Mental Health

 

Author: Anxiety Canada

 

Obsessive-compulsive disorder (OCD) is an anxiety disorder that affects about 1-2% of the population. People with OCD experience both obsessions and compulsions.

On this page: Recognizing OCD: Do I have it? What do obsessions look like? What do compulsions look like? How do I know if I have OCD? What other things do adults with OCD do in daily life? OCD:The facts Self-help: Managing your OCD at home

• 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.

Be sure to watch our video for more information!

Recognizing OCD: Do I have it?

Jenny's story

Jenny is a 31-year-old married woman with a 3-year-old son. Born and raised in China, she immigrated to Canada with her husband about 10 years ago. She has been on leave from her nursing job for over a year due to anxiety-related difficulties.

Jenny says that because of her job she has always been careful about being clean, but she was never overly concerned about germs. However, when she returned to work after a maternity leave, she started having "scary" thoughts that if she was not careful enough, she could contract a serious illness (such as AIDS) at work and make her baby sick. Although she knew that it was difficult to contract the HIV virus, she found the idea of making her son sick very upsetting. Because of this concern, she took extra care when washing her hands at work; for example, she used only very hot water to wash her hands because she thought it would get them cleaner, and washed them repeatedly until it felt "just right". She also made sure that she changed out of her work clothes before going home, and washed them with bleach. Jenny says that her fear of being contaminated was manageable at first, because she only needed to wash her hands after coming in contact with a patient. She thought that it was just a phase and that she would "get over it."

But, Jenny's fear only got worse over time. She soon found herself being consumed with worries about contracting and spreading an illness to her son. She became afraid of coming into contact with more and more things at work, and felt she needed to wash her hands more frequently. By the time she decided to take a leave from work, she was washing her hands up to 70 times a day, and they were raw and bleeding as a result. At home, she frequently "disinfects" all of her son's toys with boiling water and washes his clothes and sheets with bleach. She also avoids taking him to parks and other public places for fear that he will come into contact with a "contaminant" (e.g., animal feces, used tissue paper) and get sick. Jenny's preoccupation with her son's well-being is a major source of tension between her and her husband, because her husband feels that she is overly protective of their son. Although Jenny is aware that her fear is excessive, she finds it too difficult to resist washing and cleaning because she does not want to risk harming her son.

David's story

David is a 40-year-old accountant who is divorced and lives alone. His marriage ended because of his ways of doing things. David describes himself as a "perfectionist" who repeats everything he does (e.g., reading, writing, locking doors) at least three times to ensure that he has done every task perfectly. He says that the more anxious and stressed he is, the more times he needs to repeat a task. He knows that he has done something perfectly when it feels "just right". David says that since he was a child he has always been concerned about doing things perfectly and correctly. When he was in school, he would spend most of his time writing and rewriting his assignments to make sure that they were done perfectly. He would also read and re-read the same textbook paragraph until he felt that he completely understood and remembered the information it contained.

At work, he repeatedly checks everything he does, particularly forms and other written work, to make sure that he has done it correctly and perfectly. If he makes a mistake, he needs to redo the whole document. He states that it often takes him a long time to complete any written work, even writing an address on an envelope, because he worries that something bad might happen (e.g., loss of client) if things are not done "perfectly". David also has a strong need to know and remember things, repeatedly asking for clarification if he does not fully understand something that is said to him. He also blinks repeatedly when he is trying to understand something because he believes that doing so helps him to understand things better. David is also very concerned about saying "just the right thing" to people. He worries that if he does not communicate precisely, he will be misunderstood. He usually rehearses what he wants to say in his head first, to make sure that his responses are precise and perfect.

David knows that his need for perfection caused his marriage to fail and makes him less productive at work, but he worries that if he does not strive to do everything perfectly, he will end up making mistakes all the time and become jobless and then homeless. David feels confused and depressed; he is not sure what he should do about his condition and is not confident that he can change.

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What do obsessions look like?

There are many different types of obsessions, and many people with OCD will have more than one 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."

Doubts about their relationship.

• This obsession revolves around relationship substantiation. Individuals with these obsessions are overwhelmed with doubts that they don't love their partners, whether they are attracted or compatible with their partner, or the degree of love their partner has for them.

Repugnant obsessions.

These kinds of obsessions are particularly unwanted and people with them would never want to act on them, but they worry they might. Having them does not mean you are crazy, dangerous, or evil deep down inside. These obsessions lead to individuals with OCD worrying about what having the thoughts means about them, rather than the thoughts indicating what they actually want. Some of these subtypes include:

• Aggressive obsessions: Unwanted violent thoughts or images towards themselves or others. These thoughts make people question how safe they are around others or themselves. "Will I lose control and kill someone I love (eg. using a knife while cooking to suddenly stab their partner)?" "What if I lose control and kill myself (eg. walking off a high rise balcony)?" "Did I say something horrible to offend that person (eg. muttering something offensive to someone on the bus)?" "What if I'm secretly a killer and something happens in the future (eg. Do I like working with animals because I could get away with killing them easier)?"
• Sexual obsessions: Unwanted thoughts or images involving perverse or sexual themes that are often violent or repugnant in nature. These obsessions can lead to fear that you are attracted to family members (eg. "Do I want to have sex with my sibling?"), children (eg. "Did I get aroused seeing that child in a swimming suit?"), animals (eg. "Do I like being around dogs because I’m attracted to them?"), the dead (eg. "Am I getting turned on by this person that’s dead in the movie I'm watching?"), or inanimate objects (eg. "Am I fighting the urge to buy this cucumber for sexually gratifying purposes?"). Some of these obsessions cast doubt into whether you want to commit a heinous sexual crime like sexually assaulting a partner during sex (or worrying you may lose control and become violent during sex) or that you want to commit sexual acts on children. It is important to note that having sexually perverse obsessions is not equivalent to fantasizing about them, since unlike a sexual fantasy, sexual obsessions make the individual feel immense dread, fear, and shame without any pleasure.
• Religious or scrupulous obsessions: Unwanted thoughts causing fear that they are doing something that proves they are immoral or are doing something that goes against their religious beliefs. These can cast doubt into whether or not they recited a prayer correctly, whether they’ve offended god, whether they’ve sinned or whether they are "practicing correctly" (eg. doing the sign of the cross wrong).
• Morally scrupulous obsessions: Unwanted thoughts causing fear that they are immoral because they may question if they treat other people fairly or with equality (eg. "Did I racially profile that person?" "Did I make an assumption about that person based on what they're wearing?"), that they lied (eg. "Did I mislead that person unintentionally?" "Did I lie by not mentioning x"), or that they are doing something for wrong/unethical reasons (eg. "Am I only doing this good thing because it makes me look good?" "Which of these choices are going to prove that I'm a good person?")

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What do compulsions look like?

Some examples of common compulsions are:

Washing/cleaning compulsions.

• Washing hands excessively

• Rituals and rules for cleaning the bathroom or kitchen, washing laundry, etc.

• Grooming/teeth brushing rituals (for example, brushing your teeth in a particular order)

• Showering rituals (such as washing a specific part of the body first)

Checking compulsions.

• Checking to make sure doors are locked, stoves are turned off, electrical outlets are unplugged, etc.

• Checking to make sure everyone is okay and not harmed. For example, calling family members repeatedly to "check" if they are safe.

• Checking to make sure that you haven't made any mistakes. For example, 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.

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:

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.

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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?

1. Obsessions occur frequently, even when you try very hard not to have them. People with OCD often say that their obsessions are intrusive and out of control

2. Obsessions are time consuming. People with OCD spend at least one hour a day thinking about their obsessions.

3. Obsessions cause a lot of anxiety or distress and interfere with life.

4. 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?

1. 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".

2. 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!

3. Compulsions are also time consuming. People with OCD often spend at least one hour a day carrying out their compulsions.

4. 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.

5. Compulsions cause a lot of anxiety in the long-run. 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.

Young adults between 18 and 24 years of age are at the highest risk for developing OCD. However, many adults with OCD say their symptoms started when they were children or adolescents.

Men tend to develop OCD at an earlier age (usually between age 14 and 19.5) than women (usually between age 21 and 22). Among adults, women report having OCD slightly more frequently than men.

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.

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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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OCD:The facts!

• Young adults between 18 and 24 years of age are at the highest risk for developing OCD. However, many adults with OCD say their symptoms started when they were children or adolescents.

• Men tend to develop OCD at an earlier age (usually between age 14 and 19.5) than women (usually between age 21 and 22). Among adults, women report having OCD slightly more frequently than men.

• 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.

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Self-help: Managing your OCD at home

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