Obsessive-Compulsive Disorder (OCD) is one of the most common mental disorders; however, it is also one of the most misunderstood. It is only too normal nowadays to hear or even say phrases such as “I’m so OCD about...” or “I have so many little OCDs”; while not necessarily the most sincere of statements, it is becoming an increasingly common mistake - what the person in question is more likely to mean is that they’re either very compulsive about certain things or they have some perfectionist-type attitudes. OCD itself is primarily an anxiety disorder that can quite clearly be split into two halves: obsessions and compulsions – and it is here that the misunderstanding usually arises; despite being partly true, obsessions do not always lead to compulsions. Obsessions tend to exist on their own whereas many compulsions do indeed need an underlying obsession, but that is not to say that compulsions can’t themselves exist on their own (Sometimes mistaken for Tourette’s Syndrome, compulsions due to OCD differ in that they’re ‘voluntary’ whereas with tics are more inadvertent – It could be said that Tourette’s is to OCD what coughing is to clearing one’s throat).

Obsessive-Compulsive Disorder symptoms are, as mentioned above, split into the following two categories:

As with many symptoms of anxiety disorder, obsessive thoughts can cause high levels of tension, distress and, yes – you guessed it, anxiety. Common obsessions include: concerns over cleanliness – the conviction that everything around oneself is unclean and hence harmful and needs to be cleaned before anything is done in that environment; worries over disease and ill health – constant fear or suspicion of having contracted a deadly disease, this can often appear as a strong case of Hypochondria ( Hypochondriasis); a necessity for things to be ordered or done in a certain way– there is not necessarily a logic to the order but to the person concerned failure of objects or other people to adhere to it can cause great concern despite the lack of any real consequence.

Less apparent and certainly more distressing are the kinds of obsession that obsessive-compulsives are less likely – and unsurprisingly so – to talk about as they generally involve thoughts of extreme violence either done unto them by someone else, or – much more distressingly – the thought of themselves committing these acts on their friends, family or even a complete stranger. Thoughts of a graphic sexual nature are also possible; ranging from kissing to extremes such as rape and paedophilia, these thoughts can be about anyone or indeed, anything, of any age or sex and can often lead to doubt over one’s sexuality. Much though these sorts of thoughts are generally considered psychotic, although very disturbing, they are by no means a sign of Psychosis as generally they are recognised as being completely unacceptable and often lead to disgust with oneself for thinking such things. Thoughts and doubts of this nature can sometimes lead to cases of Social Anxiety Disorder in sufferers of OCD due to a lack of confidence in one’s ability to withstand the temptation to give in to one’s mind and a subsequent reluctance to participate in social activities. Hyperhidrosis or ‘excessive sweating’ as it is more commonly known can arise as another side effect of the suppression of these concepts when in public - which often serves only to increase anxiety levels and further enthuse them to stay at home.

It is possible for Obsessions to exist on their own without any sign of Compulsions, this is informally termed Pure-O OCD and is estimated to account for just over half of all cases of OCD. The problem with Pure-O is that while a casual onlooker may pick up on somebody carrying out their Compulsions and recognise that they have OCD, it is very hard to tell when somebody has Pure-O and often leads to confusion and anxiety amongst friends and family as they seek a reason or motivation for the avoidance of situations and even go so far as to put it down to some form of mild Autism.

As previously mentioned, many compulsions are the result of obsessions, for instance, concerns over cleanliness usually lead to excessive cleaning and – a common stereortype of OCD – the compulsive washing of one’s hands throughout the day despite no immediately obvious reason for it; it may appear harmless, or might even be considered ‘playing it safe’, however, it can lead to dermatitis and permanent damage of one’s hands if care is not taken. Another common compulsion is the organisation of objects into patterns: alphabetical, by colour, size, or placing items parallel and at right angles to each other. A need to touch certain objects and people can also arise and be dangerous in certain circumstances such as when sharp objects are concerned.. Repeated actions are also common as is the obsessive counting of objects, a precise daily routine, the checking of locks and many many more.

While compulsions can often seem strange and unnecessary to other people, failure to carry them out can cause the sufferer considerable distress to the extent that it can cause panic attacks even if – as many do – they recognise them as irrational. The mental turmoil caused to people with extreme cases of OCD can produce symptoms that often draw parallels to Bipolar Disorder – sudden unexplained fits of irritation, anxiety and anger that are swiftly followed by embarrassment, sadness and guilt once the compulsion has been fulfilled. That is not to say that it is anywhere near as severe as the symptoms of Bipolar Disorder, however, similarities can certainly be drawn.

Obsessions and compulsions based around perfection, the necessity of order, routine, rules and organisation are often associated with OCD and they are considered symptoms when present along with others. However, when isolated it is often a sign of Obsessive-Compulsive Personality Disorder (OCPD) or just Perfectionism.

The easiest and most readily available Obsessive-Compulsive Disorder Treatment is Exposure and Response Prevention (ERP) therapy and involves the gradual resistance of compulsions, the breaking of various routines and the rationalisation of obsessions. While fairly effective with compulsions, it is much harder to dispose of obsessive thoughts with this method. The same method is used with many mental disorders such as the majority of phobias.

Behavioural Therapy sessions in which a therapist will use ERP have been unsurprisingly shown to be much more effective than doing it oneself. Therapists can also help with obsessions through the use of various psychological treatments including Cognitive Therapy whereby the underlying reasons and convictions behind obsessions are explored.

Many different forms of medicine can also be prescribed or purchased to deal with OCD. While many are not specifically aimed at obsessive-compulsives, most are general anti-depressants such as Prozac which increases serotonin levels and hence helps to reduce anxiety and stress caused by OCD. (Serotonin, while the vast majority of it in your body is found in the digestive tract to regulate the movement and contractions of the gut, the rest is produced in the Central Nervous System where it regulates mood, appetite, sleep, memory and learning as well as other cognitive functions. It is a natural deficiency in Serotonin that is hypothesised to be a cause of OCD and is hence why Selective Serotonin Reuptake Inhibitors (SSRIs) i.e. anti-depressants are prescribed to sufferers).

Obsessive-Compulsive Disorder is a very complex and wide-ranging mental illness, while I hope that I’ve given a fairly good idea of just what it involves and what sufferers go through, I cannot possibly even begin to claim that it has all been covered. Every person with OCD will have different and diverse symptoms that will affect them in various levels of severity. If you have any questions about OCD or how it has affected me, feel free to ask – I’ll be happy to answer them.

Hi, I’m Sasha, the author of this article, the reason for this section is that while it’s all very well to explain the various permutations and combinations of obsessions and compulsions, it’s not really that easy to fully understand what it’s like – it is because of this that I felt the need for this part. I do have OCD in a fairly severe form, while it is mostly Pure-O I do still have several compulsions, so here’s a brief idea of what goes through my head and what I ‘need’ to do on a daily basis: Everything I do has to be started and finished either on the half hour or on the hour – including getting up and going to bed; if I were to wake up at 10:01 I would lie in bed for 29 minutes before actually getting up, the same with leaving the house. For years I’ve recited the number pattern 80808910 over and over in my head; many things have to be done in the time it takes me to do this this a set number of times, everything from having to turn over in bed before I finish to having to get from my kitchen to my room in 10 recitals.

My pillows have to be exactly in the centre of my bed with the openings to the pillow case on the right hand side (larger flap parts on the top) with the buttons at the base of my duvet cover facing upwards – I can’t sleep without this being the case, and when I do go to sleep I face left for 5 minutes then turn over to go to sleep regardless of where I am in the world. I quite often have extreme mental images of violence committed against people in my immediate surroundings by me as well as some sexual ones, however, even here in near anonymity I’m still too ashamed to go into them any further.

I often have urges to touch things – hot things especially as well as testing the sharpness of objects such as knives – i.e. pressing them into my hand until it comes close to drawing blood. I have an insanely long and complex set of ideas as to where objects in my home should be – there is very little logic behind most of them but to me it is ‘right’, for instance, the position of speakers around a computer or the orientation of a desk chair when I go to bed at night. Light switches must all be in the same position whenever possible and I will run up and down the stairs fiddling with them until they are. If placed on a shelf, books and folders are organised by colour, however, if stacked, it is by size.

These are just a few of my obsessions and compulsions, there are many others – they are not consciously thought of, they just spring into existence and with equal randomness cease to bother me. I’m not seeking sympathy here, it just seemed to be a better way of truly explaining what the symptoms are like compared to the much more vague ones found in the main body of the article.

I take no medication for my problem – I’m scared of what it might do to me. Ironic, isn’t it?

-Sasha