This is the 2007 version. Click here for the 2017 chapter 12 table of contents.

The obsessive-compulsive disorder (OCD)

OCD stands for obsessive-compulsive disorder. Obsessions are persistent thoughts that a person cannot make go away. Compulsions are irresistible impulses. In obsessive-compulsive disorder, a person (who might otherwise seem perfectly normal) feels compelled to think about certain things, or perform certain actions, even though these thoughts and actions may not make any sense and the person may know they do not make sense. About 20% of people with OCD suffer only obsessions, or only compulsions, but most (80%) experience both.

What is the obsessive-compulsive disorder (OCD)? What are common manifestations of OCD?

One common manifestation of obsessive-compulsive disorder is excessive hand washing. This obsession centers on fears of contamination. Why is fear of contamination such a common obsession? Probably this urge has deep biological roots. Normally the urge to avoid disgusting and dirty things helps people avoid infection and disease. However, when fear of contamination is so exaggerated that a person insists on washing hands 30-50 times a day, 10-15 minutes at a time, until the skin is raw and bleeding...then something is wrong.

Judith L. Rapoport wrote a book titled The Boy Who Couldn't Stop Washing, which featured many fascinating case histories of OCD.

Rapoport points out that often an OCD sufferer is a completely sane person with an isolated problem.

...One girl would get up at six every Sunday morning to spend three hours washing the walls of her room. She certainly knew that this was odd, but she just felt that she "had to do it" but didn't really know why. She said the washing had started quite suddenly about a year before. "I just woke up one morning last summer," she told me, "and I had to do this."...This girl was close to her family, and a good student. She had close friends and a boyfriend. Her grades were good and she took part in extracurricular activities at school and held a part-time job. (Rapoport, 1988, p.15)

Fear of contamination is a common manifestation of OCD. One student wrote that she "never thought there was anything wrong with washing your hands thirty times, or not wanting to touch anything in the house" until she saw an Oprah Winfrey show featuring people with OCD. She noticed that "some of their strange habits seemed very close to some of the things I did."

But that program wasn't strong enough to make me think I had OCD. Later on, my mother noticed that I had another strange habit that may have been OCD. I can't help but to wipe my after every bit of food I take. Not only that but I had to have a new napkin every time because I thought that if I used the old napkin that I would get something on my face from the napkin. It was crazy because there was nothing even on my face, plus I was using about 100 napkins at one sitting. Well, it started to bother my boyfriend so I talked to a psychologist.

I don't have OCD, but from growing up in a strict and proper house it has had other effects and makes me a little obsessive over little things. I'm okay, but I still wipe my mouth after each bit; now I just rip the napkin up before I use it so that I don't use so many. [Author's files]

Although the student denies she has OCD, her behavior is actually quite typical of OCD. She has a compulsion (she feels compelled to wipe her mouth after each bite). She knows that what she is doing is "crazy" but cannot stop. Evidently she visited a psychologist who gave her a soothing explanation of her behavior plus a simple way to avoid consuming hundreds of napkins. The psychologist apparently decided not to insist that she accept a diagnosis of OCD.

What is "checking" in OCD?

The act of checking something over and over is characteristic of OCD. Many people experience a mild form of this. For example, you may set your alarm clock, then lie in bed and ask yourself, "Did I set it?" You might turn on the light, check your alarm clock, and verify that—sure enough—the alarm was set. That would indicate you are normal, because everybody does this occasionally. If, an hour later, you are still checking your alarm clock every few minutes, then perhaps you have obsessive-compulsive disorder.

How does OCD often manifest itself, during childhood?

OCD runs in families and often shows up in childhood. In children, OCD is sometimes manifested as a counting obsession. For example, one student recalled that, as a young child, he could not climb stairs unless he counted them first.

Another student developed a counting compulsion at college:

Recently I have been having this problem. I have been having these strange feelings that if I don't do certain things, something bad may happen to me or to someone that I care about. For instance, every day when I am walking into Psychology I feel like I have to kick four pinecones before I walk into the building. After class is over, and I am walking out to my car, I feel like I have to kick four more, and after I have done this, I feel like I can get into my car and go on my way. It's really weird, because also on Fridays before I go into the lecture hall to take my test, I feel like I have to take four drinks of water from the fountain or I will fail my test. I really don't understand why I do this. It's strange to me that both of these weird things have to do with the number four. I don't know why I do these crazy things, I guess I just feel that if I don't do them, something bad will happen.

It's not only at school that I do these strange things, it's also when I'm at home. We live in a two-story home, and every time I go up or down the stairs, I feel like I have to touch every one of them, and if I don't, I have to go back to either the top or bottom and start over again. It's sort of like there's this little voice inside of me telling me to do these things or something may happen. I don't know what it is that I think will happen, and I guess that part of me is really scared to see... [Author's files]

Why is OCD categorized as an "anxiety disorder"?

This student's report sheds a light on why OCD is classified as an anxiety disorder. The motivating force behind OCD symptoms is a feeling that "something bad" will happen if hands are not washed or a ritual such as counting stairs is not performed. Such behaviors resemble avoidance behaviors, which are behaviors reinforced by the elimination of anxiety. Avoidance behaviors tend to persist because they are self-reinforcing. Even if the fear is groundless, the relief produced by a ritual is real and acts to reinforce the behavior.

What is evidence that OCD is biological in nature?

Administering a medication that raises serotonin levels, such as Anafranil or Prozac, eliminates OCD in about 60% of cases. However, medication by itself sometimes does not eliminate all the symptoms, and many people with OCD combine talking therapy or behavior therapy with medication. Some people seem to outgrow childhood symptoms of OCD and require no treatment in adulthood.

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