Obsessive-Compulsive Disorder (OCD): what is it and how does it manifest itself?

We explain what OCD is and what are its manifestations.

Not all mental disorders are based on an abnormal perception of reality. Some, such as Obsessive-Compulsive Disorder (OCD)are not expressed through the way in which information from the surrounding world is interpreted, but through actions that arise from the subject himself or herself: the so-called repetitive behaviors, o compulsionswhich undermine people's quality of life by producing unpleasant sensations and limiting their degree of freedom.

However, to talk about this type of behavior is to tell only one half of the story. The other half is to be found in intrusive thoughts, which are closely linked to compulsions.. From a psychological perspective, it can be said that both intrusive thoughts (or obsessions) and compulsions are the two main gears through which Obsessive-Compulsive Disorder is articulated. But... how do these two pieces come to be activated?

Obsessive-Compulsive Disorder: intrusive thoughts and compulsions

Obsessive-Compulsive Disorder is often considered, in many respects, to be a disorder related to anxiety disordersTherefore, it is characterized by being associated with a feeling of fear, anguish and continuous stress in a magnitude that is a problem for the day to day and has a negative impact on the quality of life of the person in virtually all areas in which it is developed.

In the specific case of Obsessive-Compulsive Disorder, the driving force of these anxiety crises is the obsession-compulsion cycle. Obsessions occur spontaneously, independently of the person's will, and become so frequent that they are invasive. They are mental images or recurrent thoughts that disturb the person and that do not leave his or her head, causing the person to desperately seek strategies to stop focusing on them.

In addition to creating distress, these intrusive thoughts trigger a series of repetitive behaviors aimed at reducing the anxiety produced by the obsessions: these are compulsions.

Compulsions are a kind of rituals that must always be performed in the same way, and if not, the person starts again the chain of actions that compose them. It is very difficult to resist the urge to perform these compulsions, and at the same time, the more they are performed, the more we depend on them.

Thus, OCD is characterized as a disorder in which anxiety symptoms are combined with symptoms of problems in controlling one's impulses. problems in controlling one's own impulses.. Its two-phase structure makes the attempt to remedy the situation part of the problem, providing temporary relief but serving to reinforce the association between obsession and compulsion and vice versa.

OCD is also characterized by repetitive behaviors.

However, far from being helpful, repetitive behaviors are actually compulsions, ie, stereotyped behaviors that are beyond the person's control.They are also the same as the thoughts whose negative effects they try to mitigate. That is why the diagnostic picture of Obsessive-Compulsive Disorder includes not only the intrusive thoughts, but also the stereotyped actions that follow them.

By dint of repetition, both obsessions and compulsions come to take control of the person's life, just as pathological gambling takes over the daily life of the gambler. The obsession-compulsion cycle causes anxiety to be maintained, as the person experiencing Obsessive-Compulsive Disorder anticipates the onset of intrusive thoughts and stereotyped behaviors and knows that they are beyond his or her control. In this way, one enters into a loop of action and reaction that is increasingly difficult to undo.

The most common compulsions in OCD

The compulsions associated with OCD cover a practically infinite and unfathomable range of possibilities, and their variety increases as they grow.The variety of compulsions grows as technological changes are introduced into our lives.

However, there are certain compulsions that are much more common than others. What are the most common behaviors among those with this disorder?

1. Need to clean

These compulsions are usually related to obsessions that have something to do with the idea of dirt or putrefaction, literal or metaphorical. People with this type of compulsions may clean their hands too often, or do the same with objects or objectsor do the same with objects or other parts of the body. It is all part of a desperate and urgent attempt to get rid of the dirt that invades what should be pure.

This is one of the most frequent variants of Obsessive-Compulsive Disorder, and it can generate skin lesions. can even cause skin lesions due to erosion..

• Learn more: "Obsession with cleanliness, causes and symptoms".

2. Need to tidy up

For some reason, the person who presents this type of compulsion of Obsessive-Compulsive Disorder has the impression that he/she needs to tidy up several elementsWe are compelled to look at things, either for the intrinsic value of being in a place where things are neatly arranged or to make a good impression. This type of compulsion has been linked to the classic laws of Gestalt, since according to this psychological current we notice a feeling of tension or slight discomfort if what we perceive does not form a meaningful and well-defined whole. In this sense, a disordered environment would create discomfort by presenting difficulties in being perceived as a perfectly defined whole: a study room, a dining room, etc.

Thus, Obsessive-Compulsive Disorder would occur when this feeling of discomfort is amplified so much that it harms the levels of well-being and quality of life of the person, by forcing him/her to tidy up in order not to feel bad.

3. Compulsions related to accumulation

In this type of Obsessive-Compulsive Disorder, the person has the need to store all kinds of items for their possible future usefulness, even though it is statistically highly improbable that a situation will arise in which every item accumulated will be usable.even though it is statistically highly improbable that there will ever be a situation in which each of the accumulated items will be usable.

From some schools of psychodynamic currents, such as classical Freudian psychoanalysis, this tends to be related to Freud's psychosexual theory. However, current clinical psychology is based on assumptions and a philosophy of research and intervention that have nothing to do with psychoanalysis.

4- Verification compulsions

Another typical example of Obsessive-Compulsive Disorder is that of a person who needs to constantly make sure that everything is working as it should. constantly needs to make sure that everything is working as it should to the point of doing the same thing several times a day. This is a case of checking compulsion, based on the need to avoid future accidents and, more specifically, to make imaginary thoughts and scenes about accidents that might occur cease altogether and stop producing discomfort. These thoughts appear involuntarily and lead to performing various checks aimed at decreasing the risk of their occurrence, which in turn becomes a habit that is difficult to change.

Causes of Obsessive-Compulsive Disorder

As is the case with many psychiatric syndromes, little is known about the Biological mechanisms of obsessive-compulsive disorder, little is known about the precise biological mechanisms by which some people develop obsessive-compulsive disorder.. This is not surprising because in order to address it, in addition to studying the complicated workings of the human brain, it is necessary to address the context in which the person has been developing, his or her habits and living conditions, etc. In short, OCD must be understood from a biopsychosocial perspective.

Manuals such as the DSM-IV describe the set of symptoms that characterize this anxiety disorder, but beyond the diagnostic criteria there is no theoretical model supported by a broad scientific consensus that explains its causes in detail. New research in neuroscience, together with the use of new technologies to study the functioning of the brain, will be decisive in determining the causes of OCD.

The relationship between this psychological phenomenon and perfectionism

Many people assume that Obsessive-Compulsive Disorder has to do with perfectionism, given that in compulsions a chain of steps is always followed as meticulously as possible. However, everything seems to indicate that OCD is not so much related to this scrupulousness as to the lack of it. For example, while people with Obsessive-Compulsive Personality Disorder score very high on Responsibility (a trait of the Big Five model created by psychologists Paul Costa and Robert McCrae), those with Obsessive-Compulsive Personality Disorder tend to score very low on this trait, those with Obsessive-Compulsive Disorder tend to score very low on this trait..

This indicates that in OCD, there is an intention to pathologically compensate for the tendency to chaotic and spontaneous behavior that occurs in all other aspects of life, i.e., one goes from exercising very little scrupulosity most of the time, to obsessing about it for a few minutes.

Relationship with Body Dysmorphic Disorder

Obsessive-Compulsive Disorder presents some symptomatic characteristics that overlap with those of Body Dysmorphic Disorder, a psychological disorder that is also based on perceptual rigidity.and in which the person is very concerned that the aesthetics of his body does not go out of some very delimited canons. For this reason, comorbidity is high: where one is diagnosed, it is very possible that the other is also present.

If they occur at the same time, it is important to treat these two disorders as separate entities, since they affect different aspects of the patient's life and are also expressed through other situations.

Treatment of this psychopathology

The treatment of OCD combines resources from the field of psychiatry and psychological therapy. In the first of these forms of intervention, mainly anxiolytics and SSRI-type antidepressants are used.As for psychotherapy, forms of intervention such as systematic desensitization and controlled exposure are used, in which the person is trained to resist anxiety without reinforcing it through anxiogenic thoughts and the realization of the compulsion.

Bibliographical references:

• Doron, G,; Derby, D., Szepsenwol. O. & Talmor. D. (2012). Tainted Love: exploring relationship-centered obsessive compulsive symptoms in two non-clinical cohorts. Journal of Obsessive-Compulsive and Related Disorders 1 (1): pp. 16 - 24.
• Colesa, M.E.; Frostb, R.O.; Heimberga, R.G.; Rhéaumec J. (2003). "Not just right experiences": perfectionism, obsessive-compulsive features and general psychopathology. Behaviour Research and Therapy 41 (6): pp. 681 - 700.
• Rhéaume, J.; Freeston, M.H.; Dugas, M.J.; Letarte, H.; Ladouceur, R. (1995). Perfectionism, responsibility and Obsessive-Compulsive symptoms. Behaviour Research and Therapy 33(7): pp. 785 - 794.
• Kaplan, Alicia; Hollander Eric. (2003). A Review of Pharmacologic Treatments for Obsessive Compulsive Disorder. psychiatryonline.org.
• Sanjaya Saxena, MD ;Arthur L. Brody, MD; Karron M. Maidment, RN; Hsiao-Ming Wu, PhD; Lewis R Baxter, Jr,M D (2001). Cerebral Metabolic in Major Depression and Obsessive-Compulsive Disorder Occurring Separately and Concurrently. Society of Biological Psychiatry.