Obsessive-compulsive disorder (OCD) is a mental disorder characterized by obsessions and compulsions. Before continuing, I should note that it is not easy to identify an obsession/compulsion without knowing more about the person and her environment. The following examples about diagnosing OCD are for illustrative purposes only.
Obsessions are recurrent intrusive thoughts (though they can also be images or impulses). Note the word “intrusive.” Obsessions are unwelcome and unwanted. They also result in high levels of anxiety. Indeed, because of the distress that obsessions cause, people try to either ignore them or to “neutralize” them with some other thought or action (about which I will say more when we talk about compulsions).¹
Let me give you some examples of what may be obsessions:
-A parent repeatedly thinking that she could kill her child while he is asleep.
-A heterosexual individual having recurrent images of being engaged in homosexual sex.
-While driving, a young man having the urge to steer his car into the oncoming traffic.
-A police officer having the intrusive thought that he might in fact enjoy killing innocent people.
The people in the above examples are terrified and distressed by their recurrent thoughts and urges. They do not enjoy them, nor identify with their obsessions.
Now consider the following examples. Do you think these are obsessions?
-Playing a video game over and over again.
-Checking your email many times throughout the day.
-Recurrent thoughts about how much you love your significant other.
-Repeatedly recalling a beautiful scene from a movie.
-Regularly thinking about emotionally powerful lyrics from a new hit song.
-Having a very strong urge to hug your best friend.
The first two examples are physical actions, so they can not be obsessions. The rest are not obsessions either, unless the urges or thoughts are intrusive and cause a lot of distress. But that is doubtful. For instance, intentionally recalling beautiful lyrics or replaying a beautiful scene from a movie is not the same as experiencing intrusive mental events. And recurrent thoughts about how much you love your partner is likely to be experienced as pleasant and not disturbing.
As I mentioned, people usually try to ignore or neutralize their obsessions. How do they do that? By performing compulsions.
Compulsions are repetitive mental or behavioral acts, intended to reduce the distress associated with the obsessions or to prevent some terrible outcome. Compulsions are either not directly related to the obsessions or are considered clearly excessive.¹
The following are some examples of compulsions:
-Repeating “go away Evil” 66 times whenever you think about hurting your child.
-Spending over an hour a day locking and unlocking the doors to your house, office, even your car doors, to make sure the doors really do lock.
-Washing your hands so many times a day and for such a long time that at the end of the day, you have spent two hours doing so.
–Because you can not really trust your memory, every twenty minutes you leave your room and go to the kitchen to make sure the stove is really off
-Taking a ritualized shower each time a homosexual image pops into your mind.
Now what about the following, do you think they are compulsions too?
-A professional athlete spending four hours a day practicing a routine.
-Having an hour-long routine of shower, facial creams, flossing and brushing, and relaxation, before bed.
-Rereading the same long poem one hundred to two hundred times a day in order to memorize it.
-Performing a spiritual/religious ritual from morning to noon.
The answer is that these are unlikely to be compulsions. One way you may be able to identify a compulsion is to try to truly understand the purpose of the action and determine if it makes sense.
For instance, a professional hockey player is expected to practice for many hours a day. And it makes sense that he would insist on doing specific warm-ups in the particular order which has been suggested to him by the coaching staff.
However, the same athlete might have obsessive-compulsive disorder if he insists on doing a complicated ritual which involves making 33 counterclockwise circles around the hockey net, then 33 laps around the rink during which he would need to touch 33 specific places.
While any athlete will likely experience some anxiety if her daily exercise routine is interrupted, an athlete with OCD will experience high levels of anxiety if she is unable to perform her OCD routine in the exact way that she wants to do it.
The key to understanding this mental illness is to remember that a person with OCD experiences mental events that she finds distressing, and as a result engages in compulsive behavior to reduce her anxiety or to prevent some future harm.
Just because someone does something repeatedly or thinks about an issue frequently, does not mean she has OCD. Or obsessions. Or compulsions.
1. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author.