What is OCD?

According to Swinburne University in Melbourne, 3% of Australians will have OCD at some point in their lives. That’s more than 750,000 people. Despite the prevalence of the condition, and growing public awareness, OCD is still misunderstood. This article aims to clarify what OCD is.

Public Misconceptions

OCD stands for 'Obsessive Compulsive Disorder'. Each of these terms is chosen carefully, as each describe different aspects of the disorder. Despite growing awareness of the OCD, misconceptions still exist. For a start, it seems that many people aren’t exactly sure what OCD stands for. Data from Google Analytics in 2023 appears to reflect this. Hundreds of search results were made for the following: 

• “Over compulsive disorder”: Although a person with OCD is ‘over’ doing their compulsions by spending hours a day on them (e.g. hand washing, cleaning, checking), the ‘O’ in OCD stands for ‘Obsessive’.

• “Obsessive compulsive syndrome”: The ‘D’ in OCD stands for ‘Disorder’. This means that a person’s symptoms are causing them distress (i.e. the person is upset that they have them) or disturbance (i.e. the symptoms interfere with work, relationships etc). A syndrome merely describes a collection of symptoms. The term disorder is used when symptom(s) cause problems for a person.

• “Obsessive compulsive disease”: A ‘disease’ is a medical condition with an identifiable cause. A mental ‘disorder’ is a group of symptoms that interferes with a person’s mental health but, unlike a disease, it does not have a known cause. There are several potential causes for OCD, but ultimately we don’t know what causes it, so that’s why the ‘D’ in OCD stands for disorder.

• “Obsessive convulsive disorder”: A ‘convulsion’ is a sudden, violent, irregular movement of the body, caused by involuntary muscle contractions. This doesn’t happen in OCD though. The ‘C’ in OCD stands for compulsive (which relates to the behaviours a person does to cope with their distress). There is some overlap between OCD and Tics. Tics are sudden twitches, movements, or sounds that people do repeatedly - but these are different to convulsions in that they can be controlled (just like compulsions can).

• “Obstructive compulsive disorder”: An obstruction is something that blocks or interferes with something. OCD can be ‘obstructive’ in that a person’s obsessive thoughts and compulsions can take up a lot of their mental energy and time. However, this term isn’t officially used

• “Oppressive compulsive disorder”:  When something is ‘oppressive’ it is burdensome, harsh, or tyrannical (e.g. like a bad boss). Although many people would describe their OCD as oppressive, the ‘O’ in OCD refers to a person’s ‘obsessive’ thoughts, feelings or urges.

• "Obsessive thoughts disorder": Obsessive thoughts are a major part of OCD, but there are compulsions (i.e. repetitve behaviours) as well. Although people use the term 'pure ocd', which implies a person only has obsessions, there are compulsions in this type of OCD too - they are just go on in a persons mind (e.g. checking, counting, memorizing).

• "Impulsive compulsive disorder" and "Impulsive obsessive disorder": There is a difference between impulsive and compulsive. "Impulsive" is when someone acts suddenly without thinking it through first. People with OCD often act "compulsively," meaning they feel the need to do things repeatedly. They are usually aware of their actions but feel driven to perform them to relieve anxiety or discomfort.

What is OCD?

Obsessive-Compulsive Disorder (OCD) is a mental health condition. The two main signs of ocd are obsessions and compulsions.

• Obsessions are unwanted, intrusive thoughts, images, or urges that cause a lot of anxiety or distress.

• Compulsions are repetitive behaviors or actions that someone feels they must do to try to ease the anxiety caused by the obsessions or to prevent something bad from happening. These actions often don't make logical sense and can take up a lot of time and energy.

An easy way to remember these signs of OCD is with the phrase ‘TO and DO’: obsessions (i.e. intrusive thoughts and feelings) happen TO us, and we DO compulsions i.e. (actions) to cope. 

Signs of Obsessive Compulsive Disorder

The four most common types or themes in OCD include: 

1. fears of germs or contamination - that goes beyond everyday concerns about cleanliness

2. Intense worries about causing harm, injury or bad luck to others

3. Needing things to be orderly, symmetrical, complete or “just right”

4. Worrying a lot about having ‘bad thoughts’ (that a person feels are unacceptable, scary, disgusting, immoral)

It's important to understand that a person’s obsessive compulsive symptoms don't always align exactly with the categories outlined above. Each person's experience with OCD is unique, although there are familiar patterns within the above subtypes.

Diagnosing OCD

OCD symptoms are assessed and diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), a manual used by mental health professionals. For a diagnosis, someone must experience persistent, unwanted thoughts (obsessions) and repetitive behaviors (compulsions) that they feel compelled to do. These behaviors take up a lot of time (i.e. more than 1 hour per day) or cause significant distress and disturbance (to work, relationships etc). Symptoms can’t be aren't caused by drugs or another medical condition, and can't be better explained by another mental health issue (e.g. another anxiety disorder). 

In diagnosing OCD, doctors also consider how well the person understands their condition:

• With good or fair insight: The individual understands that their OCD thoughts are not likely to be true.

• With poor insight: The individual believes that their OCD thoughts might be true.

• With absent insight/delusional beliefs The individual is completely convinced that their OCD thoughts are true.

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Causes of OCD

People often want to know about the causes or etiology of OCD. The truth is that Obsessive compulsive disorder causes are numerous: involving a  mix of family genes, brain chemistry, and life experiences. 

If someone in your family has OCD, you're more likely to get it too. Sometimes, seeing someone else's OCD behaviors can also influence another person to develop them. Changes in brain chemicals, like serotonin, or how the brain works might play a role. Finally, going through stressful or tough times can also bring out OCD symptoms. 

Obsessive Compulsive Disorder Treatment

The main reason people seek OCD treatment is because of the damage and stress that the condition causes. OCD symptoms cause conflict with family and friends, and make the person late for or unable to work, and can take up lots of time and money. A person with OCD is often aware of this, but they still struggle to resist doing their compulsive behaviours because of the stress that their intrusive thoughts causes them.

There has been a lot of research looking for an OCD cure. The most promising treatment we have is Cognitive Behavioural Therapy (CBT) with Exposure and Response Prevention (ERP). CBT and ERP for OCD involves three main strategies: Cognitive restructuring, Exposure and response prevention.

Cognitive Restructuring: This involves identifying irrational beliefs and replacing them with more realistic thoughts. For example:

• Fears of germs or contamination: Challenging the belief that "all germs are dangerous" and recognizing that everyday germs are normal and generally not harmful.

• Worries about causing harm, injury, or bad luck to others: Questioning the likelihood of causing real harm and understanding that accidents are rare and usually beyond one’s control.

• Needing things to be orderly, symmetrical, complete, or "just right": Recognizing that perfection is unattainable and that slight imperfections do not lead to catastrophe.

• Having 'bad thoughts': Learning that having an unwanted thought does not mean one will act on it or that they are a bad person because of it.

Exposure: Gradually facing the fears or triggers without avoiding them. For example:

• Fears of germs or contamination: Touching a doorknob or using public restrooms without washing hands immediately.

• Worries about causing harm, injury, or bad luck to others: Driving a car or using kitchen knives without checking repeatedly for damage or harm.

• Needing things to be orderly, symmetrical, complete, or "just right": Intentionally placing items asymmetrically or leaving a task slightly incomplete.

• Having 'bad thoughts': Allowing these thoughts to occur without neutralizing them through other mental acts or behaviors.

Response Prevention: Resisting the urge to perform compulsive behaviors in response to the anxiety caused by the exposure. For example:

• For someone afraid of contamination, this might mean not washing hands after touching something considered "dirty."

• For someone who worries about harm, it would involve not going back to check that the door is locked or that the stove is off.

The goal of CBT and ERP is to help individuals learn that their fears are unlikely to come true and that they can manage their anxiety without relying on compulsive behaviors. Over time, this reduces both the intensity of the obsessions and the urge to perform compulsions. These are some of the best treatments we have for OCD, with research showing that it can help people recover from OCD in 4 days!