March 16, 2016

Expanding Our Understanding of OCD

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Kimberly Glazier, PhD, and Lata K. McGinn, PhD

Albert Einstein College of Medicine, Bronx, New York


Obsessive-compulsive disorder (OCD) is often portrayed by the media and educational training materials in a limited scope. Typically, when people think of OCD, they think of symptoms such as checking locks or the stove, frequently washing one’s hands, and arranging items to make them symmetrical and orderly. While these examples are common symptoms of OCD, the condition can manifest in many ways, and a limited understanding of these manifestations is problematic from a diagnostic and treatment perspective.

OCD occurs when an individual has an unwanted thought or image (obsession), and the presence of the obsession causes the person anxiety. In an attempt to get rid of the obsession, the individual performs mental and physical behaviors, also known as compulsions or rituals. Mental rituals include actions such as counting, saying safe words, or visualizing safe images. Physical rituals include behaviors such as touching, tapping, rewriting, and confessing.

The following examples of common obsessions are often unrecognized as symptoms of OCD by medical and mental health professionals:

  • Violent obsessions about hurting/killing others or oneself
  • Sexual obsessions regarding rape, pedophilia, incest
  • Sexual obsessions related to one’s sexual orientation
  • Religious obsessions about blasphemy

The ways in which OCD can manifest are essentially limitless. Below is a case example to highlight symptoms of someone with violent OCD obsessions.

Terry experiences unwanted thoughts about harming others. Constantly throughout the day, he thinks about the fact that he may take out his pocketknife and stab people whom he walks past. Since Terry is not sure if he actually has acted on his thoughts, he turns around each time after walking by a person to make sure the individual is still alive and well. When at work, Terry worries that he may intentionally spill hot coffee on his coworker; when having these thoughts, he can actually picture himself taking the coffee cup and splashing the boiling liquid in his colleague’s face. Terry used to love drinking coffee every morning but now avoids it. However, he can still see the office coffee pot from his desk and worries he may grab the pot one day and burn his colleague. At home, Terry is concerned that, when hugging his wife, he may intentionally hug so hard that he cracks all of her ribs. Whenever he hugs his wife, Terry says aloud, “I love you.” He believes that saying “I love you” will prevent him from hurting his wife.

Terry’s distressing thoughts/images are obsessions, while the checking, avoidance, and magical thinking are compulsions.

A more accurate understanding of OCD would benefit health care professionals, individuals with OCD, and society at large. Greater knowledge of the many ways in which OCD presents (including morally unacceptable thoughts) will hopefully lead to destigmatization and normalization of all symptom presentations of OCD and improve diagnosis and treatment.

Financial disclosure:Drs Glazier and McGinn have no personal affiliations with any commercial interest to disclose.​

Category: Obsessive-compulsive Disorder
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One thought on “Expanding Our Understanding of OCD

  1. Thanks for your post, for a person who struggles with OCD I can relate to your explanation in many ways including the wacky thoughts about hurting oneself and others, Being Raised in a Fundamental Church where the evil (demons) were always in a battle against good, it has been quite an effort to attribute these thoughts more appropriately to a mental defect, especially when, I have thoughts which can make me ill as they visualize. Of course I am always trying to neutralize these unwanted intrusions to my daily life. Recently I thought that maybe I should forget ever having a relationship or marriage considering along with these is a great tendency of paranoia which in itself becomes obsessive. I think that being a workaholic most of my life was my way to run away from these thoughts, try to direct thoughts to something useful and hopefully no more bandwidth left for the bad thoughts. Being unable to relax and enjoy life or have continuity over different time-lengths vs. only able to Plan a to-do list but not able to define when and or if that list will ever get done, but it at least is a goal of sorts.

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