What is OCD really?
Have you ever heard someone say “I’m just so OCD” in response to an idiosyncrasy of theirs. Perhaps they always have a tidy home, like things to be just so, or eat their M&Ms in groups of 5. Some mental health diagnoses enter common speech, and that can really muddy the waters for people trying to understand their own struggles and diagnoses. While these people may have some struggles, particularly if their behaviors cause them to feel distressed, none of these are all that related to the clinical diagnosis of Obsessive Compulsive Disorder. If you are someone wondering if perhaps you or a loved one really DO qualify for an OCD diagnosis, hopefully this article can help you to better understand what is Obsessive Compulsive Disorder.
As I have mentioned on this blog before, the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition) is the official guide that therapists use to define and diagnose mental health disorders. Each disorder has criteria or certain symptoms that must be met to qualify or rule out a disorder, and OCD is no different. First, A person must have obsessions, compulsions, or both. By obsessions, they mean thoughts, urges, or impulses that are unwanted, happen spontaneously, occur repeatedly, and happen over time. In response to these obsessions, the person tries to ignore, shut down, or get rid of them with some other thoughts or action. This thought or action is the compulsion, the repeated behavior or mental act that a person feels they must do in response to an obsession or based on rigid rules. The compulsions try to prevent or reduce anxiety or distress, or prevent some dreaded event or situation, but the behaviors or mental acts are not connected in a realistic way with this goal or are too much. Importantly, the obsessions and/or compulsions must also take up a large amount of time, get in the way of normal activities, or cause significant distress.
Other criteria frequently require clinical expertise to really explore whether the diagnosis fits. For example, these symptoms can’t be the result of the use of a substance, such as a medication or alcohol. It is also important to make sure that another disorder is not a better fit because many diagnoses have some overlap. Finally, the nature of the obsessions is important. The thoughts or urges have to be the person’s own. For example, a person that prayed frequently because their religion required it of them does not qualify. Also, the thoughts or urges have to be unpleasant and repetitive. Finally, a person has to be unable to resist at least one thought or urges, even if the person has largely “given in” to them.
What does this look like in a real person and how to do we tell when it is OCD and not just forgetfulness or anxiety? For example, any person might be in bed and have the worry that they left the stove on downstairs after dinner, so they get up and go check to make sure it is off. That makes sense, but what if you didn’t cook dinner in the stove and this worry and compulsion still popped up? And with OCD, they might go check the stove, get back in bed, and have the intrusive thought again, and feel as if they MUST go make sure it is off. Perhaps, they might start taking a picture of the stove before leaving the house or going to bed, or maybe they have a partner check and then reassure them repeatedly. Maybe they start having to drive home from work to make sure the stove is off. This is just one example, and you can see how it could really take up a lot of time and cause a lot of distress.
If you have read all of this and are thinking, “Hmmmm, okay. Maybe that does sound like me or my loved one,” please don’t hesitate to reach out. There are treatments, including therapy and medication that can help manage symptoms and allow you to live a full and complete life. Give me a call, and we can get started today!
American Psychiatric Association, issuing body. (2022). Diagnostic and statistical manual of mental disorders : DSM-5-TR (5th edition, text revision.). American Psychiatric Association Publishing.