obsessive-compulsive disorder
Meaning of obsessive-compulsive disorder: Current classifications place it outside the anxiety disorders, in a group of its own alongside hoarding, body dysmorphic disorder and hair pulling.
Definition of obsessive-compulsive disorder
Obsessive-compulsive disorder is a condition in which unwanted intrusive thoughts, images or urges, called obsessions, drive repeated behaviors or mental rituals, called compulsions, carried out to reduce the distress those thoughts cause. The relief is brief, the thought returns, and the cycle consumes increasing amounts of time. Insight into how excessive the pattern is varies from full to absent.
How does the cycle work?
An intrusive thought arrives unbidden and creates sharp distress. The compulsion follows and the distress drops, which is exactly why the pattern strengthens: the brain records the ritual as what made the feeling stop. The relief lasts minutes or less, the thought comes back, and each repetition makes the next one more automatic. Compulsions are often invisible. Counting, silently repeating phrases, mentally reviewing an event to be certain nothing bad happened, and asking others for reassurance are all compulsions, and someone whose rituals are entirely mental can appear untroubled while spending hours a day inside the cycle.
What forms does it take?
| Common pattern | Obsession | Compulsion |
|---|---|---|
| Contamination | Fear of dirt, germs or chemicals | Washing, cleaning, avoiding places or objects |
| Harm and responsibility | Fear of causing a fire, accident or injury through carelessness | Repeated checking of locks, appliances or a route driven |
| Symmetry | A feeling that something is not right until it is exact | Ordering, arranging, repeating an action until it feels correct |
| Taboo intrusive thoughts | Violent, sexual or blasphemous images the person finds abhorrent | Mental rituals, avoidance, seeking reassurance |
The last group is the most misunderstood. Such thoughts are distressing precisely because they run against the person's values, and their content says nothing about intent.
Where does it sit among other conditions?
It was long grouped with the anxiety disorders and is no longer. Current diagnostic systems place it in a separate family of obsessive-compulsive and related disorders, which also holds body dysmorphic disorder, hoarding disorder, hair pulling and skin picking, on the grounds that these share repetitive behavior driven by an internal urge. It is entirely distinct from obsessive-compulsive personality disorder, a lasting pattern of perfectionism and control that the person generally experiences as reasonable rather than intrusive. Severity ranges widely, and the diagnosis turns on how much time the cycle consumes and how far it interferes with activities of daily living.
Also known as
Used in a sentence
The patient was referred for evaluation of obsessive-compulsive disorder after describing persistent intrusive thoughts and repetitive checking behaviors.
Good to know
Obsessive-compulsive disorder is distinct both from a preference for order and from obsessive-compulsive personality disorder, since the diagnosis requires intrusive thoughts and rituals that cause marked distress or consume substantial time.
Word origin
Where “obsessive-compulsive disorder” comes from
Formed from obsessive, from Latin obsidere, meaning to besiege, and compulsive, from Latin compellere, meaning to drive or force.