What is Obsessive-Compulsive Disorder?

Listed amongst the top 10 most debilitating illnesses by the World Health Organisation and often referred to as the secret illness, Obsessive-Compulsive Disorder (OCD) is thought to affect 2-3% of the UK population.

Sufferers are plagued by persistent, recurring and unwanted thoughts about feared situations (obsessions), which they often attempt to fight with mental or physical rituals, i.e. excessive repetition of actions, washing, checking or counting, or agonising ruminations (compulsions).

It would be fair to say that most individuals, at some stage in their lives, have come into contact with the phenomenon of obsessional or intrusive thinking and/or succumbed to the seemingly nonsensical need to perform the odd, and often unrelated, behaviour pattern in order to avert a real or imagined danger (i.e. touching a certain item of furniture before going to bed in order to 'ward off' a nightmare) but the key difference which segregates these little 'quirks' from the disorder proper is when the distressing unwanted experience of obsessions and/or compulsions impacts, to a significant level, upon a person's everyday functioning - this represents a principal component in the clinical diagnosis of Obsessive-Compulsive Disorder.

Cars, sex, gambling, drugs, football may be compelling obsessions - but these pleasurable interests are never part of clinical OCD. People with OCD suffer from more mundane compulsions: things like repeated and stereotyped checking, counting, ordering or cleaning. Obsessive thoughts are sometimes distressingly violent or obscene.

The experience of OCD can be traced historically, cross-culturally and across a broad social spectrum and does not appear to restrict itself to any specific grouping of individuals per se. On the contrary, increased availability of information show numerous examples of OCD and its occurrence in the lives of various well-known figures, this observation implies a negligible difference in terms of the disorder's incidence rates across race, creed, class and, indeed, the greater passage of time.

For example, the eminent evolutionist Charles Darwin suffered from it, as did the nineteenth century pioneer of nursing and reformer of hospital sanitation methods, Florence Nightingale. More currently, Academy Award-winning writer, actor and director, Billy Bob Thornton, has candidly discussed his battle with the disorder but perhaps most famous of all was the twentieth century billionaire aviator and entrepreneur Howard Hughes (The Aviator), who in spite of his immeasurable financial wealth, spent his final days mentally and physically incarcerated by his own contamination terrors and elaborate cleaning rituals.

OCD affects males as frequently as females. Its mean age of onset is around 20 years old, but studies have shown that it takes up to 7-8 years for someone to present to the psychiatric services (Rasmusen and Tsuang, 1986).

OCD has two main features, the Obsessions and the Compulsions.

More specifically, Obsessions can be typified as thoughts or ruminations of a characteristically unpleasant, intrusive nature, which are recurrently and uncontrollably evoked at a conscious level within the individual.

Common obsessions include fears around contamination, causing harm to ones self or others, inappropriate sexual thoughts, hypochondria, 'unlucky' numbers and inordinate concern with order, arrangement or symmetry (this list is not exhaustive, see also types of OCD page).

Another obsession previously considered to be part of the Obsessive-Compulsive family is the inability to discard useless or worn out possessions, commonly referred to as 'hoarding'. Recent research now suggests that hoarding may spring from unique, previously unrecognised neurobiological malfunctions that standard treatments do not necessarily address.

Most sufferers are actually aware that their obsessions and compulsions are irrational but none the less still feel unable to control them.

Compulsions or compulsive acts can be defined as repetitious, purposeful actions that the individual feels compelled to engage in according to their own strict rules or in a stereotyped manner. Typically, the individual experiences a sense of resistance to the act but this is overridden by the strong, subjective drive to perform the action. Most often the principal aim behind the compulsive act is to generate temporary relief from the anxiety elicited by a preceding 'obsession'.

Compulsions can be overt or covert.

Overt compulsions typically include checking, washing, hoarding, symmetry of certain motor actions.

Covert compulsions or 'cognitive compulsions', as they are sometimes referred to, are mental actions performed as opposed to physical motor ones, for example, mental counting, compulsive visualisation or substitution of mental images or ideas with neutralising alternatives. A practical example would be a sufferer who feels compelled to silently repeat a string of words over and over on experiencing a negative or violent thought or, similarly, the need of a sufferer to transpose negative words or images which may intrude into consciousness with positive ones. i.e. feeling compelled to mentally substitute the word 'hell' that pops up, either as a thought or mental visual image, with the word 'well'. (Padmal de Silva, 1994)

What is Pure 'O'?

In the same way that compulsive drives can occur in the absence of obsessional thought, intrusive mental thoughts or images can also be experienced without any subsequent explicit compulsions - this is commonly referred to as pure 'O' (purely obsessional thoughts). An example would be a person who suffers with distressing blasphemous thoughts but does not engage in any elaborate compulsive rituals or someone who fears harming loved ones.