From the physicians in the Department of Psychiatry at Yale School of Medicine, we learn all about the causes, nature, symptoms and treatment of OCD – obsessive-compulsive disorder.
What are the symptoms of obsessive-compulsive disorder?
Obsessive-compulsive disorder, or OCD, is a condition that affects about 2.5% of the population at some point in their lives. Obsessions are intrusive thoughts that people experience as coming from inside the mind or brain but as being somehow different from normal thoughts – more urgent, difficult-to-control, and repetitive. They are accompanied by anxiety or distress, and people typically make substantial efforts to control, neutralize, or suppress them. Compulsions are repetitive behaviors that people perform, often in a ritual-like way, to reduce the anxiety caused by the obsessions.
There are several types of OCD symptoms; two individuals with OCD can look quite different from one another. The most common groups of symptoms are anxiety about dirt or germs, accompanied by excessive cleaning; fears of violence or harm, associated with compulsive double-checking or with superstitious rituals; and discomfort with things being disordered or asymmetrical, accompanied by compulsive sorting, ordering, and arranging.
There are a number of other conditions that are thought of as being related to OCD but as importantly distinct. These include compulsive hoarding; compulsive skin-picking and hair-pulling; repetitive patterns of movement such as are seen in tic disorders; and irrational concerns with particular aspects of one’s appearance, which are seen in a condition known as body dysmorphic disorder.
What causes OCD?
The short answer is that, as is the case for almost all psychiatric disesaes, we don’t yet know what causes OCD. It is likely to be a complex interaction between genes, other biological factors, life history, and particular stresses.
It is clear that OCD can run in families. Researchers are actively searching genetic variations that may help explain why one person gets OCD and another does not. Genes are not the whole story, though: even identical twins, who have identical genetic material, can differ, with one having OCD and the other not. The best current estimate is that about 40% of the risk for OCD comes from the genes.
Environmental causes of OCD have been difficult to pin down. Stressful life events can cause symptoms to appear or to worsen; in some cases it may be that they actually cause OCD in a susceptible person, but it is more likely in most cases that they trigger or worsen a condition that was already there. Hormonal fluctuations may also influence OCD. The illness commonly starts during adolescence, and some women report symptoms worsening with their menstrual cycle or around the time of pregnancy. Some cases, especially among children, may be related to an autoimmune reaction to infection. However, this appears to be rare. The precise mechanism whereby an immune reaction may lead to OCD symptoms has been difficult to pin down, and a connection remains difficult to establish in most individual cases.
What’s the difference between being “neat/tidy” or a “germaphobe” and having OCD?
OCD can appear in different ways; indeed, two people can both have clear cases of the disorder but show totally different symptoms.
Most manifestations of OCD are really exaggerations of what would, in moderation, be normal and even helpful patterns of behavior. For example, a concern with germs and dirt, and a pattern of keeping this clean, is clearly a good thing in many contexts, such as the hospital, and was still more important in past centuries before the development of effective sewer systems and of antibiotics. It is only when such concerns get out of control and start to interfere with normal life that they are indicative of a disorder.
The official guideline for diagnosis is that the distressing thoughts and behaviors must occupy at least one hour a day and must cause significant problems with social or work functioning. The key is that it is only meaningful to call a pattern of behavior a ‘disorder’ if it leads to some significant degree of distress or problems with other aspects of life, such as relationships or work. If an individual just likes things neat and is comfortable with that, then that is best understood as a part of their personality, and not as OCD.
The term “OCD” has become a part of the common language to describe people with patterns of behavior such as in these examples. You’ve probably heard this before: “I’m so OCD about _________.” From a psychiatrist’s or psychologist’s perspective, this is a misuse of the term. Liking things a certain way is not necessarily OCD, even in cases where it causes friction with others, if it does not cause repetitive behaviors and a significant amount of anxiety or distress.