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"I'm feeling a little OCD..."
Many people use this phrase, or one like it, without really thinking about what it means. They might say this because they spent the day cleaning, or because they prefer to work at an organized desk rather than a messy one, or because they are a punctual person.
Is this the same thing as OCD? Not at all. There is a huge difference between liking a clean house or an organized desk, or wanting to get to appointments on time, and having OCD. For a person with obsessive compulsive disorder, it's not a case of preferring to have a clean house or an organized desk, it's a case of having to have those things, of turning them into a ritual that must be adhered to in order to feel safe and in control.
Obsessive compulsive disorder comprises two main symptom groups: obsessive thoughts, and compulsive behavior. When someone with OCD is affected by these symptoms, the link between obsessive compulsive disorder and interfering with life is very strong.
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Obsessive Thoughts and Compulsive Behavior
Obsessive thoughts are those which run through the mind over and over again. They might be ideas, mental images or impulses towards a certain action. Someone who has OCD has obsessive thoughts that are not controllable: they can’t be pushed out of the mind or forgotten about, and they can quickly become all-consuming to the point where he or she simply cannot think of anything else.
People with OCD cope with obsessive thoughts by performing rituals to ease the anxiety. Rituals can take many forms: hand-washing, straightening items, counting, checking appliances to make sure they are off, or checking doors and windows are locked. Someone might have a compulsive need to perform every action twice, or three times: for example, he or she might have to sit down, then stand up and sit down again before remaining in a chair, or touch an object twice before performing an action with it.
For people with OCD, these actions aren't games or whims that they decide to do every once in a while. They are absolute requirements, necessary to keep obsessive thoughts from becoming overwhelming. The need to perform these rituals to keep the obsessive thoughts at bay can interfere with having a normal life, simply because performing the rituals takes precedence over every other activity.
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What does it mean to have OCD?
Do you check that your oven is turned off before you leave the house? How many times do you check? Most people won’t think to check this at all, unless they have just finished using the oven before going out. Some people might check once every time they go out.
For someone with obsessive-compulsive disorder, the answer might be five times, or eight times, ten, twenty, or more. For some, the need to check is so strong, they end up staying at home, because it’s less stressful than constantly getting as far as the car, or the mailbox, before the need to check becomes overwhelming.
Is the oven off? What if it's not off? My house might burn down. Is the oven off? Did I check the oven? What if one of the elements was just a little bit on? Is the oven really off? What if my house burns down? I need to go back and check the oven, NOW.
Some people can get as far as going to work, but find they are unable to concentrate because worrying about the oven is all-consuming.
For someone with OCD, that worry can turn into obsessive thoughts that might trigger feelings of intense anxiety, or even a panic attack. As a coping mechanism, he or she is compelled to perform certain rituals, such as hand-washing or straightening items, in order to stop worrying about the oven.
Is the oven off? Did I check the oven? Is it really off? What if my house burns down? My house is burning down! I need to get home and check the oven, NOW. I can't check the oven, I'm at work. If I wash my hands three times for three minutes each time, organize the cups in the lunch room so all the handles are facing in, and make sure all the papers on my desk are at the top-right corner of the desk exactly an inch from the edge, I will feel safe. For a while.
Of course, not everyone with OCD has the same fears and obsessive thoughts, or even the same rituals. It's different for every individual. As strange as it might seem, the nature of the rituals isn't, strictly speaking, the defining part of the disorder. It's the need for the rituals, and the effect they have on the person, that is the characteristic of the condition, and the reason why there is such a strong link between obsessive compulsive disorder and interfering with life. The compulsion to perform the rituals at moments of stress and anxiety takes precedence over everything else.
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Levels of Symptom Severity
Someone with mild OCD can have a fairly normal life if his or her obsessive thoughts are relatively non-intrusive.
For example, in mild OCD, the person might be compelled to count items or wash the hands, but only in intensely stressful situations. He or she might be able to cope with mild stress or anxiety without triggering obsessive thoughts that lead to the need for rituals. People with mild OCD can often cope with relationships, work, and other everyday situations in a relatively normal fashion. They might even be able to make a good job of concealing the rituals they perform so that only very close friends and relatives are aware of the condition at all.
For someone with severe OCD, obsessive thoughts can be so intrusive that rituals might need to be performed for several hours a day. The person's thoughts and rituals become so intrusive that normal relationships, work, and in some cases, even leaving the house at all, are impossible. The need to perform the rituals is so intense that they are prioritized above everything else, and in very severe OCD, it is often the case that the individual will spend the majority of his or her time performing rituals.
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American Academy of Family Physicians: Obsessive-Compulsive Disorder: What It Is and How to Treat It
International OCD Foundation: Obsessions and Compulsions
National Institute of Mental Health: When Unwanted Thoughts Take Over: Obsessive-Compulsive Disorder
Penn State Milton S. Hershey Medical Center College of Medicine: Obsessive-Compulsive Disorder (OCD)