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Obsessive compulsive disorder (OCD): Do I have a mild form of OCD?

Behaviour, Mental Health | July 14, 2014 | Author: The Super Pharmacist

behaviour, mental health

Obsessive compulsive disorder (OCD): Do I have a mild form of OCD?

Do you really have obsessive compulsive disorder? We've all done it. You check the lock on your door to make sure that it is secure even though you just locked it. Or once you embark on a long road trip you can't fight the sensation that you left something behind or left something running that should've been turned off. Some of us may compulsively wash our hands even if they are not dirty. It is common to hear people say “I'm OCD” or “that's just my OCD” when describing certain compulsions or hang-ups that they have. It is a way to justify or explain their meticulous nature or for insisting that certain things are done in a particular manner. But do you really have a mild form of obsessive compulsive disorder?

The official diagnosis of obsessive compulsive disorder

The American Psychiatric Association recently released the latest version of the Diagnostic and Statistical Manual of Mental Disorders called the DSM-5. This manual is considered the benchmark of psychiatric diagnoses and includes diagnostic criteria for virtually every psychiatric disorder and illness.

A. Presence of obsessions, compulsions, or both:

‚ÄčObsessions as defined by:The official diagnosis of obsessive compulsive disorder

  • 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 or distress.
     
  • The individual attempts to ignore or suppress such thoughts, urges, or images, or to neutralise them with some other thought or action (i.e., by performing a compulsion).

Compulsions as defined by:

  • Repetitive behaviors (e.g., hand washing, ordering, checking) or mental acts (e.g., praying, counting, repeating words silently) that the individual feels driven to perform in response to an obsession, or according to rules 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 either are not connected in a realistic way with what they are designed to neutralise or prevent, or are clearly excessive.

B. The obsessions or compulsions are time-consuming (e.g., take more than one hour per day) or cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

C. The obsessive-compulsive symptoms are not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition.

D. The disturbance is not better explained by the symptoms of another mental disorder. 

For example:

  • Excessive worries, as in generalised anxiety disorder
  • Preoccupation with appearance, as in body dysmorphic disorder
  • Difficulty discarding or parting with possessions, as in hoarding disorder
  • Hair pulling, as in trichotillomania (hair-pulling disorder)
  • Skin picking, as in excoriation (skin-picking) disorder
  • Stereotypies, as in stereotypic movement disorder
  • Ritualised eating behavior, as in eating disorders
  • Preoccupation with substances or gambling, as in substance-related and addictive disorders
  • Preoccupation with having an illness, as in illness anxiety disorder
  • Sexual urges or fantasies, as in paraphilic disorders
  • Impulses, as in disruptive, impulse-control, and conduct disorders
  • Guilty ruminations, as in major depressive disorder
  • Thought insertion or delusional preoccupations, as in schizophrenia spectrum and other psychotic disorders
  • Repetitive patterns of behavior, as in autism spectrum disorder

The Obsessive Compulsive Disorder

Obsessive compulsive disorder is an illness of obsessions and compulsions. Obsessions are thoughts, and compulsions are behaviors.

The obsessions and compulsions in obsessive compulsive disorder are repetitive, persistent, time-consuming, and cause significant stress or anxiety for the sufferer. Of note, the symptoms must not be due to drug intoxication or drug withdrawal. Also, the diagnosing clinician must consider other forms of mental illness (e.g., schizophrenia) that may explain the symptoms better than a diagnosis of obsessive-compulsive disorder. 

Obsessions and compulsions tend to go hand in hand. For example, someone with obsessive compulsive disorder may be obsessed with symmetry.

The Obsessive Compulsive DisorderThe person is constantly looking for examples in his environment that are asymmetric and feels compelled to make those items more symmetric. When things are asymmetric, the person feels acutely uncomfortable and distressed.

In order to relieve this uncomfortable feeling, he performs a compulsion, such as making the asymmetric items line up symmetrically.

In severe obsessive compulsive disorder, seemingly symmetric items may appear to be asymmetric to the sufferer such that any amount of compulsive arrangement cannot ease the discomfort of the obsession. The person with obsessive compulsive disorder may avoid all places with asymmetry. The person may even become trapped in his or her own home.

Perhaps most importantly, the diagnosis of obsessive compulsive disorder requires that obsessions and/or compulsions significantly disrupt the patient's life. For example, does the sufferer avoid social or pleasurable activities so they can avoid the unpleasant feelings of an obsession? Do they devote significant time to a compulsion instead of doing other, important or pleasurable things? In essence, do these obsessive thoughts and compulsive rituals interfere with the person’s life or the lives of friends, coworkers, and/or family? If so, the person may have obsessive compulsive disorder.

Types of obsessions and compulsions 

Various obsessions and compulsions can occur in people with obsessive compulsive disorder; however, some features or clusters of symptoms appear to be more common than others are. People with obsessive compulsive disorder often have one or more of the following symptoms (symptom clusters):

  • Washing/cleaning - People wash themselves or clean their environment compulsively because they feel they are unclean or objects are contaminated. This may be related to fears of germs and illness, particularly infectious illnesses. Likewise, washing and cleaning obsessions may be related to a compulsion to maintain an ordered environment.
     
  • Checking – Checking is the repetitive obsession/compulsion to make sure items are in a certain configuration. For example, checking that the doors are locked or appliances are off. People with these symptoms of obsessive compulsive disorder generally have complex rituals for mundane tasks such as getting dressed or leaving the house. If they cannot perform a ritual in a particular way, they may feel compelled to repeat the ritual until they have performed perfectly.
     
  • Symmetry/ordered environment - Some people with obsessive compulsive disorder require any two or more items to be placed symmetrically. Likewise, singular items may need to be placed in an orderly manner. Symmetry and order may be difficult to accomplish (to the satisfaction of the person with obsessive compulsive disorder)
     
  • Hoarding - Hoarding is the collection of useful or useless items coupled with the inability to discard them. When hoarding is the only symptom of obsessive compulsive disorder, it may be considered a discrete disorder.
     
  • Violence/harm - Some people with obsessive compulsive disorder feel that they may cause harm to others or may be the victim of violence even in situations that are completely safe to the objective observer.
     
  • Sexuality - Obsessions of a sexual nature, such as the fear that one might become attracted to children or members of their own family. These obsessions might lead to compulsive avoidance of entire groups of people (e.g., all children or all family members).
     
  • Religious/magical thinking - Sufferers of this OCD symptom believes that their thoughts or actions can control remote activities (similar to superstitions). For example, talking about someone's death may hasten that person's demise. The associated compulsion is that the person must perform complex rituals to avoid or undo the potential damage of these supposedly harmful thoughts/words.

Do I have a mild form of obsessive compulsive disorder?

Obsessive-compulsive disorder can be a debilitating illness that can severely impair a patient's functioning and quality of life. On the other hand, people may experience a mild form of obsessive compulsive disorder that only slightly, but significantly disrupts their lives.

The true test of whether someone has obsessive compulsive disorder is whether obsessions and/or compulsions cause significant distress or are inordinately time-consuming.

Do I have a mild form of obsessive compulsive disorder?Being neat and orderly is not a disease; however, preventing people from visiting your home for fear they will make it dirty or contaminated is an abnormal behavior and may indicate obsessive compulsive disorder.

If you run back from the car to make sure the front door is locked—this is not obsessive compulsive disorder—you are probably just being thorough. However, if it takes you several minutes to check and recheck the front door, which makes you late for work or social engagements,
this could be obsessive compulsive disorder.

Avoiding dangerous situations is prudent. On the other hand, avoiding common situations because of irrational worries about being harmed or harming others could be a symptom of obsessive-compulsive disorder.

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References:

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (DSM-5). 5th ed. Washington, DC: American Psychiatric Association; 2013.

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