People with OCD have obsessions and/or compulsions Table 02. If you have OCD, you will have obsessions, compulsions, or both. Obsessions and compulsions are unpleasant, and are usually accompanied by high levels of anxiety. Obsessions are ideas, thoughts, and images that occur over and over. Common examples include fears of contamination by germs, fear that loved ones will be harmed, or worries that things are not in order.
Compulsions are behaviors that people perform in order to get rid of their obsessions. These may manifest as frequent handwashing, repeatedly checking to make sure that doors are locked, or mental exercises such as habitual counting, praying, or repeating special phrases.
Table 2. Common Obsessions and Compulsions
Type Characteristics Percent of cases Obsessions Contamination Incessant worries about dirt, germs, and contagion 37.8% Fear of harming yourself or others Recurrent thoughts that something has not been done properly, even when you know it has 23.6% Symmetry Feelings that certain things must always be in a certain place, position, or order 10.0% Somatic Worries about the shapes of body parts or about bodily functions 7.2% Religious Blasphemous thoughts or concern about right and wrong 5.9% Sexual Unwanted or repulsive thoughts about sexual acts 5.5% Hoarding Urge to collect objects that have no inherent or sentimental value 4.8% Unacceptable urges Often of a violent nature 4.3% Miscellaneous ? 1.0% Compulsions Checking rituals Checking locks, doors, appliances, or other objects 28.2% Washing/cleaning rituals Excessive handwashing, showering, bathing, toothbrushing, grooming, or household cleaning 26.6% Miscellaneous compulsions e.g., compulsion to perform a task very slowly 11.8% Repeating Touching certain objects, going in and out of a door, putting clothes on and taking them off 11.1% Mental rituals Repetitive thoughts regarding obsessions, such as silently praying or counting in one's head 10.9% Ordering Placing objects in a certain position 5.7% Hoarding/collecting Acquiring and collecting objects that have no inherent or sentimental value 3.5% Counting ? 2.1%
Adults with OCD usually realize that their thoughts or behaviors are irrational or excessive. Most adults with OCD are aware that their obsessions and compulsions are extreme and unrealistic. This feature often distinguishes people with OCD from those who are psychotic and cannot differentiate fantasy from reality. People with OCD are usually ashamed of their problem, realize that their fears and behaviors are irrational, and try to hide their symptoms from others.
Obsessions or compulsions are time-consuming, or significantly interfere with normal daily life. Activities associated with obsessions and compulsions take up more than one hour a day, or significantly interfere with work, social activities, relationships, or a normal daily routine.
Other psychiatric conditions have symptoms similar to those of OCD, but are different in important ways. People with depression, generalized anxiety disorder, and hypochondria also have obsessive thoughts. However, unlike individuals with OCD, they usually do not consider their worries to be absurd or unreasonable, and have no rituals to attempt to block such thoughts.
People with anorexia nervosa may have obsessions with they know are unreasonable, and may also have rituals surrounding eating. However, because these symptoms are specific only to this one issue, anorexia nervosa is not considered to be a generalized problem like OCD.
Obsessive-compulsive personality disorder is another disorder that has overlapping traits with OCD. People with this personality disorder tend to be workaholics, and are preoccupied with orderliness, rules, and perfectionism. They need orderliness and exactness in every aspect of their life, and usually do not have the insight to recognize that they may have a problem.
Younger people are more at risk for OCD. OCD usually first appears during childhood or young adulthood. Boys usually get OCD earlier than girls. The average age for boys is between 6 and 15 years of age. Girls usually begin having symptoms in puberty. Both sexes frequently have their first episode in their early twenties.
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