Obsessive-Compulsive Disorder (OCD)
Updated: Feb 14, 2021
Obsessive-Compulsive Disorder is characterised by the presence of obsessions and/or compulsions (from the DSM-5 Manual ). Obsessions are recurrent and persistent thoughts, urges, or images that are intrusive and unwanted. Whereas, Compulsions are repetitive behaviours or mental acts that an individual feels driven to perform in response to an obsession or according to rules that must be applied rigidly.
The specific content of the obsessions and compulsions varies among individuals. However, there are certain symptom dimensions* common in OCD, including those of cleaning (contamination obsessions and cleaning compulsions); symmetry (symmetry obsessions and repeating, ordering and counting compulsions); forbidden or taboo thoughts aggressive, sexual and religious obsessions); perfectionism (concern about evenness or exactness, fear of losing things); and harm (fears of harm to oneself or others).
I’m sure you’ve heard many people say things along the lines of “I need to go organise my planner. I’m so OCD.” Statements like these have led to a wide misunderstanding of the mental disorder and how serious it can be. A common misconception about OCD is that it is just about hand-washing, cleaning and being neat. Not all people with OCD have obsessions about cleanliness. In fact, the DSM-5 does not even list fears of contamination as diagnostic criteria for OCD. People with OCD may even be messy. In fact, a 2010 study  found that 14.4% of people with OCD engage in compulsive hoarding, a person who hoards is likely to have a disorganized home.
A cleanliness complex can also be a personality trait, says Jeff Szymanski, PhD, executive director of the International OCD Foundation and one of the world’s leading authorities on OCD. “And that’s part of the confusion. If it’s a personality trait, you have control — you can choose to do it or not. If you have obsessive compulsive disorder, you’re doing it out of unrelenting debilitating anxiety.” - 8 Common Myths About OCD (Everyday Health, 2011) 
I’ve often heard people say this “OCD is not that big a deal, they just need to relax and stop worrying.” Having OCD is not simply an overreaction to the stresses of life. While stressful situations can make things worse for people with OCD, they do not cause it. People with OCD face severe anxiety over any number of things - obsessions. This level of extreme worry and fear can be so overwhelming that it gets in the way of their ability to function. To try to overcome this anxiety, people with OCD use compulsions or rituals. These compulsions are not activities a person with OCD does because they want to, but rather because they feel they have to, in order to ease their fears. OCD is not about logic — it is about anxiety and trying to get relief from that anxiety.
OCD cannot be diagnosed by blood tests or scans like other illnesses, instead, mental health professionals look for these signs in patients . (Note that this is solely for awareness, do not try to diagnose yourself. If you find yourself to be having any of these, please reach out to a mental health professional to get their professional opinion)
Presence of obsessions, compulsions, or both
The obsessions or compulsions are time-consuming (e.g., take more than 1 hour per day) or cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
The obsessive-compulsive symptoms are not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition.
The disturbance is not better explained by the symptoms of another mental disorder (e.g., excessive worries, as in generalized anxiety disorder; preoccupation with appearance, as in body dysmorphic disorder; difficulty discarding or parting with possessions, as in hoarding disorder etc.)
There is still no known cause for OCD but there are risk factors such as:
Family studies have shown that people with first-degree relatives (such as a parent, sibling, or child) who have OCD are at a higher risk for developing OCD themselves. The risk is also higher if the first-degree relative developed OCD as a child or teen.
Brain structure and functioning
Imaging studies have shown differences in the frontal cortex and subcortical structures of the brain in patients with OCD. There appears to be a connection between the OCD symptoms and abnormalities in certain areas of the brain, but that connection is not clear. Research is still underway.
An association between childhood trauma and obsessive-compulsive symptoms has been reported in some studies. More research is needed to understand this relationship better.
How can you help?
Stigma is one of the biggest problems faced by people with OCD, but often, people don’t realise that their words or actions are stigmatizing or trivializing the suffering of those with OCD. The next time you hear that someone or something is “so OCD,” engage them in conversation about what OCD really means and why what they’re saying is dismissive and inaccurate. Also please don’t make fun of someone's obsessions and compulsions even if they are illogical - chances are the individual knows that it is illogical but still has to go through with the compulsions just to alleviate the anxiety.
*Symptom dimension: It is not to be confused with a symptom as it is a broad category under which many specific 'symptoms' may fall. This is used in OCD because the specific obsessions can vary from individual to individual, hence the term 'symptom dimension' is needed to help mental health professionals diagnose the disorder.
Writer: Rhea Rangarajan
Illustrator: Rhea Rangarajan