On the National Counselor Examination (NCE), the Counselor Preparation Comprehensive Examination (CPCE), or another counseling exam, you may come across questions related to diagnoses from the Diagnostic and Statistical Manual of Mental Disorders, fifth edition, text revision (DSM-5-TR). This video will help you understand Obsessive-Compulsive Disorder (OCD).
What is Obsessive-Compulsive Disorder? That’s a great question that will be answered in depth in this video. Often portrayed as someone who wants to be tidy, washes their hands often, or who turns a light on and off multiple times, OCD is more than these stereotypes. We’ll cover some of the other ways OCD can show up.
What is Obsessive-Compulsive Disorder? One of the most disabling mental health conditions, Obsessive-Compulsive Disorder—or OCD—starts with obsessions that a person can’t control (even though they want to) and cause a lot of distress. Obsessions then lead to compulsions, which are acts people do to try to control the high anxiety that can go with OCD.
What are obsessions? According to the Diagnostic and Statistical Manual of Mental Disorder, 5th edition, text revision (DSM-5-TR), obsessions are unwanted and intrusive thoughts, images, or urges. They are also persistent and recurrent, meaning they keep happening. Typically, the person attempts to suppress, ignore, or neutralize the obsessions.
What are compulsions? Obsessions lead to compulsions, which are repetitive behaviors or mental acts that the person feels they must do, according to the DSM-5-TR. For the person with OCD, they serve to reduce or prevent the distress or anxiety from the obsessions. Compulsions might also feel like they must be done to prevent a feared situation from happening.
Are there different kinds of obsessions? Yes. We often see people in shows that have OCD and are concerned about germs. This is one type of obsession, but there are others that aren’t typically shown. The Yale Brown Obsessive-Compulsive Scale puts obsessions into the categories of aggressive, contamination, sexual, hoarding, religious, symmetry/exactness, somatic, and miscellaneous.
What are aggressive obsessions? Aggressive obsessions might include intrusive thoughts that the person will hurt themselves or hurt other people. It might also be that the person has horrible or violent imagery that intrudes their mind. They might also struggle with obsessions that they might steal something or that they may blurt out inappropriate words or phrases.
What are contamination obsessions? Contamination obsessions may include obsessions related to bodily fluids, dirt, germs, environmental contaminants, or chemicals. There may also be obsessions related to sticky residue, or fears that they may become contaminated or might contaminate others.
What are sexual obsessions? Sexual obsessions might include unwanted sexual thoughts about strangers, family, or friends. This category could also include obsessions related to the person’s sexual orientation when there is otherwise no basis for them to question them.
What are hoarding obsessions? While the media often portrays people with OCD as clean and tidy, some people with OCD will struggle with hoarding. For people with hoarding obsessions, they might have fears related to throwing away items for fear of needing them in the future. This could also include wanting to keep, pick up, or collect useless objects.
What are religious obsessions? Obsessions related to religion can include thoughts that the person would consider blasphemous—or inappropriate according to their religious beliefs. This can also show up as fears they will then be punished for these thoughts. They may also experience obsessions related to acting morally, which might include concerns about doing the right thing, fears that they have lied to someone, or that they have cheated someone, for example.
What are symmetry and exactness obsessions? Symmetry or exactness obsession could include wanting things to be perfectly aligned, or wanting things to be perfect (such as handwriting). For some, these obsessions may appear as wanting this “just so” or to be in a particular way.
What are somatic obsessions? Somatic obsessions—or obsessions related to the body and health—can include obsessions that the person has a disease, such as AIDS or cancer. These obsessions will persist despite reassurance from a medical professional. There are also somatic obsessions related to a fear that a body part is hideous, despite reassurance that it is not.
What are some other obsessions? Other obsessions might be related to superstitions, feeling as though they must remember various unimportant details (such as an old phone number or a passing license plate), and belief they must use the “perfect” word and fear of saying something wrong. There are also obsessions in this category related to neutral intrusive thoughts or images, and nonsense music, sounds, or words that are intrusive. This category also contains obsessions related to colors that the person feels have a specific meaning, or lucky and unlucky number obsessions.
Are there different kinds of compulsions? Like obsessions, there are multiple categories of compulsions. The categories include cleaning/washing, checking, repeating, ordering/arranging, hoarding/collecting, and a miscellaneous category.
What are cleaning and washing obsessions? A typical example that we see in the media is related to hand washing. However, people with OCD will often have a ritualized way of washing their hands. Often, they will wash their hands so much they will have raw, cracked skin. This category might also include rituals related to showering, bathing, or brushing teeth. Cleaning compulsions may take excessive amounts of time. With any compulsion, if the ritual or routine is interrupted, the person will often have to start over.
What are checking compulsions? Checking compulsions might include the person verifying they did not hurt or kill another person. For example, if they hit a bump in the road, they may have an obsession that they ran someone over. As a result, they may have to turn around to check the spot multiple times to make sure they did not hit someone. They might also check to make sure they did not hurt themselves, or checking to make sure they didn’t make a mistake. They may also check household appliances to verify they are off, which they may do multiple times. Some people with OCD will check their pulse or something else health- or body-related, or go to the doctor often to make sure they are healthy. Then, when the doctor confirms they are healthy, they will often be concerned that the doctor missed something.
What are repeating compulsions? Repeating compulsions might include re-reading or re-writing, or repeating a routine until they do it the “right” number of times. They might also have compulsions related to counting, such as counting how many tiles are on the floor or counting how many times they wash their hands.
What are ordering and arranging compulsions? Ordering and arranging compulsions can include spending hours arranging items in a specific way. They might also be arranging things until they “feel right” or are “just so”.
What are hoarding and collecting compulsions? Hoarding and arranging compulsions are related to saving various items. It might be old newspapers or cans, or picking up various items to satisfy an urge to that they might need them at some point.
What other compulsions are there? Other compulsions can include mental rituals (such as praying) or having to think a “good” thought to overwrite or undo a “bad” thought. Compulsions in this category might also be that some people with OCD will have to tap or touch items—which might include dangerous items like a hot stove. Some compulsions might include avoiding items that could cause harm, like scissors. Eating in a ritualized way, or compulsions related to superstitions also fit in this category. Another compulsion in this category is trichotillomania—or hair pulling—which includes eyelashes, eyebrows, or hair from the person’s scalp or pubic area.
