Obsessive-Compulsive Disorder (OCD)

OCD: Meaning & Types

What Is Obsessive-Compulsive Disorder (OCD)?

According to the National Library of Medicine, around 2% of the general population all over the world has OCD. But what is the meaning of OCD?

Obsessive-Compulsive Disorder, or OCD, is a chronic mental health condition characterised by recurring, intrusive thoughts (obsessions) and repetitive behaviours or mental actions (compulsions).

Individuals with OCD recognise their obsessions and compulsions as irrational but feel powerless to resist them. Many of us tend to double-check the stove, make sure we’ve locked the door, and so on. These habits reassure us of our safety.

However, for people living with OCD, these habits are less of a personal choice. It can profoundly disrupt their daily lives, cause distress, and complicate their everyday functioning.

Usually, people are confused about how OCD manifests. Does constantly washing your hands mean you have OCD? Or does thinking about one specific thought, like dying your hair orange, mean you have intrusive thoughts? It is all a bit confusing.

Hence, this article aims to dispel several misconceptions about OCD and delve deeper into its underlying causes and manifestations.

Symptoms of OCD

OCD manifests through two primary symptoms: obsessions and compulsions. People with OCD usually experience both symptoms, but some people may only have one of them.

Symptoms of OCD typically emerge during late adolescence or early adulthood. The duration and severity can vary among individuals; however, in many cases, symptoms persist over long periods unless treated.

Without intervention, it’s rare for the symptoms to fade completely. Periods of heightened stress can further exacerbate them. Some people may also exhibit tic disorders, such as rapid, sudden movements or vocal outbursts.

While the exact cause remains uncertain, a combination of genetic, neurological, behavioural, cognitive, and environmental factors might play a role in its onset.

Obsessions

Distressing and intrusive thoughts, images, or urges characterise obsessions in OCD. These are not merely excessive worries about real-life concerns but tend to focus on specific themes. Some of them include:

Aggressive impulses can be distressing, with the sufferer fearing they might hurt someone, even without genuine intent. Some may grapple with sexual or religious taboos, experiencing unwanted, blasphemous, or inappropriate thoughts.

Recognising these symptoms is crucial for early intervention and ensuring those affected get the support they need.

A person with OCD sitting apart from the group due to fear of interaction.

Compulsions

Compulsions are repetitive behaviours performed in response to an obsessive thought.

It often manifests as an individual’s attempt to mitigate their obsessions. These might be either overt actions or covert mental rituals. While they might provide temporary relief, they do not offer a long-term solution.

Symptoms include:

Over time, these compulsive acts can become habitual, leading to an increased cycle of anxiety and repetition.

At TYHO, we provide counselling for anxiety in Singapore and globally. 

What Causes OCD?

Several factors may cause OCD, and each factor could depend on individual circumstances and genetics. 

Genetic factors, in particular, play a crucial role in OCD.

Research shows that twin and family studies have a key role in someone developing OCD.

Additionally, distinct irregularities in areas such as the basal ganglia and frontal lobes indicate structural and functional brain abnormalities.

Lastly, early life trauma and other environmental triggers can also increase these inherent vulnerabilities.

However, it’s usually a combination of multiple factors that contribute to the development of the disorder.

Psychological

OCD is deeply interlinked with specific psychological triggers and cognitive processes.

Individuals with OCD often feel unduly accountable for preventing harm or ensuring safety, even when circumstances are out of their control. For instance, fearing a fire outbreak, someone might repeatedly check the stove, convinced their negligence would be the sole cause.

Another factor is the belief in thought-action fusion. This is when people believe thinking about an event increases its likelihood or equates to its actual occurrence.

Imagine someone fearing they’ll drop their baby just because the thought crossed their mind. This amplifies guilt and anxiety, further entrenching compulsive behaviours.

Moreover, OCD sufferers struggle with ‘mental neutralising’. After encountering an intrusive, distressing thought, they might engage in an opposing mental ritual to ‘counteract’ or ‘neutralise’ the perceived threat.

For example, after thinking they might fail an exam, a student might repeatedly visualise themselves succeeding to counterbalance the initial thought.

Lastly, intolerance of uncertainty plays a pivotal role. Many people with OCD desire definite outcomes or reassurances.

A child with OCD sitting on the tableand feeling upset.

Experiences

Life experiences, especially those steeped in stress or marked by significant changes, play a pivotal role in the onset of obsessive-compulsive disorder.

Life transitions, such as starting a new academic journey, embarking on a career, relocating homes, or stepping into parenthood, can increase feelings of anxiety.

One noticeable trigger for OCD is the advent of new responsibilities. When an individual is entrusted with a new responsibility, the accompanying fear of erring can manifest in repetitive behaviours.

For instance, it’s not uncommon for new parents, overwhelmed by the responsibility of infant care, to engage in ritualistic practices. These include repeatedly sterilising feeding equipment or checking a cot’s safety mechanisms.

Additionally, emotional, physical, or sexual maltreatment, neglect, social alienation, or sustained bullying can worsen the symptoms. However, it’s crucial to recognise that while these experiences increase risk, OCD can also materialise in their absence.

Biological

Many people with OCD have no family history of the disorder. This suggests that while genetics might predispose someone, they do not solely determine the outcome.

Neurochemically, imbalances in the brain’s serotonin levels have been implicated in OCD. Serotonin, a neurotransmitter, plays a pivotal role in mood regulation. An imbalance in its levels might contribute to the manifestation of obsessive thoughts and compulsive behaviours.

Brain imaging studies have also shown structural differences in individuals with OCD.

Areas such as the orbitofrontal cortex, anterior cingulate cortex, and basal ganglia exhibit altered activity patterns, suggesting their involvement in the disorder’s pathophysiology.

Types of OCD

Common Types of OCD

While there isn’t an official categorisation for the various OCD types, experts often divide the symptoms into distinct subgroups:

1. Symmetry, Perfectionism, and Ordering

People with this subtype often feel compelled to ensure that objects are aligned just right, or tasks are done to a precise standard. This isn’t simply a preference for neatness.

The fear might be that something terrible will happen if everything isn’t symmetrical or perfect. For instance, they may repetitively check if books are aligned perfectly on a shelf.

2. Contamination and Cleaning

This is characterised by an excessive worry about germs, dirt, or toxic substances. Those affected may wash their hands relentlessly or clean their homes obsessively to ward off perceived threats of contamination.

3. Intrusive Thoughts

People might experience unwelcome, distressing thoughts of a violent, sexual, or religious nature. They may fear they’ll act on these thoughts even when it’s against their character.

For instance, a loving parent might be tormented by the irrational thought of harming their child.

4. Hoarding

People with this subtype face extreme difficulty discarding items, even when they hold no real value.

The distress of parting with such items can be overwhelming; it leads to an excessive accumulation and causes safety and health concerns.

Lesser-Known Types of OCD

1. Relationship OCD [ROCD]

People with ROCD constantly doubt their romantic partners’ suitability or their feelings’ genuineness. 

For example, these people may often wonder if their partner is cheating or become preoccupied with thoughts such as ‘does my partner really love me?”. 

People with ROCD may also frequently seek reassurance, obsessively analyse their partner’s behaviours, or even question their own feelings. They fear they might be with the wrong person or their feelings aren’t genuine.

ROCD makes it difficult to have a healthy and peaceful relationship. If you notice these signs in yourself or your partner, couples counselling can help you develop trust and improve your communication skills!

2. Scrupulosity

People with this type of OCD may have an overwhelming concern with moral or religious rightness. 

Those affected may obsessively worry they’ve committed a sin or offended a higher power. 

For example, if a person forgot to reply to their partner’s time in say – 5 minutes – the person may feel guilty and like they’ve committed a sin.

People with scrupulosity may engage in excessive praying, confessing, or seeking reassurance. They fear divine retribution for perceived wrongdoings (ie things that they think are ‘wrong’ but, in reality, are normal and common habits).

OCD Diagnosis

There is no laboratory test or a clear ‘symptom’ to identify OCD. Obsessions and compulsions may manifest in completely different ways in different individuals.

Hence, mental health professionals follow specific criteria to make a diagnosis.

Firstly, Therapists may look for the presence of obsessions. These are not merely excessive worries about real-life problems but rather irrational fears or preoccupations (eg “I will die if I forget to clean my room”).

Secondly, the diagnostic test evaluates the presence of compulsions or repetitive behaviours performed to reduce the distress caused by the obsessions.

These behaviours are not connected in a realistic way to what they’re designed to prevent. (eg cleaning the room every few hours to get rid of the thought “I’ll die”).

The important element that a Therapist will look into while diagnosing OCD is that these obsessions or compulsions are time-consuming (often around one hour per day) and cause significant pain or impairment in one’s daily life.

A thorough evaluation often involves discussing the onset, duration, and impact of symptoms. Psychologists may use structured assessment tools or interviews to gauge the severity and nature of the symptoms.

OCD Diagnostic Questions

A structured conversation with a therapist often delves into the symptoms’ nature, frequency, and impact.

Here are some questions that professionals might pose to people living with OCD during the diagnostic process:

  1. Can you describe the thoughts or images that frequently intrude your mind?
  2. How often do these thoughts or images occur?
  3. How distressing do you find these recurring thoughts or images?
  4. Do you perform specific actions or rituals to alleviate the anxiety from these thoughts?
  5. How much time do you spend daily on these rituals or behaviours?
  6. Have you ever tried to resist these thoughts or actions? What happens when you do?
  7. How have these thoughts and behaviours affected your daily life or relationships?
  8. Are there specific situations or places you avoid because of your symptoms?
  9. Are you currently taking any medication, or have you in the past for these symptoms?
  10. Do you have any family history of OCD or other mental health disorders?

These questions help professionals tailor a specific treatment approach and understand the severity and uniqueness of each individual’s experience with OCD.

OCD Treatment

Finding a therapist with the expertise to treat OCD will help people explore the right treatment options.

Treatment for OCD generally involves a combination of psychotherapy and medication.

Psychotherapy

Psychotherapy, specifically Cognitive Behavioural Therapy (CBT), is a front-line treatment option for OCD.

  • Exposure and Response Prevention (ERP): This is a primary technique within CBT. Therapists gently expose individuals to their feared situations or thoughts (exposure) and teach them to refrain from performing compulsive behaviour (response prevention).

  • Cognitive Therapy: Targets catastrophic thinking patterns. It helps individuals recognise irrational beliefs and challenge and modify these beliefs.
A therapist sitting opposite to the client and showing the symptoms of OCD.

Benefits of CBT for OCD

Effectiveness: Numerous studies have shown CBT, especially ERP, to be highly effective for many OCD sufferers.

Lasting Impact: Skills acquired during CBT empower individuals to manage symptoms long-term.

Flexibility: Can be adapted to personal needs and conducted individually, in a group, or even online.

Medication

In many cases, medication plays a crucial role in managing OCD symptoms.

Selective Serotonin Reuptake Inhibitors (SSRIs)

Fluoxetine (Prozac): This option is widely prescribed, usually the first choice for OCD treatment. A typical dose is higher than when used for depression.

Sertraline (Zoloft): Another preferred SSRI for OCD. This medicine shows efficacy in both adults and children.

Paroxetine (Paxil, Pexeva): This medication is FDA-approved. However, it is not the first line of treatment due to the varying side effects.

Tricyclic Antidepressants

Clomipramine (Anafranil): Specifically approved for OCD treatment. It is an effective option but with more potential side effects than SSRIs.

Augmentation Strategies: In some cases, when SSRIs or clomipramine alone do not work, other medications may be added.

Antipsychotics: Like risperidone or aripiprazole can be used to boost the effect of an SSRI.

Tips to Start Medications

Remember that only medical doctors (ie psychiatrists) can prescribe medications. Your doctor will advise you on how to start and cope with medications. 

You can consult your doctor and psychologist at the same time to tailor the treatment plan. For example, if you have a problem with the physical side effects of medication, your doctor may change the dosage accordingly. 

On the other hand, if your meds cause psychological issues such as lack of concentration – your psychologist can equip you with effective strategies to manage or eliminate the symptoms. 

Below are some general tips for can follow for a smooth and effective transition. 

  • Start Slow: Medications typically start at a low dose and gradually increase. Hence, do not increase the dosage of your meds before consulting your doctor. 
  • Monitor Side Effects: Some common side effects include dizziness, dry mouth, and sleep disturbances. Make sure to consult your doctor when you notice these symptoms. Seek immediate help if your symptoms have not reduced after a few days. 
  • Continue Regularly: Sudden discontinuation of medications can lead to withdrawal symptoms or a relapse. Try not to stop or start a new medication. Instead, whenever you face a problem (ie increase in the side effects), your doctor may be the best person to evaluate the reason and switch your current treatment plan. 

Managing OCD

If you have OCD, you may struggle to perform daily activities or maintain important relationships in your life. 

However, you can manage OCD through professional help and effective self-care tools. 

Try to include some of the below tips in your lifestyle:

  • Routine: Starting a routine can help you overcome some of the OCD triggers. For example, you can reduce unpredictability in your life. Try setting a daily schedule – your routine can involve sleep schedules, eating balanced meals, and allocating time to hang out with your loved ones. 
  • Mindfulness and Meditation: Some effective mindfulness tools can help you replace obsessive thoughts with helpful ones. For example, try ‘stillness’. In this type of meditation, you should simply pause whatever you’re doing and breathe in and out slowly. Repeat this sudden meditation throughout the day or whenever you feel anxious.
  • Limit Stimulants: Reduce your caffeine, alcohol, and sugar intake, as they might increase or trigger anxiety and OCD tendencies. Avoiding caffeine 6 hours before your sleep can be especially helpful in developing a good sleep-wake-cycle. 
  • Join Support Groups: Talking about your struggles with others who are going through the same thing can provide social support and understanding. Consider joining a local or online OCD support group. Similarly, you can also visit in-person groups if you have access to the same. 
  • Celebrate Small Victories: Try to appreciate even the slightest progress. Celebrating your efforts reinforces positive behaviour.

The above tips can help you self-regulate and manage OCD. However, talking to a professional Therapist is important as you can work with a personalised therapeutic plan!

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