OCD characteristics

• OCD: categorised by either obsessions (recurring thoughts, images, etc.) and/or compulsions (repetitive behaviours such as hand washing). Most people with a diagnosis of OCD have both obsessions and compulsions.
• Trichotilomania: compulsive hair pulling.
• Hoarding disorder: the compulsive gathering of possessions and the inability to part with anything, regardless of its value.
• Excoriation disorder: compulsive skin picking.

Compulsions-

• The behavioural component of OCD is compulsive behaviour.
• There are two elements to compulsive behaviours:
  • Compulsions are repetitive-
    • Typically sufferers of OCD feel compelled to repeat a behaviour.
    • A common example is hand washing.
    • Other common compulsive repetitions include counting, praying and tidying/ordering groups of objects such as CD collections (for those who have them) or containers in a food cupboard.
  • Compulsions reduce anxiety-
    • Around 10% of sufferers of OCD show compulsive behaviour alone - they have no obsessions, just a general sense of irrational anxiety.
    • However, for the vast majority compulsive behaviours are performed in an attempt to manage the anxiety produced by obessions.
    • For example, compulsive hand washing is carried out as a response to an obsessive fear of germs.
    • Compulsive checking, for example that a door is locked or a gas appliance is switched off, in in response to the obsessive thought that it might have been left unsecured.

Avoidance-

• The behaviour of OCD sufferers may also be characterised by their avoidance as they attempt to reduce anxiety by keeping away from situations that trigger it.
• Sufferers of OCD tend to try to manage their OCD by avoiding situations that trigger anxiety.
• For example, sufferers who wash compulsively may avoid coming into contact with germs.
• However, this avoidance can lead people to avoid very ordinary situations, such as emptying their rubbish bins, and this can in itself interfere with leading a normal life.

Anxiety and distress-

• OCD is regarded as a particularly unpleasant emotional experience because of the powerful anxiety that accompanies both obsessions and compulsions.
• Obsessive thoughts are unpleasant and frightening, and the anxiety that goes with these can be overwhelming.
• The urge to repeat a behaviour (a compulsion) creates anxiety.

Accompanying depression-

• OCD is often accompanied by depression, so anxiety can be accompanied by low mood and lack of enjoyment in activities. 
• Compulsive behaviour tends to bring some relief from anxiety but this is temporary.

Guilt and disgust-

• As well as anxiety and depression, OCD sometimes involves other negative emotions such as irrational guilt, for example over minor moral issues, or disgust, which may be directed against something external like dirt or at the self.

• The cognitive appraoch is concerned with the ways in which people process information.
• People suffering from OCD are usually plagued with obsessive thoughts but they also adopt cognitive strategies to deal with these.

Obsessive thoughts-

• For around 90% of OCD sufferers the major cognitive feature of their condition is obsessive thoughts, i.e. thoughts that recur over and over again.
• These vary considerably from person to person but are always unpleasant.
• Examples of recurring thoughts are worries of being contaminated by dirt and germs or certainty that a door has been left unlocked and that intruders will enter through it or impulses to hurt someone.

Cognitive strategies to deal with obsessions-

• Obsessions are the major cognitive aspect of OCD, but people also respond by adopting cognitive coping strategies.
• For example, a religious person tormented by obsessive guilt may respond by praying or meditating.
• This may help manage anxiety but can make the person appear abnormal to others and can distract them from everyday tasks.

Insight into excessive anxiety-

• people suffering from OCD are aware that their obsessions and compulsions are not rational.
• In fact this is necessary for a diagnosis of OCD.
• If someone really believed their obsessive thoughts were based on reality that would be a symptom of quite a different form of mental disorder.
• However, in spite of this insight, OCD sufferers experience catastrophic thoughts about the worst case scenarios that might result if their anxieties were justified.
• They also tend to be hypervigilant, i.e. they maintain constant alertness and keep attention focused on potential hazards.