Those who suffer from obsessions and compulsions vary widely in their personality characteristics, life circumstances and the degree to which their lives are disrupted by symptoms.
Some researchers suggest those with OCD come from a perfectionistic or possibly moralistic upbringing, more concerned than others with avoiding mistakes. Or, they may overestimate the risk involved in their obsessive concern, with some avoiding any risk. Others doubt their decision-making ability and need others’ reassurance. There are also those who appear normal in their social, recreational and work lives.
Despite the heterogeneity of OCD symptoms, there are symptom patterns, described either as obsessions or compulsions:
OBSESSIONS
Obsessions are unwanted or distressing thoughts, fears, images or impulses that provoke anxiety, guilt or shame. Obsessions can continue even when a person tries to ignore or forget them and take many common forms:
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- Concerns that objects or people are “contaminated” or poisoning by germs, dirt or chemicals, accompanied by an urge to wash or clean
- Mistakes, such as doors left unlocked, appliances left on or important papers thrown away, accompanied by fears of burglary, fire or other losses
- Accidents or unfortunate events that might be prevented by superstitiously repeating particular actions or thoughts
- Urges or impulses to do something harmful, such as stabbing one’s child, experiencing horrific or upsetting images relating to religious themes, or doubts and thoughts of sex
Ordinary people are concerned by many of the same fears, upsetting images and impulses. For those with OCD, however, the fear and guilt or other unpleasant emotions are out of proportion to the actual risk of danger or harm, driving them to carry out compulsions to rid themselves of the worry.
COMPULSIONS
Compulsions are often desperate attempts to “neutralize” the obsession and anxiety and may involve repetitive thoughts or behaviors (washing, checking, counting, tapping or touching things). These “rituals” are usually carried out according to certain rules or in a rigid fashion. While recognizing such rituals are unreasonable and clearly excessive, a person with OCD feels unable to control them.
Most compulsions stem logically from the disturbing obsessions people with OCD feel driven to reduce or prevent. Compulsive thoughts or actions may temporarily reduce discomfort, but become habitual and are difficult to control. Examples include:
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- Handwashing, showering or cleaning to remove “contamination”
- Checking to prevent theft, fire or loss of important things
- Repeating actions or needing repeated reassurance from others to prevent a catastrophic event from happening
- Arranging objects in a particular way before beginning an activity
Some compulsions are performed mentally without behavioral manifestation. Examples include:
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- Praying to relieve guilt about an unwanted idea
- Repeating mental phrases or images to prevent a catastrophe
