive concern with dirt, germs. certain illnesses, bodily waste or secretions (e.g., urine, feces, semen, sweat), environmental contaminants (e.g., asbestos or radioactive substances), household cleaners/solvents, animals/insects, and sticky substances.
Fear of getting ill as a direct result of coming into contact with a contaminant, concerned will get others ill by spreading contaminants.
Fear of vomiting.
Aggressive Obsessions: fears of acting on an unwanted impulse to harm self or others (e.g., stab self/others with a knife, drive off the road, hit and run while driving), fear of harm coming to self and others (e.g., home invasion, fire, car accident), intrusive violent or horrific images, fear of doing something embarrassing, like blurting out obscenities or insults.
Sexual Obsessions: forbidden or perverse intrusive sexual thoughts, including those that might involve children, animals or aggressive acts.
Hoarding or Saving Obsessions: Worries about throwing unimportant things away because you might need them in the future, urges to pick up or collect useless things.
Religious Obsessions (Scrupulosity): Overly concerned with offending God, having blasphemous thoughts, being sent to Hell or imprisoned for life. Excessive concern with right/wrong and morality (e.g., worries about having told a lie, breaking rules or cheating someone).
Somatic Obsessions: Fear of acquiring an illness (e.g. cancer, heart disease, HIV/AIDS, ALS), preoccupation with a certain part of one’s appearance.
Miscellaneous Obsessions: include fears of certain numbers, colors, losing things or not saying just the right thing.
Compulsions
Cleaning or Washing Compulsions: Excessive or ritualized handwashing, showering, bathing, toothbrushing, grooming and toilet routine, excessive cleaning of items/objects, the need to use a barrier to prevent coming into contact with perceived contaminants.
Checking Compulsions: the need to check to make sure nothing bad did or will happen (e.g., need to check the stove before leaving the house, need to check that doors and windows are locked prior to leaving the house or going to bed at night, asking reassurance to make sure everyone is safe and nobody’s been hurt, looking for injuries or bleeding after handling sharp or breakable objects, searching the newspaper or television for new about catastrophes, checking one’s body/searching the internet for signs and symptom of illness, checking that one did not make a mistake while reading/writing.
Repeating Compulsions: the need to repeat routine activities to prevent something bad from happening (e.g., turning light switches on/off, walking in and out of doorways, getting up and down from chairs, turning appliances on/off. Need to re-read, erase and rewrite.
Counting Compulsions: the need to count objects or own actions such as steps or words spoken.
Ordering and Arranging Compulsions: the need to arrange/order items objects so that they are even/symmetrical.
Hoarding and Collecting Compulsions: difficulty throwing things away, saving bits of paper, string, old newspapers, notes, cans, paper towels, wrappers and empty bottles; may pick up useless objects from the street or garbage.
Miscellaneous Compulsions: includes reassurance seeking, list making, touching, tapping and rubbing things, and rituals involving blinking and staring.
Related Disorders
Body Dysmorphic Disorder
Hoarding Disorder
Trichotillomania
(Hair-Pulling Disorder)
Excoriation
(Skin-Picking Disorder)
Tic Disorders
Anxiety Disorders
Separation Anxiety Disorder
Specific Phobia
Social Anxiety Disorder
Panic Disorder
Generalized Anxiety Disorder
"Life begins at the end of your comfort zone."
Neal Donald Walsch