What are the symptoms of obsessive-compulsive disorder (OCD)?

Symptoms

OCD normally includes the symptoms of obsessions and compulsions. But, it is also possible that some patients only experience the symptoms of obsession or only the symptoms of compulsion. However, more often than not, the patient will experience both of the above symptoms.

Obsessive symptoms

The obsessions of obsessive-compulsive disorder are known as persistent, repeated and unwanted urges, thoughts or images that intrude upon the patient’s mind and result in anxiety and an overwhelming feeling of stress. The patient may attempt to ignore these obsessions or rid their minds of them through completing a compulsive behaviour or a ritual.

Obsessions typically invade the patient’s mind when they are trying to work or think. They are known to have themes or categories to them, and the types of obsessions can include one or several of the following and vary from case to case:

• The fear of dirt or contamination
• Needing things to be ordered, symmetrical or colour-coded
• Unwanted thoughts that can include those of sexual intentions, aggression or religious subjects
• Horrific or aggressive thoughts of harming themselves or others
• Safety and securing one’s environment
• Doubt with regard to one’s perception and memory

Now that we have covered the basic themes of obsessions, the following further explains the examples that fall under these themes:

• Not wanting to touch anything dirty, or in some more severe cases, not wanting to touch anything in the fear of being contaminated by it.
• Avoiding situations that often trigger obsessions, such as not wanting to shake hands with someone in fear of contamination.
• Feeling intensely stressed when an object is not ordered or is not facing the ‘right’ way. The patient will be the judge of which way is the ‘right’ way.
• Feeling distressed over certain sexual images in their heads.
• Having thoughts of acting out inappropriately or shouting out obscenities that make the patient feel uncomfortable and in fear that they may act on these thoughts.
• Experiencing images of hurting themselves or others, these images are often unwanted and can make the patient uncomfortable and anxious.
• Constantly doubting whether the door is locked or the stove was turned off.
• Constantly doubting if an event occurred in the way the sufferer thinks it did.
• Difficulty in remembering if an action was performed.

Compulsive symptoms

The compulsions of obsessive-compulsive disorder are known as repetitive behaviours that the patient feels driven to act on or perform. These behaviours are mental ideas that are acted upon in an attempt to reduce or prevent the anxiety that is related to the patient’s obsessions or to make the patient feel that by completing these acts, he or she is preventing something bad from happening.

However, it is often the case that when the patient performs a compulsive behaviour that they only experience temporary relief from their anxiety or stress.

Patients may create rules for themselves to follow to aid in controlling their anxiety when experiencing obsessive thoughts. These compulsive behaviours are often excessive and unrealistic or illogical and irrelevant to the issue they are intended to solve.

Compulsions are similar to obsessions in that they can also be categorised into themes.

These themes are:

• Cleaning and washing
• Demanding reassurances
• Counting or repetitive actions
• Orderliness
• Continual checking
• Sticking to a routine
• Making lists
• Tapping or touching things
• Storing things in a hoarding fashion

Following the basic themes of compulsions, they can be further explained as follows:

• Washing hands until the skin is raw.
• Spending extended periods cleaning surfaces and disinfecting these at regular intervals regardless of use.
• Counting the number of steps taken wherever one walks.
• Arranging bottles, cans, or any items with labels to face the same way.
• Arranging belongings to be in a specific order, such as colour-coding clothes.
• Repeatedly checking doors to ensure they are locked.
• Constantly checking to ensure that the stove is off.
• Repeatedly saying a phrase, word or prayer silently.
• Performing daily activities in an exact order each day with no deviation and any interruptions causing anxiety.
• Making lists of everything from friends and acquaintances to foods consumed or TV shows watched.
• Tapping or touching things in a certain way and a specific number of times.
• Keeping seemingly useless items and hoarding them.

Variation in OCD severity

OCD normally starts to show signs in childhood or the adolescent years. The symptoms will usually start gradually and then vary in their severity throughout the patient’s life. Stress is known to worsen the symptoms. Obsessive-compulsive disorder is considered to be a lifelong condition, with symptoms ranging from mild to moderate and then severe. In severe cases, the patient’s symptoms are often disabling.

When to see a doctor

It is important to note that there is a difference between when someone is a perfectionist in requiring flawless performance or results and when someone has OCD. OCD symptoms are not simply worrying about real-world issues in the patient’s life or just liking things arranged or ordered in a certain way.

The difference between someone being a perfectionist and someone having OCD is that the perfectionist will like their clothes neatly folded and their house being ordered in an organised fashion. However, someone with OCD may feel compelled to have their orange and white shirts together (for no reasonable explanation) and has to wipe their right foot three times before entering their house. This is just an example, but the difference between the two people is clear. Perfectionism is a characteristic and is accompanied by realistic, albeit sometimes frustrating, mannerisms. Someone who is a perfectionist can often control their urges to clean or organise. Whereas OCD is a mental disorder accompanied by obsessions and compulsions that the patient has no control over.

If a person is experiencing obsessions and compulsions that are affecting their quality of life, then is it advised that they seek professional mental health care assistance.