Obsessive-compulsive disorder (OCD) is characterized by repetitive, persistent, unwanted, and intrusive thoughts, urges, or images (obsessions) and/or recurring behavior or mental actions that make patients experience a strong need (compulsions) to try to reduce or prevent the anxiety that causes these obsessions.
Obsessions — intrusive undesirable thoughts, images, or urges that cause significant discomfort or anxiety.
Compulsions — are excessive repetitive rituals that people feel the need to perform in order to reduce anxiety caused by their obsessive thoughts or neutralize these obsessions.
Obsessions and/or compulsions have to take a really big amount of time (>1 hour per day, usually much more) or cause significant discomfort or problems in livelihood.
Obsessive-compulsive disorder can be accompanied by other symptoms:
Symptoms of anxiety disorders — panic attacks or general anxiety, for example.
Symptoms of depression — it is the source of major pain for the patient and creates problems for their activity at home, at work, at school, or at university. This leads to a worse mood, reduces self-esteem, the feeling of helplessness and hopelessness, and even to the development of a whole depressive episode.
Depersonalization and derealization — sometimes anxiety and stress combined with obsessive conditions or attempts to resist them get so bad that they lead to the constant feeling of unreality — the patient may feel like they have no contact with the world, people and objects are artificial and surreal, as if they are decorations (derealization) or that their thoughts are separated from them as if they belong to the patient, their feelings, emotions, actions or even part of their body do not belong to them (depersonalization) — these symptoms are usually very worrisome and might cause the fear of “going insane”, approaching “madness”.
Tics are involuntary repetitive movements (e.g. blinking, shrugging, making faces) or vocal sounds (coughing, barking, hissing, etc), that feels like something incredibly hard to resist, just like compulsions.
Aichmophobia — is a morbid fear of sharp objects and avoidance of them.
Mysophobia — is a morbid fear of dirt combined with a need to avoid contact with it, get rid of it, and avoid “desecration” by it.
Bacillophobia — analogical to mysophobia, a fear of microbes.
Intrusive touches and movements
Less known compulsion is the need to touch or move. The following actions can be observed in people with these symptoms.
- Viewing or looking at something in a special way
- Symmetrical movements or performed in a special way
- The need to walk in a special way or specific places when walking
- Special movements when performing certain actions
- Reversing movements just made
- Repeating certain actions (sitting, standing, walking through doors or places) a particular amount of times or until the person feels like they did it right
- Touching furniture before sitting or standing up
- Touching doors or boxes before opening or closing them
- Touching the doorframe before passing through it
- Touching objects a specific amount of times
- Touching objects in special patterns
- Touching, holding or handling objects in a specific way before using them
Compulsions like this or other categories are usually done in order to get rid of the anxiety caused by obsessive thoughts.
Compulsive hand washing
People with OCD usually believe their intrusive thoughts and compulsive behavior are irrational but feel too helpless to resist them. Those who experience compulsive hand washing are obsessed with the fear of infection and often wash their hands multiple times until their skin is chapped or even starts to bleed.
Patients with compulsive hand washing wash their hands very excessively and often in order to alleviate the severe stress caused by an intrusive irrational fear of infection. Repetitive hand washing often causes noticeable changes in the skin or worsens the skin diseases that existed before the compulsion.
Compulsive hand washing is a grueling psychodermatological condition that interferes with a patient's daily life and quality of life. Intrusive hand washing may lead to inflammatory degenerative and infectious changes on the back and palm sides of the hands.
Cleaning or washing is performed several times, often accompanied by rituals of repetitive hand or body washing until the person doesn’t “feel clean”. The time spent on these rituals can have a significant impact on a person's relationships or productivity at work, and a secondary impact on the physical health caused by constant rubbing and cleaning of the skin especially hands that people usually rub until they bleed.
A person can wash their hands, and frequently shower because of irrational thoughts about the death of loved ones if they don’t shower or wash their hands several times. The person has to do this “task” not because it’s hard, but because if they ignore it, it’s impossible to do other things. Moreover, there might be a fear of being dirty or infected or the fear of viruses and microbes. Meaning that there is one more reason for compulsive hand washing.
A person can also avoid places, people, or objects if they have experienced the fear of infection. Constant usage and purchase of cleaning products, as well as electrical items like mobile phones that were damaged due to excessive exposure to liquids, are all linked to expenses.
The fear of being dirty and infected is a compulsive worry. Usually, the fear is contamination that can be harmful to the person or their loved ones. Common compulsions are cleaning, washing, or avoidance.
Compulsive inspection in OCD
Compulsive Inspection in OCD is a prevalent form of OCD that is characterized by compulsive behavior based on inspection. People with OCD are afraid that somehow they might be the cause of something bad happening to them or others, intentionally or not. This compulsive concern evokes anxiety, to which people respond with check-up rituals in order to assure that nothing horrible has happened or will ever happen. Generally, intrusive thoughts tend to focus on the possibility of something terrible happening.
Common intrusive fears in compulsive inspection in OCD:
- Fear about safety — concerns are usually about fire, flood, burglary, or any other threat to life or property.
- Health problems — fear of developing a serious illness.
- Fear of mistakes — worry about making mistakes of any kind.
- Concern about inappropriate behavior — fear of bad attitude.
These intrusive thoughts lead to distress (usually in the form of anxiety) and this subtype of OCD is compulsive behavior used to ease anxiety. The goal is to assure oneself that the awful results did not happen and will not happen.
Behavior checks:
- Physical examination: attentive analysis of things (sometimes taking photos in order to have a more reliable “proof”) or their physical analysis.
- Avoidance: avoiding responsibility means running from the distress that comes from uncertainty. If someone else leaves the house or the room the last, they relieve the person with OCD of the responsibility for checking locks, gas, taps, etc. If the concern is about mistakes then avoiding the possibility of making a mistake (not sending emails or not interacting with people) can reduce anxiety.
- Comfort: people often seek reassurance. It can come from within, people reminding themselves that they did everything right. Seeking solace from others is also common, people ask “Did you see me locking the door, right?” or “This action, is it normal to you?” a lot.
- Rituals: there are a lot of inspections going on in the head: It could be replaying events in the mind: the person can lie down for hours repeating conversations that happened earlier again and again, in order to be sure that they didn’t do anything offensive or inappropriate.
Intrusive actions (compulsions)
Intrusive actions (compulsions) — just like obsessions feel meaningless, awkward or embarrassing, but unavoidable - it is tough to resist them.
They can be in different forms:
- Compulsive check-ups (doors, taps, items, etc) as an answer to compulsive uncertainty.
- Repetitive clean-ups, washing (hand washing), stacking, etc — are connected to insecurity if the actions were performed correctly, according to the self-imposed procedures and effectiveness.
- Repetitive correction, stacking, and ordering that are associated with the obsessive desire for cleanness, symmetry, and a specific disposition of objects.
- Complex actions resembling quirky rituals that the person is obliged to perform in order to prevent the increasing anxiety or threat with impossible consequences, even though they perfectly understand the futility of their actions and thoughts (e.g. “I have to jump on one leg two times around the car in the parking lot otherwise something terrible could happen to my daughter”).
- Compulsory collection and accumulation of objects.
Intrusive ideas (obsessions)
Intrusive ideas (obsessions) — are unwanted thoughts of alien nature. The patient experiences their occurrence very emotionally because of threatening them critically, and tries to get rid of them, however, can not accomplish that on their own. The main difference between intrusive thoughts and delusion is that the person is certain of their disordered nature.
Intrusive thoughts have a strong intense character and are always perceived as “unwanted”, “shameful”, “absurd”, “and undesired”. Even though intrusive thoughts occur against the patient’s will and cause resistance, they still are perceived by them as their own thoughts.
Obsessions can be divided into the following categories:
- Obsessive uncertainty — usually about everyday things, for example: repetitive and consistent, despite multiple and various checks, uncertainty about whether the door was closed, whether the lights were turned off, whether the water taps were closed, whether objects were evenly and properly laid out, whether hands were correctly and effectively washed, etc.
- Intrusive, unwanted, and often contradicting someone’s worldview thoughts of obscene or vulgar character — usually getting more intense in places or under circumstances in which they are especially inappropriate.
- Intrusive impulses — intense, irresistible thoughts about starting to scream in a public space, committing an incriminating act, or acting aggressively towards people to whom one has no bad intentions or to close people (for example: pushing a person, leaning out of the window) — essentially in obsessive-compulsive disorder they are never realized by the patient, although they are accompanied by severe anxiety about their occurrence and intense attempts to prevent that.
- Rumination is continuous, hours-long, useless, pseudophilosophical, and difficult-to-interrupt of one single topic, question, or thought without any decisions or constructive conclusion.
- Obsessive fear of dirt, uncleanness, and making oneself or others dirty.
- Obsessive demand to keep a perfect, unreal order, symmetry, certain placement of objects, etc.
Arithmomania
Arithmomania — a person constantly makes arithmetic calculations in their brain not related to the surrounding environment.
Arithmomania (from Greek arithmós “number” and manía “coercion”) — is a mental disorder that can be classified as a type of OCD.
People with this disorder experience a strong need to count their actions or objects around them.
Patients might feel obligated to count their steps when they go up or down stairs or count the number of letters in words. They also feel obligated to repeat an action a certain amount of times to prevent an alleged disaster.
They can count everything they see — tiles on the floor or the ceiling, amount of lines on a highway or simply the number of inhales or blinks, or a certain amount of touches to objects.
Sometimes arithmomania develops into a complicated system in which the patient assigns values and numbers to people, objects, or events in order to find their connection.
Sometimes numbers are connected to events from the past, and the person remembers the events over and over again through certain numbers.
A person completes their actions a specific number of times and that number is connected to their particular completed event. Counting can be made out loud or mentally.