If you think of Obsessive-Compulsive Disorder you might think of the maniac Melvin Udall dodging tiles in ( As good as it gets ).

The great Jack Nicholson appears on the tape obsessed with order and neatness, perfectly aligning his walking shoes at home, or being unable to go to bed without having locked the door several times. These rituals are only a small example of the many hobbies that the novelist presents, his life being articulated around them.

What is obsessive-compulsive disorder?

Obsessive-Compulsive Disorder, popularly known as OCD, is a disorder characterized by obsessive thoughts and compulsive actions such as cleaning, checking, sorting, or excessive accumulation.

Obsessions are repetitive, unwanted thoughts, images, or impulses that cause anxiety and discomfort for people with OCD. Obsessions occur in an intrusive manner, regardless of the person’s will, and become so frequent and disabling that they can completely dominate the life of someone with OCD.

The person who has these obsessive thoughts tries to ignore or suppress them. To do so, he or she carries out compulsions or compulsive rituals, which are intended to neutralize the obsessions and their feared consequences.

Compulsions are like repetitive motor or cognitive behaviours (praying, counting numbers) that are performed according to certain rules, in a stereotypical way. The purpose of these behaviors or thoughts is to prevent or reduce distress, or to avoid a feared situation or event.

Most frequent obsessions

Among the most common obsessions in OCD are those related to dirt and pollution, order and checking.

1. Ideas of contamination

One of the most common types of obsessions is pollution obsessions. These are characterized by a
exaggerated fear of dirt , germs, getting infected or contracting a disease.

Many times the fear in these patients may be to feel dirty, and they may spend a great deal of time washing themselves. These ideas may be focused on someone else as well, such as fearing that a loved one will become ill or die from an infection or germs.

2. Need for pathological verification or doubt

The obsession of these individuals consists of
constantly check that they have not been careless in such a way that they are responsible for the negative consequences they fear, for example starting a fire by forgetting to turn off the stove, leaving the tap running, or not locking the door when leaving the house.

Excessive doubt and the need to check commonly lead to checking rituals.

3. Need for order or symmetry

In this case the concern is
arrange or order things “perfectly” , perform certain activities in an exact, symmetrical or balanced way, such as parking correctly or arranging clothes meticulously.

The thought that lies at the base of the obsessive idea is: “It is absolutely essential that everything is in order and in its place.

4. Aggressive and sexual obsessions

These individuals have
excessive fears of doing harm to others or committing an unacceptable sexual act such as thinking they may stab a loved one, fantasizing about sexually abusing someone or an exaggerated fear of being homosexual.

Many are horrified by their obsessions and do not tell others about them out of embarrassment, mistakenly believing that thinking something reprehensible is equivalent to doing it.

5. Religious Obsessions

The excessive fear in this case is based on
committing sins, blaspheming , not praying enough, fear of going to hell or not being forgiven, etc. The behaviors or compulsions they perform to eliminate their anxiety may be praying repeatedly or going to church numerous times.

Most frequent compulsions or rituals

The following are the most commonly described rituals for OCD. Many of these types of compulsions are directly related to the obsessions described above.

1. Cleaning

Washing is the most frequent compulsion
associated with the pollution obsession . People with this kind of compulsion can clean their hands too often, just as Melvin Udall did, washing his hands three times in a row every time he came home and using different new soaps that he then threw away.

Other examples are: excessive brushing of teeth, avoiding public toilets or thorough cleaning of the home for fear of germs. This behavior typically occurs after contact or proximity to the contaminated object.

2. Of order or symmetry

The ritual seeks to alleviate a fear that
if something is not done, a misfortune will occur , or mitigate the unpleasant feeling that things are not as they should be. These compulsive actions are derived from the need for symmetry or order.

Some examples would be to avoid stepping on black tiles, sorting things according to certain predetermined criteria, etc.

3. Repeat

Individuals are characterized by
repeating phrases or behaviours insistently , in the belief that this will prevent the dreaded catastrophe from occurring. They may want to follow certain routines, such as always eating at the same table in the same cafeteria, or always going to work the same way.

4. Accumulation

In this type of OCD, the person has the need to
save all kinds of elements according to their possible use in the future. They can accumulate a lot of unnecessary things like old newspapers, empty bottles or cardboard boxes.

5. Checking

They focus on
prevent the occurrence of possible disasters . They are associated with pathological doubt and the need for verification.

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In general, those who perform these rituals tend to use the strategy of re-insurance, asking people close to them things like “Did you see me put out the fire?” or “Did I close the door of my house?

6. Mental Compulsions

These are thoughts or mental acts that, like observable behaviors, are performed to neutralize or reduce the anxiety caused by the obsession. It is common
repeat words, phrases or numbers in order to alleviate distress.

Mental compulsions are often confused with obsessions because they are covert rather than motorized behaviors; the fundamental difference is that obsessions generate anxiety and compulsions reduce or prevent it.

Bibliographic references:

  • American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5).