Obsessive Compulsive Disorder (OCD)
The essential features of Obsessive Compulsive Disorder according to the Diagnostic and Statistical Manual of Mental Disorders (DSM fourth edition) are as follows:
Recurrent obsessions or compulsions that are severe enough to be time consuming or cause marked distress or significant impairment.
Obsessions are persistent ideas, thoughts, impulses, or images that are experienced as intrusive and inappropriate and that cause marked anxiety or distress. Some of the most common obsessions are repeated thoughts about contamination (e.g., becoming contaminated by using a public restroom), repeated doubts (e.g., wondering whether one has turned off the stove or locked a door), a need to have things in a particular order (e.g., intense distress when an object is out of place or asymmetrical), aggressive or horrific impulses (e.g., that one may hurt a love one or may molest a child), and sexual imagery (e.g., recurrent pornographic images). These thoughts and images are not simply excessive worries about real-life problems and are unlikely to be related to a real-life problem. The individual with obsessions usually attempts to ignore or suppress these thoughts or to neutralize them with another thought or action, also called compulsions.
Compulsions are repetitive behaviors (e.g., hand washing, ordering, checking) or mental acts (e.g., praying, counting, or repeating words silently) the purpose of which is to prevent or reduce anxiety or distress. In most cases the individual feels driven to perform the compulsion to reduce the distress that is caused by the obsession or to prevent a dreaded event from supposedly occurring. For example, an individual who is concerned about germ contamination may repeatedly and excessively wash or otherwise cleanse their hands. An individual with obsessions that they may commit a hit-and-run when driving might repeatedly drive back and forth to make sure they did not harm someone. Individuals distressed by blasphemous thoughts may repeat a mantra or prayer in an attempt to neutralize the intrusive and unwanted thought. The most common compulsions involve washing and cleaning, counting, checking, asking for reassurance, ordering, and the repetition of actions.
By the DSM-IV definition, adults with Obsessive Compulsive Disorder have at some point recognized that the obsessions and compulsions are excessive or unreasonable. However, there is a broad range of insight into the reasonableness of the obsessions or compulsions. Some individuals are uncertain about how reasonable their obsessions and compulsions are, and insight levels may vary depending on different times and situations. Obsessions or compulsions can displace useful and satisfying behavior and can be highly disruptive to overall functioning. Many individuals avoid objects or situations that provoke obsessions or compulsions. Such avoidance can become extensive and can severely hinder general functioning.