Individuals with OCD have obsessions – thoughts, images, or urges that occur over and over even though individuals do not want them to.
These obsessions intrude even when individuals are thinking about and doing other things. Also, obsessions usually cause great distress or anxiety. The obsessions usually involve thoughts of harm, risk, or danger.
Common obsessions include the following:
- Concerns about contamination (for example, worrying that touching doorknobs will cause disease);
- Doubts (for example, worrying that the front door was not locked); and
- Concern that items are not perfectly lined up or even.
Because the obsessions are not pleasurable, individuals often try to ignore and/or control them.
Compulsions (also called rituals) are one way individuals respond to their obsessions. For example, they may feel driven to do something – repetitive, purposeful, and intentional – to try to prevent or relieve the anxiety caused by their obsessions.
Common compulsions include the following:
- Washing or cleaning to be rid of contamination;
- Checking to allay doubt (for example, checking many times to make sure a door is locked);
- Counting (for example, repeating an action a certain number of times); and
- Ordering (for example, arranging tableware or workspace items in a specific pattern).
Most rituals, such as excessive hand-washing or repeated checking to make sure a door has been locked, can be observed. Other rituals, such as repetitive counting or quietly mumbling statements intended to diminish danger, cannot be observed.
Rituals may have to be done in a precise way according to rigid rules. The rituals may or may not be logically connected to the obsession.
When compulsions are logically connected to the obsession (for example, showering to avoid being dirty or checking the stove to prevent fire), they are clearly excessive. For example, individuals may shower for hours each day or always check the stove 30 times before they leave the house.
All obsessions and rituals are time-consuming, and individuals may spend hours each day on them. They may cause so much distress or interfere with functioning so much that individuals are incapacitated.
Most individuals with OCD have both obsessions and compulsions.
Most individuals with OCD are somewhat aware that their obsessive thoughts do not reflect actual risks and that their compulsive behaviours are excessive. However, a few individuals are convinced that their obsessions are well-founded and that their compulsions are reasonable.
Some individuals with OCD are aware that their compulsive behaviours are excessive. Thus, they may perform their rituals secretly, even though the rituals may occupy several hours each day.
As a result of OCD symptoms, relationships may deteriorate, and individuals with OCD may do less well in school or at work.
Many individuals with OCD also have other mental health disorders. About 75% of individuals with OCD also have a lifetime diagnosis of an anxiety disorder, about 50 to 60% have a lifetime diagnosis of a major depressive disorder, and 23 to 32% have obsessive-compulsive personality disorder. About 15 to 20% of individuals with OCD have major depressive disorder at the time the disorder is diagnosed.
About half of individuals with OCD have suicidal thoughts at some point, and up to one fourth attempt suicide.
Risk of a suicide attempt is increased if individuals also have major depressive disorder.