Not all mental disorders are based on an abnormal perception of reality. Some, such as obsessive-compulsive disorder (OCD) , are expressed not through the way information from the surrounding world is interpreted, but through actions that arise from the subject himself: so-called repetitive behaviors , or compulsions , which undermine people’s quality of life by producing unpleasant sensations and limiting their degree of freedom.

However, talking about this kind of behavior is only half the story. The other half is found in intrusive thoughts, which are closely linked to compulsions . From a psychological perspective, it can be said that both intrusive thoughts (or obsessions) and compulsions are the two main gears through which obsessive-compulsive disorder is articulated. But… how do these two pieces come to be activated?

Obsessive-compulsive disorder: intrusive thoughts and compulsions

Obsessive-compulsive disorder is a anxiety disorder , and therefore is characterized by being associated with feelings of fear, distress and continuous stress in a magnitude that is a problem for the day to day and negatively affects the quality of life of the person in virtually all areas in which it is developing.

In the specific case of obsessive-compulsive disorder, the motor of these anxiety crises is the obsession-compulsion cycle . The obsessions occur spontaneously, independently of the person’s will, and become so frequent that they become invasive. In addition to creating distress, these intrusive thoughts trigger a series of repetitive behaviors aimed at reducing the anxiety produced by the obsessions.

Thus, OCD is characterized as a disorder that combines the symptoms of anxiety and those of impulse control problems .

OCD is also characterized by repetitive behaviors

However, far from being helpful, repetitive behaviors are actually compulsions, that is, stereotypical behaviors that are beyond a person’s control , as are thoughts whose negative effects they try to mitigate. That is why the diagnostic picture of obsessive-compulsive disorder includes not only intrusive thoughts, but also the stereotypical actions that follow them.

By dint of repetition, both obsessions and compulsions come to take over the person’s life, just as pathological gambling takes over the gambler’s everyday life. The obsession-compulsion cycle makes the anxiety persist, since the person who experiences the obsessive-compulsive disorder anticipates the appearance of intrusive thoughts and stereotyped behaviors and knows that they are beyond his control. In this way, the person enters a loop of action and reaction that is increasingly difficult to undo.

The Most Common Compulsions in OCD

The compulsions associated with OCD cover a practically infinite and unmanageable range of possibilities , and moreover its variety grows as technological changes are introduced in our lives.

However, there are certain compulsions that are much more common than others. What are the most common behaviors among people with this disorder?

1. Need to clean

These compulsions are usually related to obsessions that have something to do with the idea of dirt or rot, literal or metaphorical. People with these types of compulsions may clean their hands too often , or do the same with objects or other parts of the body. It is all part of a desperate and urgent attempt to get rid of the dirt that invades what should be pure.

This is one of the most frequent variants of Obsessive-Compulsive Disorder, and can lead to skin lesions due to erosion .

  • Learn more: “Obsession with cleanliness, causes and symptoms”

2. Need to order

For some reason, the person who has this type of OCD compulsion feels that he or she needs to sort out various elements , either because of the intrinsic value of being in a place with things neatly packed away or to make a good impression. This type of compulsion has been linked to the classic laws of Gestalt, since according to this psychological current we notice a feeling of tension or a slight discomfort if what we perceive does not form a well-defined and meaningful whole. In this sense, a disordered environment would create discomfort by presenting difficulties in being perceived as a perfectly defined whole: a study room, a dining room, etc.

Thus, obsessive-compulsive disorder would occur when this feeling of discomfort is amplified so much that it harms the person’s levels of well-being and quality of life, by forcing them to order so as not to feel bad.

3. Accumulation-related compulsions

In this type of obsessive-compulsive disorder, the person has the need to save all kinds of elements, taking into account their possible use in the future , despite the fact that, purely for statistical reasons, it is highly unlikely that a situation will arise in which each of the accumulated things will be able to be used.

From some schools of psychodynamic currents, such as classical Freudian psychoanalysis, this tends to relate to Freud’s psychosexual theory. However, the current clinical psychology starts from some assumptions and a philosophy of research and intervention that have nothing to do with psychoanalysis.

4- Checking compulsions

Another typical example of obsessive-compulsive disorder is a person who needs to constantly make sure everything is working as it should to the point of doing the same thing several times every day. This is a case of a compulsive check, based on the need to avoid future accidents and, more specifically, to make the thoughts and imaginary scenes about the accidents that might occur stop altogether and stop producing discomfort. These thoughts appear involuntarily and lead to various checks aimed at reducing the risk of their occurrence, which in turn becomes a difficult habit to change.

Causes of obsessive-compulsive disorder

As with many psychiatric syndromes, little is known about the precise biological mechanisms by which some people develop obsessive-compulsive disorder . This is not surprising because in order to address it, in addition to studying the complicated functioning of the human brain, it is necessary to address the context in which the person has been developing, his or her habits and living conditions, etc. In short, it is necessary to understand OCD from a biopsychosocial perspective.

Manuals such as the DSM-IV describe the set of symptoms that characterize this anxiety disorder, but beyond the diagnostic criteria there is no theoretical model supported by a broad scientific consensus that explains its causes in good detail. New research in neurosciences, together with the use of new technologies to study the functioning of the brain, will be decisive in finding out what causes OCD.

The relationship between this psychological phenomenon and perfectionism

Many people assume that OCD has to do with perfectionism, since in compulsions a chain of steps is always followed as closely as possible. However, everything seems to indicate that OCD is not so much related to this scrupulousness as to the lack of it. For example, while people with Obsessive-Compulsive Personality Disorder score very high on Responsibility (a feature of the Big Five model created by psychologists Paul Costa and Robert McCrae), those with Obsessive-Compulsive Disorder tend to score very low on this feature .

This indicates that in OCD, there is an intention to pathologically compensate for the tendency to chaotic and spontaneous behavior that occurs in other aspects of life, that is, to move from exercising very little scruples most of the time, to obsessing over it for a few minutes.

Relationship to Body Dysmorphic Disorder

The obsessive-compulsive disorder presents some symptomatic characteristics that overlap with those of Body Dysmorphic Disorder, a psychological alteration that is also based on perceptive rigidity , and in which the person is very concerned that the aesthetics of his body does not get out of a very defined canons. For this reason, its comorbidity is high: where one is diagnosed, it is very possible that the other is also there.

If they occur together, it is important to treat these two disorders as separate entities, as they affect different aspects of patients’ lives and also express themselves through other situations.

Bibliographic references:

  • Doron, G,; Derby, D, Szepsenwol. O. & Talmor. D. (2012). Tainted Love: exploring relationship-centered obsessive compulsive symptoms in two non-clinical cohorts. Journal of Obsessive-Compulsive and Related Disorders 1 (1): pp. 16 – 24.
  • Colesa, M.E.; Frostb, R.O.; Heimberga, R.G.; Rhéaumec J. (2003). “Not just right experiences”: perfectionism, obsessive-compulsive features and general psychopathology. Behaviour Research and Therapy 41 (6): pp. 681 – 700
  • Rhéaume, J.; Freeston, M.H.; Dugas, M.J.; Letarte, H.; Ladouceur, R. (1995). Perfectionism, responsibility and Obsessive-Compulsive symptoms. Behaviour Research and Therapy 33(7): pp. 785 – 794.
  • Kaplan, Alicia; Hollander Eric. (2003). A Review of Pharmacologic Treatments for Obsessive Compulsive Disorder.
  • Sanjaya Saxena, MD ;Arthur L. Brody, MD; Karron M. Maidment, RN; Hsiao-Ming Wu, PhD; Lewis R Baxter, Jr,M D (2001). Cerebral Metabolic in Major Depression and Obsessive-Compulsive Disorder Occurring Separately and Concurrently. Society of Biological Psychiatry.