Lots of people describe themselves, family members or friends, as "a bit OCD," meaning they like to keep things organized, or they keep their apartment super clean. But keeping your pencils sharp and hoovering every day is a far cry from the reality of the real clinical disorder of obsessive-compulsive disorder.

What is OCD?

To begin, watch the following video, made by a film-maker who has OCD and demonstrates what daily life looks like for him.  How does the disorder influence his ability to do his job and have a "normal life?"

What are the symptoms of OCD?

Obsessions are defined as ‘recurrent and persistent thoughts, urges, or images’ that are experienced as ‘intrusive or unwanted’, (APA 2013). The obsessions lead to feelings of distress or anxiety. The person may try to ignore or suppress their obsessions or ‘neutralize’ them by engaging in a specific behaviour - a compulsion. For example, a person may have a fear that something bad will happen to their child while she is at daycare. The thought is recurring and the person may believe that by thinking about it, they may actually cause something bad to happen. In order to reduce the possibility of something bad happening, they may develop rituals such as folding all of the child’s clothes six times or counting the child's possessions repeatedly.

Behaviours are described as compulsive if they are repetitive and the person feels that they have no choice but to perform the action as a way of neutralizing their obsessive thoughts. Although carrying out the compulsion may reduce anxiety associated with the obsessive thoughts, the behaviours that are performed are generally disproportionate in their intensity - for example, washing your hands for hours after pressing the bell on a public bus  - or irrelevant - for example, repeating the elements of the periodic table to cancel out sexual thoughts.

Before a diagnosis of OCD is made the clinician will establish whether the symptoms could have been triggered by drug-use or an underlying medical condition. Obsessions and compulsions may be triggered by certain situations, leading to avoidance, and potentially leading to the development of other conditions, such as panic disorder, or agoraphobia.

Categories of OCD

There are many individual differences in the way in which OCD manifests itself and you will see in the sections on cognitive and socio-cultural factors that a person’s obsessive thoughts and behaviors are affected by their personal experiences and the cultural beliefs, values, and attitudes to which they have been exposed. This said, there are three broad types of OCD. People may have symptoms relating to more than one of these categories.

Clinical characteristics of OCD

Another key aspect of OCD is that people with these conditions often make repeated and unsuccessful efforts to control their behaviour. They often find their condition very distressing, not least due to the disruption it causes to their everyday lives, as their routines and rituals can be extremely time-consuming. In fact, one of the DSM criteria that is required to receive an OCD diagnosis is that symptoms must be experienced for at least an hour a day.

Distress and dysfunction are important indicators that a person may benefit from treatment. In contrast, some people may appear to be ‘obsessed’ with certain topics or activities, but if they are unconcerned about the narrowness of their interests or behaviours, and they are not interfering with their ability to live a relatively fulfilling and healthy life, then it is unlikely that treatment is required. This being said, people sometimes lack insight into their condition; they are unaware of the extent to which it has overtaken their life and is hampering their well-being.

When making a diagnosis, a clinician may administer a psychometric test such as the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) or the Maudsley Obsessive-Compulsive Inventory (MOCI). The Y-BOCS is a comprehensive checklist used by clinicians to guide the diagnostic interview. Clinicians rate the severity of symptoms experienced in the last week on a scale of 0 to 4. The final score is out of 40 and is used to classify symptoms as mild, moderate, or severe. This questionnaire is often used to detect subtle changes in a person’s symptoms over time and is commonly used in research into OCD. The main difference between the Y-BOCs and the MOCI is that the MOCI collects self-report data, as opposed to being completed by a clinician. The MOCI contains 30 true or false statements and helps classify the type of OCD symptoms a person is experiencing.

 Teacher only box

Take a look at this online version of the Y-BOCS test.  What would be your concerns about the questions that are asked?  What might this tell us about the validity of the test?

One concern is asking people to quantify their thoughts and behaviours over the past week. Humans are not really good at this - and this means that memory distortion may play a significant role in the validity of the responses. However, researchers are aware of this.  They are able to see how the trends in the responses to this test correlate with OCD symptomology and diagnosis.

Students should notice that the responses are ranked on a 1 - 4 scale. This avoids the problem of respondents gravitating toward the mean.

The test is also self-reported data. This is, in and of itself, not a limitation as this is the only way that we can actually gather information about cognitive symptoms. However, the test would be stronger if there was either data triangulation - e.g. asking a partner or parent to fill it in for the participants - or having the participant take the test more than once to test for test-retest reliability.

The concept of "control" is rather vague - and this may be interpreted differently by participants.

The Y-BOCS test is the standard clinical test in the diagnosis of OCD.  However, it is important to recognize that there are potential limitations.

Myths of OCD

Now that you are familiar with the disorder, watch the following video that addresses some of the myths about OCD.

Checking for understanding