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OCD usually involves both obsessions and compulsions, although in rare cases, one may be present without the other.
Obsessions:
Obsessions are defined as recurrent and persistent thoughts, impulses or images that you feel unable to control or prevent. You will usually experience these as senseless, disturbing and intrusive, and try to ignore or suppress them. Obsessions are often accompanied by anxiety, fear, disgust or doubt.
Common Obsessions:
• Worrying excessively about dirt or germs and that you may become contaminated or contaminate others
• Imagining you have harmed yourself or others; having doubts about safety issues (such as whether you have turned off the stove)
• Fearing something terrible will happen or that you will do something terrible
• Preoccupations with symmetry, or a need to have things "just so"
• Intrusive sexual thoughts
• Intrusive violent or repulsive images
• Excessive religious or moral doubt or guilt; intrusive blasphemous images
• Excessive doubting or indecision: "should I - shouldn't I?"
• A need to tell, ask or confess
Compulsions:
Compulsions on the other hand, are defined as repetitive and ritualistic behaviour or mental acts, often performed according to certain "rules".
Common compulsions:
• Washing or cleaning: such as showering repeatedly or washing your hands until the skin is red and painful
• Checking: such as repeatedly checking that you have turned off the stove or locked the front door
• Repeating: such as repeating a name or phrase many times to ease anxiety
• Completing: performing a series of steps in an exact order or repeating them until you feel they are done perfectly
• Repetitive ordering, arranging or counting of objects
• Hoarding: collecting useless items you may repeatedly count or order
• Excessive and repetitive praying
• Repetitive touching
Unlike compulsive drinking or gambling, OCD compulsions are not pleasurable, but are often are performed to obtain relief from obsessions. For example, you may repeatedly check that you have turned off the stove because of an obsession about burning the house down or you may count certain objects repeatedly because of an obsession about losing them.
Not all obsessive-compulsive behaviours are OCD. Some rituals (such as religious practices, exercise routines) are part of daily life. Normal worries, such as contamination fears, may increase during times of stress, such as when someone in the family is sick.
You may have OCD if your obsessions or compulsions:
• Cause you marked distress
• Persist and take up a lot of time (over an hour a day). People with OCD may spend hours each day performing compulsive acts
• Significantly interfere with your normal routine, work, social activities or relationships
• Are senseless
People with OCD are usually aware that their obsessions or compulsions are excessive or senseless, and are more than just normal worries. "OCD with poor insight" is diagnosed when someone with OCD does not recognise that his or her beliefs and actions are unreasonable.
OCD symptoms usually have a "waxing and waning" course, i.e. tend to come and go over time, and vary in intensity. Some symptoms may be mild and fairly easy to ignore; others cause severe distress and disability.
People with OCD also often have depression or depressive symptoms, including:
• Guilt
• Sadness
• Low self-esteem
• Anxiety
• Fatigue
Reviewed by Dr Stefanie van Vuuren, MBChB (Stell), M Med (Psig) (Stell), FC (Psych) SA, Psychiatrist in private practice, Durbanville Cape Town, February 2015.
Previously reviewed by Christine Lochner, Coordinator: Genetics and Anxiety Disorders Research, MRC Unit on Anxiety Disorders.
