OCD

Obsessive–compulsive disorder (OCD) is a mental disorder characterized by intrusive thoughts that produce anxiety, by repetitive behaviors aimed at reducing anxiety, or by combinations of such thoughts (obsessions) and behaviors (compulsions). The symptoms of this anxiety disorder range from repetitive hand-washing and extensive hoarding to preoccupation with sexual, religious, or aggressive impulses. These symptoms can be alienating and time-consuming, and often cause severe emotional and economic loss. Although the acts of those who have OCD may appear paranoid and come across to others as psychotic, OCD sufferers often recognize their thoughts and subsequent actions as irrational, and they may become further distressed by this realization. OCD has become so popular in society that one sometimes says "That person is OCD."

OCD is the fourth most common mental disorder and is diagnosed nearly as often as the physiological ailments asthma and diabetes mellitus.^[1] In the United States, one in 50 adults has OCD.^[2] The phrase "obsessive-compulsive" has become part of the English lexicon, and is often used in an informal or caricatured manner to describe someone who is meticulous, perfectionistic, absorbed in a cause, or otherwise fixated on something or someone.^[3] Although these signs are often present in OCD, a person who exhibits them does not necessarily have OCD, and may instead have obsessive–compulsive personality disorder (OCPD), an autism spectrum disorder or some other condition

Symptoms

[edit] Obsessions

Main article: Intrusive thoughts

The typical OCD sufferer performs tasks, or compulsions, to seek relief from obsession-related anxiety. Within and among individuals, the initial obsessions, or intrusive thoughts, can vary in their clarity and vividness. A relatively vague obsession could involve a general sense of disarray or tension, accompanied by a belief that life cannot proceed as normal while the imbalance remains. Among the more articulable obsessions one may have is a preoccupation with the idea of violently hurting others or oneself.^[4][5] A survey of healthy college students found that virtually all of them had these types of thoughts from time to time,^[6] Like these students, OCD sufferers generally do not enact or even enjoy these violent thoughts.^[7] On the contrary, they are pathologically disturbed^[8] by these ideas—and by the sense that they could inexplicably possess them. Other obsessions concern the possibility that someone or something other than oneself—such as God, the Devil, or disease—will harm either the sufferer or the people or things that the sufferer cares about. Some people dread entire concepts, fearing their materialization by causes that may seem implausible or indiscriminate to others. For example, a generalized fear of contamination might entail not only wariness of bodily secretions or excretions, but also apprehension toward household chemicals, radioactivity, newsprint, pets, or even soap.^[9]

Sexual obsessions may involve intrusive thoughts or images of "kissing, touching, fondling, oral sex, anal sex, intercourse, and rape" with "strangers, acquaintances, parents, children, family members, friends, coworkers, animals and religious figures", and can include "heterosexual or homosexual content" with persons of any age.^[10] As with other intrusive, unpleasant thoughts or images, most people have some disquieting sexual thoughts at times, but people with OCD may attach extraordinary significance to the thoughts. For example, obsessive fears about sexual orientation can appear to the sufferer, and even to those around them, as a crisis of sexual identity.^[11][12] The doubt that accompanies OCD leads to uncertainty regarding whether one might act on the troubling thoughts, resulting in self-criticism or loathing.^[10]

Some people with OCD may sense that the physical world is qualified by certain immaterial conditions. They might intuit invisible protrusions from their bodies, or could feel that inanimate objects are ensouled. These people tend not to profess religious or metaphysical convictions, such as a belief in animism, through which such notions are derived; even a child with OCD might find these notions ultimately silly.^[13] However, regardless of how these ideas actually correspond with the external world, they can underpin the OCD sufferer's conception of the most practical or proper way for them to understand and face that world. For example, an individual who engages in compulsive hoarding might be inclined to treat inorganic matter as if it had the sentience or rights of living organisms, but such an individual might see no need or way to rationalize their hoarding on behalf of the items they collect.

Compulsions

Main article: Compulsive behavior

While some with OCD perform compulsive rituals because they inexplicably feel they must, others act compulsively so as to mitigate the anxiety that stems from their obsessive thoughts. The sufferer might regard these actions as the conditions set forth by an ominous obsession, or might frame them as a more direct route to eliminating the obsessions from the mind. In either case, the sufferer's reasoning is idiosyncratic or distorted to a maladaptive level. Compulsions include counting specific things (such as footsteps) or in specific ways (for instance, by intervals of two) and doing other repetitive actions, often with atypical sensitivity to numbers or patterns. People might repeatedly wash their hands^[14] or clear their throats; repeatedly check that their parked cars have been locked before leaving them; turn lights on and off, or touch objects, a certain number of times before exiting a room; or walk in a certain routine way.

For some people with OCD, these tasks, along with the attendant anxiety and fear, can take hours of each day, making it hard for the person to fulfill their work, family, or social roles. In some cases, these behaviors can also cause adverse physical symptoms: people who obsessively wash their hands with antibacterial soap and hot water (to remove germs) can make their skin red and raw with dermatitis.^[15] To others, these tasks may appear odd and unnecessary. But for the sufferer, such tasks can feel critically important, and must be performed in particular ways. OCD sufferers are aware that their thoughts and behavior are not rational,^[16] but they feel bound to comply with them in order to fend off feelings of panic or dread.

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