by Capt. Daniel Gibson, US Air Force Psychologist
Obsessive Compulsive Disorder (OCD) is one of the most misunderstood set of symptoms/experiences when compared to other behavioral health diagnoses. For example, you likely have heard many people say “I’m OCD….” after desiring order/control of some sort; when people say this, they usually confuse OCD with Obsessive Compulsive Personality Disorder (OCPD). So, what is the difference and how can you know if what you have been going through is part of the symptoms of OCD?
The meaning of a mental health diagnosis
Before I label what OCD is, to help you determine if you have this disorder, I first want to explain what a diagnosis is and why we have them. Let’s compare a behavioral health diagnosis (e.g., OCD, Major Depressive Disorder, etc.) to a constellation of stars. Each symptom (e.g., avoiding a crowd) can be compared to a star in the sky. Having one, two, or four symptoms doesn’t mean someone meets criteria for a particular diagnosis, just as having one, two, or four stars around each other doesn’t necessarily make them a constellation. So, just because someone has a particular routine (e.g., knock on baseball dug-out before entering the field, wearing “my lucky” shirt or things won’t work out, etc.) doesn’t mean they meet criteria for an OCD diagnosis. Diagnoses were organized by health care professionals due to a vast amount of individuals presenting with a very similar set of symptoms that have impacted their and their families’ lives. Because of this, researchers have organized a set of criteria individuals must meet in order to meet full criteria for the diagnosis. Most importantly, health professionals can study the causal and maintaining factors for diagnoses and design specific interventions/treatments to help unravel the constellation of symptoms.
Next, I will identify the key symptoms of OCD:
OCD is characterized by recurrent obsessions and/or compulsions that are time-consuming, or impact daily functioning, or cause high levels of distress to the individual and or the individual’s family/significant others.
- Obsessions: are insistent thoughts, images, or impulses that an individual experiences as unwanted and intrusive (i.e., invasive, intruding, interfering, etc.) and that the person tries to suppress or ignore. These obsessions usually accompany high levels of distress or anxiety. Some examples could be repeated thoughts about being contaminated and repeated doubts about your actions to resolve “feeling” contaminated, but it often continues despite repeated efforts.
- Compulsions: are deliberate, repetitive behaviors or mental actions the individual feels powerfully, compelled to perform either by a set of unbending rules (e.g., compulsive praying, counting, hand-washing, etc.). The objective of the behaviors or mental actions is to reduce mental/emotional anguish and or to prevent something bad from happening, but they are either excessive or not connected in a “logical way” to this goal.
OCD is diagnosed when the Obsessions and Compulsions:
- Cause significant distress and anguish
- Interfere with daily functioning at home, school, or work; or interfere with social activities/ family life/relationships
- Consume excessive amounts of time (i.e., approximately 1 hr. or more per day)
OCD vs. OCPD
Now, Obsessive-Compulsive Personality Disorder (OCPD) should be distinguished from OCD. Though the names are similar their defining features differ. Confusing to the name, OCPD doesn’t involve obsessions or compulsions but, rather a preoccupation with control, orderliness, and perfectionism. Additionally, while both conditions involve rituals, they are performed within OCD to reduce anxiety and or something terrible from happening but with OCPD, it’s about perfectionism. You may tell yourself, “well, I am a perfectionist, maybe I have OCPD.” It has been my experience that seeking perfection is a common goal for individuals who struggle with OCD and other similar anxiety disorders. Individuals who meet full criteria for an OCPD diagnosis often get lost in the rules and desire that things must be a certain way. Their getting lost in their own rules is often why OCPD is classified as a disorder, because of its impact on having difficulty getting tasks done at work, home, etc. and/or difficulty working with others, especially in familial relationships. If you are concerned about whether what you have been experiencing fits within OCPD or OCD, please review the Types and Sub-types of OCD below and/or talk to a behavioral health provider who specializes in working with people with OCD.
Types and Sub-types of OCD
You’re Not Alone!
Most all individuals who battle with OCD report a unique theme, and that is their obsessions latch on to their values. I have heard, time and time again from individuals in group treatment report, “I wish I had your obsessions…those don’t bother me” to other group members. As such, I will remind you of my comparison between a behavioral health diagnosis and a constellation of stars, well, as research and knowledge of OCD has advanced, we have found many unique presentations. Though there are several types of OCD that an individual may battle with, the foundational principles of what classifies an obsession and compulsion still apply for all types of OCD. The differing OCD presentations focus on the classifications of obsessions.
The differing sub-types of OCD will fall under one of the following 4 types:
- Contamination / Mental Contamination
- Checking
- Ruminations / Intrusive Thoughts
- Hoarding