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How often have you heard the phrase, “That person is so OCD”? I know that even as a therapist, I’ve found myself referring to other people who have certain behaviors that appear extremely particular as “OCD.” The truth is, though, society has latched on to this title to describe a large spectrum of actions, without really understanding what Obsessive Compulsive Disorder really is. What most people don’t know is that Obsessive Compulsive Disorder is a mental health disorder, which means an individual must present with very specific criteria in order to fall under that description. Because we all know people who seem “obsessive” about one thing or another, sometimes it’s hard to know when you should worry and what you should do. So I want to start by defining what OCD is and how one goes about being diagnosed.
As a warning, this post is rather technical, but I hope it helps give a better overview and understanding of OCD. You’ll see there are a lot of different forms of OCD, but you’ll also see that there are a lot of behaviors that might present as OCD but actually don’t merit that diagnosis. If after reading this, you are worried about yourself or someone you know, my best advice is to consult a therapist. This isn’t something you should try to solve on your own!
The Basics: What Is OCD?
First, it’s important to note that in order for someone to be diagnosed they need to have the presence of obsessions, compulsions or both. Now we need to define obsessions and compulsions. According to the DSM 5 (the bible of psychiatry), obsessions are persistent thoughts, urges, or images that are experienced as intrusive and unwanted and that in most individuals cause marked anxiety or distress. The person must also be attempting to ignore or suppress thoughts, urges or images, or neutralize them with some other thoughts or action. Compulsions are defined by repetitive behaviors, like hand-washing, checking several times or mental acts such as praying or counting. The individual needs to be performing these behaviors in response to an obsession or according to rules that must be applied rigidly. Second, the behaviors or mental acts are aimed at preventing or reducing anxiety or distress or preventing some dreaded event or situation. However, these behaviors or mental acts are not connected in a realistic way with what they are designed to neutralize and in many occasions, they are excessive.
The obsession compulsions must be time consuming and take more than one hour per day as well as cause clinically significant distress or impairment socially, occupationally or in another important area of functioning to the individual. It is important to be aware that sometimes obsessive compulsive symptoms can be attributed to other causes, such as to substance abuse or medication or another medical condition. Finally, obsessive compulsive disorder cannot also be explained by another mental disorder, such as generalized anxiety disorder or body dysmorphic disorder, and so before making the diagnosis that someone is struggling with obsessive-compulsive disorder, you need to rule out other related disorders that are similar in nature.
What is considered obsessive-compulsive disorder?
Under the OCD umbrella, there are nine different disorders that are included.
The first one is Obsessive Compulsive Disorder, with the above criteria mentioned. The second one is Hoarding Disorder, which most of us are familiar with (particularly if you’ve seen the show Hoarders). Another disorder is Body Dysmorphic Disorder, where the individual is obsessed with one or more body parts, which causes repetitive behaviors such as checking oneself in the mirror often, grooming oneself excessively, picking skin or mental acts like comparing oneself to other individuals in response to the apparent concern. In order to reach the distinction of a disorder, that preoccupation with whatever body part must cause clinically significant distress or impairment in social circles or other areas of functioning and it cannot be explained by another disorder such as an eating disorder.
If you have school-age kids, then you probably have noticed someone in the school who is missing parts of their hair. This is known as trichotillomania, which is also considered an OCD. In order to be diagnosed with trichotillomania or “hair pulling disorder,” the individual must have the following criteria: recurring pulling out of hair; the individual tried to decrease this behavior on several occasions; also, just as with most of these disorders, that behavior must cause clinically significant distress or impairment in several areas of functioning; finally, the hair pulling or hair loss cannot be attributed to another medical condition and cannot be explained by symptoms of another mental disorders.
Another disorder that I think is extremely important to discuss because people are not as familiar with it is Excoriation -- which is basically skin picking disorder. I've noticed many kids and individuals who are struggling with skin picking disorder and a lot of therapists don't specifically ask about it. Excoriation involves recurring skin picking, which results in skin lesions; the individual tried to stop and decrease that behavior and couldn’t; the skin picking causes significant distress or impairment and, as in all these orders, it cannot be better explained by symptoms of another mental disorder or attributed to the physiological effects of substance abuse.
There are also substance and medication induced obsessive compulsive and related disorders, but I’m not going to get too much into those in this blog. However, there are also obsessive compulsive and related disorders that are due to another medical condition, which I think are worth noting -- especially if you are a parent of young children and you notice certain behaviors. I recently had a mom call me in great distress because she believed her 9-year-old daughter was exhibiting signs of OCD. After talking with her pediatrician, she was told that the OCD behaviors could've been precipitated by a pediatric autoimmune neuropsychiatric disorder that is associated with strep throat. This is more commonly known as pandas. I don’t write this to scare you, but it is worth noting that when strep is left untreated it can cause severe autoimmune disorders that can also result in cognitive and physical problems down the line.
Lastly, know that OCD can be treated. If you are a parent, you should be on the lookout for the symptoms mentioned in this blog post, but also understand that the symptoms need to persist and be severe. There are lots of options depending on the exact diagnosis, and there are so many resources that can help. Don’t be afraid to ask questions and seek treatment. Knowledge is the most powerful tool you can arm yourself with if you are trying to help your child.
With much love,
Limor
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