A brief psychological overview of obsessive-compulsive disorders
Posted Jul 29, 2014
Unsurprisingly and self-evidently, obsessive–compulsive disorder (OCD) is indicated by the presence of either obsessions and/or compulsions and is a clinically heterogeneous condition. In the International Classification of Diseases (10th Edition) of the World Health Organization, a diagnosis of OCD is indicated if the obsessive and/or compulsive behaviour is present on most days for at least two weeks. To be classed as having OCD, the behaviour(s) must cause significant distress or interfere with a person’s social and/or individual functioning (typically by time wasting). Other psychiatric disorders (e.g., Tourette’s syndrome, depression, schizophrenia) may include OCD behaviours. Furthermore, the World Health Organization ranks OCD as in the top ten most handicapping illnesses as measured by lost income and decreased quality of life.
The British psychiatrist Dr David Veale and one the UK’s leading experts on obsessive-compulsive disorders, provides the following two definitions and classic features for compulsions and obsessions:
• Compulsions: These are repetitive behaviours or mental acts that the person feels driven to perform. A compulsion can either be overt and observed by others (e.g., checking that a light has been switched off) or a covert mental act that cannot be observed (e.g., repeating a certain phrase repeatedly in one’s mind). Covert compulsions are usually more difficult to resist than overt ones as they are viewed as "portable" (and therefore easier to perform). A compulsion is not pleasurable for the person who experiences it. This differentiates it from impulsive acts such as shopping or gambling that are associated with immediate gratification
• Obsessions: These are defined as unwanted intrusive thoughts, images or urges that repeatedly enters the person’s mind. They are distressing (i.e., the person views the thoughts and/or behaviours as repugnant or inconsistent with their personality) but originate in the person’s mind and not imposed by an outside agency. Unwanted intrusive thoughts, images or urges are almost universal in the general population and their content (e.g., the urge to push someone over, the thought that the oven has been left on, etc.) is indistinguishable from clinical obsessions. However, the difference between a normal intrusive thought and an obsessional thought is the meaning that the person attaches to the occurrence and/or content of the intrusions.
In a study published in the journal Psychological Assessment led by Dr Edna Foa on 431 people with OCD, the most common compulsions were checking things such as gas taps (28.8 percent), cleaning and washing (26.5 percent), repeating acts (11.1 percent), mental compulsions such as prayers being constantly repeated (10.9 percent), ordering, symmetry and/or exactness (5.9 percent), hoarding and collecting (3.5 percent), and constant counting (2.1 percent). The same study found that the most common obsessions were contamination from dirt, germs, viruses, bodily fluids or faeces, chemicals, sticky substances, and dangerous materials (37.8 percent), fear of harm (23.6 percent), excessive concern with order or symmetry (10 percent), obsessions with the body or physical symptoms (7.2 percent), religious, sacrilegious or blasphemous thoughts (5.9 percent), sexual thoughts such as being a paedophile or a homosexual (5.5 percent), urges to hoard useless or worn-out possessions (4.8 percent), and thoughts of violence or aggression such as stabbing one’s own baby (4.3 percent).
Similar findings were found in a study led by Dr David Mataix-Cols and published in the American Journal of Psychiatry. Following a comprehensive literature review, they reported 12 factor-analytic studies involving more than 2,000 OCD patients were identified. These studies typically showed at least four symptom dimensions. These were (i) symmetry and ordering, (ii) hoarding, (ii) contamination and cleaning, and (iv) obsessions and checking. They concluded that the complex clinical presentation of OCD can be summarized with these few consistent, temporally stable symptom dimensions.
In relation to prognosis, both psychological interventions (e.g., cognitive-behavioural therapy) and pharmacotherapy may lead to a significant decrease in OCD symptoms for typical sufferers. However, symptoms can continue to persist even after treatment. A completely OCD symptom-free period following treatment is relatively uncommon.
References and further reading
Eddy, K.T., Dutra, L., Bradley, R. & Westen, D. (2004). A multidimensional meta-analysis of psychotherapy and pharmacotherapy for obsessive-compulsive disorder. Clinical Psychology Review, 24, 1011-1030.
Foa, E.B., Kozak M J, Salkovskis P.M., Coles, M.E. & Amir, N. (1998). The validation of a new obsessive-compulsive disorder scale: The Obsessive-Compulsive Inventory. Psychological Assessment, 10, 206-214.
Hodgson R.J., Budd R. & Griffiths M.D. (2001). Compulsive Behaviours (Chapter 15). In H. Helmchen, F.A. Henn, H. Lauter & N. Sartorious (Eds) Contemporary Psychiatry, Vol. 3 (Specific Psychiatric Disorders). pp.240-250. London: Springer.
Mataix-Cols, D., Conceição do Rosario-Campos, M. & Leckman, J.F. (2005). A multidimensional model of Obsessive-Compulsive Disorder. American Journal of Psychiatry, 162, 228-238.
Rachman, S.J. & Hodgson, R. (1980). Obsessions and Compulsions. Englewood Cliffs, NJ: Prentice Hall.
Veale, D. (2004). Psychopathology of obsessive-compulsive disorder. Psychiatry, 3(6), 65-68.