Obsessive-Compulsive Disorder

People with obsessive-compulsive disorder (OCD) experience obsessions, compulsions or both.

  • Obsessions are unwanted and disturbing thoughts, images or impulses that suddenly pop into the mind and cause a great deal of anxiety or distress.
  • Compulsions are deliberate behaviours (e.g. washing, checking, ordering) or mental acts (e.g. praying, counting, repeating phrases) that are carried out to reduce the anxiety caused by the obsessions.

What do "Obsessions" Look Like?

There are many different types of obsessions and many people with OCD will have more than 1 type of obsession. Some examples of common obsessions are:

Fear of contamination

This obsession involves a fear of coming into contact with germs, getting sick or making others sick from touching "dirty" or "contaminated" items, sticky substances or chemicals. For example, "I will be contaminated by germs if I pick up this pen off the floor" or "I can be poisoned by lead if I come into contact with paint."

Thoughts of doubt

This obsession involves constant doubt about whether you've done something wrong or made a mistake. For example, "Did I turn off the stove?";  "I think I made a spelling error on the email I just sent.";  "I think I threw away something important"; or "I might not have answered that question clearly and precisely enough."

Fear of accidentally harming self or others

Adults with these obsessions are afraid of harming themselves or others through carelessness. For example, "If I don't make sure that the door is locked at night, the apartment might get broken into and I might be robbed and murdered", "If I don't immediately change out of my work clothes and wash them with bleach, I might bring outside germs home and cause my whole family to be sick."

Need for symmetry/exactness

Adults with this obsession feel a need to have objects placed in a certain order or position or tasks or events to be completed in a set way. For example, "I need to sort all my clothes by colour and have them face the same direction. Otherwise, it just does not feel right!"; "I just scratched my right arm twice and now I need to balance it out by scratching my left arm twice."

Repugnant obsessions

Repugnant means disgusting. These kinds of obsessions include unwanted thoughts, images, or impulses of doing something horrible to a loved one (e.g. throwing your baby off a balcony, kicking your elderly grandmother; jumping off a bridge); sexual obsessions (e.g. thoughts of touching someone sexually against his/her will, images of molesting one's baby, doubts about one's sexuality); and obsessions that violate religious beliefs (e.g. swearing in temple/church, images of having sex with a priest). Repugnant obsessions can also take the form of doubts, for example; "Did I run over someone without realizing?"; "Did I become sexually aroused while bathing my baby?"; or "Did I sin but forget to repent?

These kinds of obsessions are particularly unwanted and people who experience them would never want to act on them. Having them DOES NOT mean you are crazy, dangerous or evil deep down inside.

What do "Compulsions" Look Like?

These behaviours are performed in an attempt to stop something bad from happening. However, repeated checking often makes people feel even less sure that they have successfully prevented the bad event from happening. Some examples include:

Washing/cleaning compulsions

This category of compulsion involves excessive washing and cleaning behavior. For example, you may wash your hands excessively, follow intricate rituals and rules for cleaning the bathroom or kitchen, or follow rituals with regards to grooming, tooth brushing, or showering. Rituals may including having a specific order you have to follow (e.g. washing a specific part of your body first or brushing your teeth in a particular order).

Checking compulsions

This category involves behaviors aimed at ensuring something is done properly, everyone is safe or mistakes have not been made. For example, you may repeatedly check to make sure doors are locked, stoves are turned off, or electrical outlets are unplugged. Other examples may also include checking to make sure everyone is okay and not harmed (e.g. calling family members repeatedly to "check" if they are safe). Checking can also include making sure that you haven't made any mistakes (e.g. re-reading emails over and over to "check" for spelling/grammar mistakes or visually checking the environment to make sure that you have not left anything important behind).

Ordering/arranging compulsions

This category of compulsion involves arranging items in specific ways, such as clothes, books, shoes, etc. For example, you might line up all the clothes in the closet so that they are arranged according to colour, with all the hangers facing in the same direction. Adults with this compulsion will sometimes arrange things until it "feels right". Some will do it to prevent bad things from happening; for example, "If I don't arrange all the books and magazines in the house so that they face east, then someone in my family will die."

Mental rituals

These are compulsions that are performed in your head. For example, you might mentally repeat a prayer whenever you have thoughts about something bad happening, or you might replace a "bad" thought (e.g. mom dying) with a "good" one (e.g. mom smiling and in good health).

Need to ask or confess

Some adults with OCD are afraid that they have done or thought something "bad", and therefore feel a strong urge to confess all of their thoughts to friends or family (for example, telling a loved one that "I just had a thought about pushing someone into the street"). Most people who feel the need to confess will also seek repeated reassurance that everything is okay (for example, asking a loved one, "Do you still love me even though I had a bad thought?").

Hoarding

Some adults with OCD have a very hard time throwing away things that seem to others useless or of limited value. Hoarding can lead to excessive clutter in the home and interfere with daily life. For example, some people are not able to throw away any receipts, financial documents, or old newspapers.

*Tip: Over time, OCD symptoms can change. For example, you might start off with washing your hands compulsively but later develop excessive checking behaviours and actually stop compulsive washing altogether.

How do I Know if I Have OCD?

Everyone has thoughts that are upsetting or do not make a lot of sense from time to time, this is normal. Just having an unpleasant thought does not mean you have obsessions. Similarly, it is not uncommon for people to repeat certain actions, such as double-checking whether the door is locked. However, these behaviours are not always compulsions.

When is it an obsession?

  • Obsessions occur frequently, even when you try very hard not to have them. People with OCD often say that their obsessions are unwantedintrusive and out of control.
  • Obsessions are time consuming. People with OCD spend at least 1 hour a day thinking about their obsessions.
  • Obsessions cause a lot of anxiety or distress and interfere with life.
  • Obsessions often lead to compulsions. People who have normal unwanted thoughts will not engage in compulsive or ritualistic behaviours to "fix" or "undo" the obsession.

When is it a compulsion?

  • Compulsions are related to obsessions. For example, if you have obsessions about being contaminated by germs, you will compulsively wash your hands to reduce the fear of being contaminated by touching something "dirty".
  • Compulsions are repetitive. They are often done repeatedly and in an excessive and very specific way (e.g. washing each finger carefully, using only hot water). If the compulsions are not performed "correctly" or are interrupted, you might need to perform the entire compulsion again. Once is never enough.
  • Compulsions are also time consuming. People with OCD often spend at least 1 hour a day carrying out their compulsions.
  • Compulsions are deliberate. Although people with OCD describe their obsessions as being unwanted thoughts that "pop" into their heads uninvited, compulsions are carried out deliberately, because compulsions reduce anxiety in the short-term. While obsessions cause anxiety, performing a compulsion reduces that anxiety. For example, if you have an obsession about being contaminated by germs, you will probably feel anxious. However, if you then start compulsively washing your hands, your anxiety will probably diminish.
  • Compulsions cause a lot of anxiety in the long-term. Although people with OCD perform compulsions to "deal with" their obsessions, they often find that they become "slaves" to their compulsions. That is, they need to carry out the compulsions so often that they feel that they have no control over them.

In Summary, You Have OCD If

  1. You spend a lot of time thinking about (or avoiding) your obsessions and/or performing your compulsions.
  2. You feel quite anxious or nervous most of the time.
  3. Your daily life is significantly affected by it. For example, your OCD might cause you to take hours to do a small task (e.g. writing a casual email), get in the way of spending time with your family and friends, or prevent you from meeting work deadlines or even getting out of the house.

What Other Things do Adults with OCD do in Daily Life?

  • Avoidance. Adults with OCD often spend a lot of time and effort trying to avoid anything that might trigger their symptoms. For example, if you have contamination fears, you might avoid shaking hands with people. If you are afraid of harming others, you might avoid using sharp objects (e.g. knives, scissors). Sometimes this avoidance can be extreme and prevent you from getting things done or going out of your home.
  • Distraction. People with OCD will often try to shift their attention away from their obsessions by doing or thinking about something else.
  • Getting family involved in rituals. Adults with OCD can become so distressed and anxious about their obsessions that they also have their friends and family engage in certain compulsions or live by certain "rules". For example, such a person might ask family members to change out of their "dirty" clothes immediately upon arriving home or not allowing family members to use certain words.

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Debbie's Story
Jamal's Story
Mr. and Mrs. Whyte’s Story
Obsessive Compulsive Disorder (OCD)

Debbie starts grade one in a few weeks, and Debbie’s mom is starting to feel concerned about her daughter's "odd" behaviors. During her last year at preschool Debbie started doing everything evenly or in pairs. At first it was just when she ate food, for example, eating an even number of orange slices, leaving the last slice on her plate if she was served an odd number. This seemed harmless, and even a little cute and quirky to the preschool teachers and her parents.  However, this pattern quickly expanded to other areas such as wearing two shirts and opting for pants and shorts as there are two legs, never a skirt or dress, and brushing her teeth in even strokes, and watching TV shows in sets of 2 or 4. Although it didn’t seem to impact Debbie very much in school last year, summer camp has been challenging. Debbie is consistently late as she gets stuck at home counting her steps from the house to the car, and from the car to camp, repeating the process if she ends on an odd number. And has started throwing tantrums in camp when she cannot do an activity in an even way, which is highly out of character for a usually easygoing kid. Debbie’s parents are afraid that the demands of grade one are really going to make these behaviours worse, and they have no idea what is going on or what they can do to help. 

 

Jamal is a 16-year-old boy whose parents have noticed a sudden change in their son’s behavior and they are worried he might be using drugs. Jamal was always an outgoing, bright, and friendly kid. In the last couple of months, however, he has started avoiding his friends and family; he dropped out of rugby, and now spends hours in the bathroom or locked in his room. Jamal is highly secretive about what he is doing, snapping at his parents whenever they ask him what is going on. His parents have noticed Jamal seems to take more showers than usual and they are frequently running out of soap and toilet paper.  Things finally came to a head last week when Jamal insisted that his parents install a lock on his bedroom door so that he can lock his room when he is at school. His parents feel terrible that they enforced a room search on Jamal, and although they didn’t find any drugs, they are worried that something bad is going on with their son.

 

Mr. and Mrs. Whyte have a 14-year-old daughter, Jenny, who has been diagnosed with OCD. Jenny has been working with a CBT therapist for about six weeks now. Mr. and Mrs. Whyte are feeling relieved that Jenny has found someone to help her, but they are extremely anxious about what lies ahead. Mr. Whyte is a leader in his field and used to being in control and informed about all relevant matters. However, with the recent diagnosis of his daughter he feels as though his whole world is on shaky ground. While it is hard for him to admit it, this is the first time he doesn’t have all the answers, and he blames himself for not being more available for Jenny in the past year. Mrs. Whyte is trying her best to manage Jenny’s frequent anger outbursts and excessive reassurance seeking, as well as her husband’s unusual irritability, but she is starting to feel as though she cannot manage it alone.

Obsessive Compulsive Disorder (OCD) is an anxiety disorder that affects about 1-2% of the population. People with OCD experience both obsessions and compulsions. * Obsessions are unwanted and disturbing thoughts, images, or impulses that suddenly pop into the mind and cause a great deal of anxiety or distress. * Compulsions are deliberate behaviours (e.g. washing, checking, ordering) or mental acts (e.g. praying, counting, repeating phrases) that are carried out to reduce the anxiety caused by the obsessions.