Obsessive-Compulsive Disorder

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Obsessive-Compulsive Disorder (OCD) is an anxiety disorder characterized by recurrent and persistent intrusive thoughts and impulses that are recognizable as problematic by the sufferer.

Those afflicted with OCD will make attempts to suppress the thoughts and behaviors, but the thoughts reassert themselves the more the person tries to suppress them.

Anxiety causes compulsion that makes the feeling go away - negative reinforcement - causes positive feedback loop.

In OCD, adult patients will recognize their thoughts and behaviors as unreasonable. This contrasts with Obsessive-Compulsive Personality Disorder (OCPD), where the patient experiences compulsion but does not recognize it as problematic. The two require very different forms of treatment.

OCD can be diagnosed in children without insight because children are inherently unable to recognize they have a problem. As a result, OCPD can’t be diagnosed in children.


Compulsions are the need to perform acts or to dwell on thoughts to reduce anxiety. Approximately 55% of the “normal” population acknowledges compulsive behaviors.

Severe compulsive state: stereotyped/rigid behaviors, often with magical qualities.

Common obsessions and compulsions

  • Obsessions
    • Contamination - most common
    • Harm - less common
    • Exactness/orderliness - even less common
  • Compulsions
    • Checking - most common
    • Cleaning/washing - slightly less common
    • Repeating - less common

Etiology and treatment

Freud believed that OCD is related to anal stage.

From a psychodynamic perspective, OCD is an attempt to fend off anal sadistic and anal libidinous impulses. Defense mechanisms used include substitution, undoing, reaction formation, isolation. Their suggested treatment for OCD is to bring impulses to awareness. There's no evidence at all that this works.

Scientists have found that the anterior cingulate cortex will be overactive in OCD patients.

The cognitive behavioral perspective of OCD is most widely accepted. Negative reinforcement and anxiety reduction is very powerful.

Treatment: exposure and response prevention. Expose the obsessions and then not allow them to make the compulsion happen. There are gentle, gradual ways to do this. Systematic muscle relaxation can be used.