Obsessive-Compulsive Disorder (OCD): Signs, Symptoms, and DSM-5 Criteria

Compulsions: The Repetitive Rituals.

Individuals with OCD engage in repetitive behaviors or rituals (compulsions) to alleviate the distress caused by their obsessions temporarily. These compulsions often provide a false sense of control or relief. Common compulsions include:

1. Washing and Cleaning: Excessive handwashing, showering, or cleaning of objects and surfaces due to fears of contamination or germs.

2. Checking: Repeatedly checking locks, appliances, or other objects to ensure they are secure and no harm will come to oneself or others.

3. Counting: Engaging in repetitive counting of objects, actions, or words to reduce anxiety or prevent a feared event.

4. Repeating: Repeating specific phrases, prayers, or activities multiple times until it feels “just right.”

5. Arranging and Ordering: Rearranging objects or items in a particular order to reduce feelings of discomfort or anxiety.

6. Mental Rituals: Engaging in mental activities or prayers to neutralize or prevent intrusive thoughts.

7. Seeking Reassurance: Constantly seeking reassurance from others to alleviate doubt or uncertainty.

8. Avoidance: Avoiding specific situations, places, or people that trigger obsessive thoughts.

9. Tapping or Touching: Tapping or touching objects or surfaces in a specific pattern or sequence.

10. Hoarding: Collecting and holding onto items that others may view as useless or unnecessary, driven by anxiety about discarding them.

11. Mental Reviewing: Going over past events or conversations repeatedly to ensure nothing was said or done to harm oneself or others.

12. Ritualized Eating: Following strict or elaborate eating rituals to prevent potential harm or contamination.

DSM-5 Criteria for OCD:

The DSM-5 outlines specific criteria for diagnosing Obsessive-Compulsive Disorder including:

1. Presence of Obsessions, Compulsions, or Both:

   1. Obsessions: Recurrent and persistent thoughts, urges, or images that cause anxiety or distress with attempts to ignore, suppress or neutralize them.

   2. Compulsions: Repetitive behaviors or mental acts performed in response to the obsessions to reduce distress or prevent a feared event.

2. Time-Consuming or Interfering: The obsessions or compulsions take up a significant amount of time (more than one hour per day) or significantly interfere with daily functioning.

3. Not Attributable to Other Conditions: The symptoms are not better explained by the effects of substances or another medical or psychological condition.

4. Not better explained by another mental disorder: obsessive compulsive personality disorder, generalized anxiety disorder, body dysmorphic disorder, hoarding disorder, trichotillomania, excoriation disorder, eating disorders, etc.

Treatments for OCD:

Treatments for OCD generally include a combination of accurate diagnosis, medication and therapy. Treatment approaches are diverse and should be tailored to the individual’s unique symptoms and experiences. An important aspect of treatment is to determine an accurate diagnosis, especially since so many other psychiatric diagnoses have overlapping symptoms. 

Accurate diagnosis can be complex, as symptom overlap is particularly evident with Obsessive-Compulsive Personality Disorder (OCPD), Generalized Anxiety Disorder (GAD), Body Dysmorphic Disorder (BDD), tic disorders, skin and hair pulling disorders, and hoarding disorder. all share some overlapping symptoms with OCD. For example, OCD with a preoccupation on cleanliness or contamination can resemble the perfectionism and desire for control in OCPD. The pervasive worry characteristic of GAD can resemble the obsessive worries seen in OCD. Obsessions in OCD can resemble the intense preoccupation with physical appearance in BDD. Moreover, compulsive rituals of OCD shares similarities with the repetitive movements in tic disorders. OCD’s compulsions may also resemble the compulsive need to save items (regardless of their value) seen in hoarding disorder.

Evidence-based psychotherapies like Cognitive-Behavioral Therapy (CBT) and Exposure Response Prevention (ERP) are at the forefront of OCD treatment. CBT helps in identifying and altering negative thought patterns, while ERP involves gradual exposure to anxiety-provoking stimuli, teaching individuals to resist the urge to perform compulsions. Habit Reversal Therapy, another effective approach, is particularly beneficial in managing compulsive behaviors and tic symptoms often associated with OCD.

Medication management, particularly with antidepressants such as Selective Serotonin Reuptake Inhibitors (SSRIs) and Serotonin Norepinephrine Reuptake Inhibitors (SNRIs), plays a vital role in alleviating OCD symptoms. Medications like fluvoxamine (Luvox), escitalopram (Lexapro), fluoxetine (Prozac), sertraline (Zoloft), and duloxetine (Cymbalta) have been effective in reducing the intensity of OCD symptoms, helping to reduce how overwhelming the disorder can be and providing a more stable platform for individuals to engage in therapy.