Obsessions are thoughts, images, or ideas that are disturbing or disruptive. Obsessions occur repeatedly, and are sources of great anxiety. Obsessions can range from religious concepts to thoughts of losing control. They can involve unreasonable distress about becoming contaminated. Some obsessions involve such pedestrian concerns as whether a door has been locked. Other obsessions include bizarre and frightening fantasies.
Fear of being contaminated by dirt is the most common obsession. Other common obsessions are:
- Fear of harming oneself or someone else.
- Fear of disease.
- Preoccupation with losing or discarding something of minimal value.
People who have OCD (Obsessive-Compulsive Disorder) feel compelled to repeat ritualistic behaviors and follow rigid routines that they have devised. These compulsions are designed to alleviate the anxiety that these obsessions induce. Nine out of 10 people who have OCD have both obsessions and compulsions. Many recognize the irrationality of their thoughts and actions but cannot overcome them. Some spend hours adhering to behaviors that they hope will repel unwanted thoughts and images. Others live in dread of inadvertently doing the wrong thing or saying something other than what they mean.
Cleaning oneself or household items, often for hours at a time, is the most common compulsion. Checking — from several to hundreds of times a day — for symptoms of illness or to make sure a task has been performed, for example, is another. Other common compulsions are:
- Counting objects.
- Using verbal repetition.
- Hoarding items like rubber bands.
- Rearranging items to maintain precise alignment.
- Making lists.
- Using an extremely painstaking approach to performing routine tasks.
- Apologizing over and over.
- Performing tasks again and again.
Several hours a day may be devoted to concentrating on obsessions and performing rituals that make sense to no one but the person with OCD. Concentrating on routine activities becomes difficult. Perfectionists often develop perfection paralysis, which prevents them from completing or turning in work that they fear might not be flawless.
Equally common in men and women, OCD afflicts about one percent of the U.S. population 18 years of age and older. OCD is more prevalent than schizophrenia, bipolar disorder, or panic disorder. About one- [hyphen] third of adults with OCD experienced their first symptoms as children. Unlike adults, children with OCD do not recognize the irrationality of their obsessions or compulsions.
OCD often coexists with depression and other anxiety disorders. This chronic long-term illness is generally characterized by periods when symptoms are severe and is followed by times when symptoms are more moderate. Treatment results in considerable improvement for most patients, but entirely symptom-free periods are rare.
Disorders that may be part of OCD or are strongly associated with it include:
- Body dysmorphic disorder (BDD), in which patients are obsessed with the idea that they are ugly or a part of their bodies is deformed.
- Trichotillomania, which causes people to pull out enough of their hair to leave bald patches.
- Tourette’s syndrome, the symptoms of which include jerking motions, tics, and involuntary vocalization.
Diagnosis of OCD is usually based on the patient’s description of his or her own behavior. Physical examination can rule out physical sources of symptoms, and psychiatric evaluation may be used to eliminate psychiatric causes. The Yale-Brown Obsessive Compulsive Scale and other questionnaires can be useful in diagnosing OCD and monitoring treatment efficacy.