OCD (Obsessive Compulsive Disorder) is constantly featured in movies, and people usually laugh or have a good time watching the curious behaviour of these characters. However, suffering from this disorder and living with an obsessive-compulsive patient is anything but funny. These individuals have recurrent thoughts that become disturbing and pressing if they don’t do something about it. These pressing thoughts are called obsessions. On the other hand, the steps and actions they take to relieve these thoughts are often repetitive, but it’s their way to “solve the problem” and be done with it. These actions are called compulsions.
In this article, we will break down the signs and symptoms of obsessive-compulsive disorder into three different categories: Obsessions (pressing thoughts), compulsions (actions taken to relieve pressing thoughts) and other physical symptoms common in these individuals.
Obsessions
Constant fear of contamination
Obsessive-compulsive patients have a pressing concern that their surroundings are contaminated and they might become infected as well when they have close contact. We would usually understand these symptoms as fear of germs and dirt, but it is not only about being clean all the time. Instead, obsessive-compulsive individuals develop a very complex contamination fear, and they would be wary and careful around things like broken glass, pets, and even substances that feel sticky or unwelcome to the touch.
Every patient would have his own array of fears and obsessive thoughts against certain type of materials, and they can experience pressing ideas to clean themselves from body fluids like saliva, sweat, and even tears. Some would even feel contaminated after touching certain types of soap and would prefer one over the other.
Sometimes, their obsessive thoughts about contamination go beyond the physical realm and become intellectual or even magical. In these cases, obsessive-compulsive patients would be afraid of becoming contaminated with certain mental images, with bad luck, being around or touching certain colours, or staying in places where bad things happened.
Aggressive or embarrassing thoughts
There are many forms of obsessive thoughts, not only those related to staying clean or uncontaminated. In some patients, there is an aggressive type of obsessions instead. These patients are utterly afraid of causing harm to others, and they have constant thoughts of doing just that for no reason. When these thoughts come to mind, they would consider them dangerous and become upset and worried about actually doing what they thought unintentionally. This often builds up and as the symptoms perpetuate they would grow anxious and depressed.
For example, in a case scenario, an obsessive-compulsive patient is using a knife while cooking in the kitchen with his loved one, and the aggressive thought would start pressing on his mind that he can stab his wife with that same knife just as he’s doing with the tomatoes. They instantly become afraid of their own thoughts and starts worrying about actually performing these aggressive behaviors someday.
Aggressive thoughts may not only be focused on another person but the patient himself. They might become worried about losing their own control and jumping off a cliff or doing something against him or herself.
Embarrassing thoughts are common as well, as in fear of insulting people or screaming in public. These fears can be severe enough to make them sweat and tremble out of anxiety, terrified on the thought that they might forget all they need to say in their speech or do something incorrectly. In this case, obsessive-compulsive behaviour should be differentiated with social phobia, and if you have a doubt, it would be a good idea to schedule a visit with a psychiatrist to get a full review of your symptoms.
Constant need of perfect order
Obsessive-compulsive individuals have a pressing thought around order and arranging. They grow preoccupied with maintaining things symmetrical and organised, lined up and precisely ordered in colours or shapes. When something does not feel right, they can’t stop looking, become increasingly anxious, and there’s a moment they cannot think of anything else and need desperately to go fix the problem.
The need for perfect order is always “their” ideal order, and there’s a correct way to do things according to their standards. When these are not met, they feel a constant source of discomfort. These obsessive thoughts slow down productivity and impair the daily life and activities of people with obsessive-compulsive disorder as they take excessive amounts of time to maintain everything tidy.
Compulsions
Excessive cleaning
The most commonly known compulsion in obsessive-compulsive disorder is excessive cleaning. It is a compulsion associated with the obsessive thought of being afraid of contamination, and it is about spending excessive amounts of time to clean every item and object in the house and doing the same thing with clothes and everything they consider to be dirty. It is an exaggerated behaviour that may reach the point of cleaning the credit card after every use or their cellphone whenever someone else touched it.
Everything that comes into contact with something or someone that is not themselves is a potential threat, and they feel the urge to clean them. In most cases, they do so repeatedly and with excessive or exaggerated methods.
Scrupulous handwashing
The second most commonly known compulsion is scrupulous handwashing, but obsessive-compulsive individuals do not only wash their hands excessively, but they may do the same thing with their grooming while taking a bath or tooth brushing. All of these activities become a repetitive ritual, and they take a very long time cleaning themselves until they are satisfied.
Excessive washing includes not only removing dirt but also a repeated behaviour, cleaning each finger individually and sometimes with various tools, paying close attention to details on their fingernails, and even ending up with red of bleeding hands when they finish washing. Their showering is also a long ritual consisting of repetitive cleaning in the same areas over and over again.
In trying to maintain their hands off dirt, they would also use extra measures to keep away from contamination, such as maintaining tissues around to open and close doors, wearing gloves while interacting with other people and avoiding certain places out of the fear of being in contact with too many contaminants.
Ordering and arranging
Ordering and arranging are associated with the obsessive thought of maintaining a perfect order around them. As we mentioned, obsessive-compulsive patients have an obsessive idea to keep everything symmetrical and in order. However, it is not exactly how things are arranged but the number of times they perform an arranging protocol. They start counting and would not stop organizing the same thing over and over again until a certain number is met.
They might also become distressed or even aggressive when someone breaks their tidying cycles or moves their things to another place where they do not belong. Whatever anybody else does or thinks, obsessive-compulsive patients need to perform these rituals to quiet their minds and keep on with whatever they need to do. Thus, it becomes a problem with other people living around them, who are constantly seen as a source of disorder and mess. This often creates social conflicts and ultimately impairs the relationships of these individuals with their loved ones and family members.
Counting once and over again
Another possible compulsive behaviour in these patients is counting, which can be adapted to many things, even some we have already talked about. For example, they may need to count the times they wash their hands before leaving the bathroom. Counting compulsions are repetitive tasks of whatever nature that should be performed a number of times. Otherwise they would not be satisfied, and the thought would be kept in their minds that they have not finished what they started.
These patients are often fixed for one given number, and they count every action they make trying to match the number every time. They may even smoke an extra cigarette, not because they really want to, but trying to complete the number they are always aiming at.
In most cases, these patients perform this counting compulsion without even noticing as in counting the steps or counting the number of cars or people passing by. They may also do this in their mind or aloud for everyone else to listen. In this regard, counting becomes a secondary compulsive behaviour that contributes to another, as in people who have the compulsive behaviour of washing their hands, and the secondary compulsive behaviour of counting the number of times they clean all around their fingers.
In some cases, counting becomes a source of extra fear, apprehension and obsessive thoughts. There are patients who believe certain numbers are bad luck and they would die of severe disease if they keep staring or stay in contact with this specific number, so they do whatever it takes not to match the said number in their daily counting. As illogical as it may sound for anyone else, it is a structured thought and makes perfect sense in their minds to the point of becoming distressed and angry if they are unable to fix the problem.
Continuously checking on things
Similar to counting, checking on things becomes a secondary type of compulsive disorder meant to relieve an obsessive thought. Obsessive-compulsive patients have a checking ritual associated with their obsession, and it is meant to make sure that the problem is solved and everything is under control. Still, they keep on checking when there is the slightest doubt that they have made a mistake.
For instance, a patient with an obsessive thought about safety would have the compulsive behaviour of staying up in the middle of the night to open and close the locks. Even if they did just that a moment ago, they need to keep on repeatedly checking if the locks are properly bolted and if nobody can enter their house by chance. Or they suddenly remember about the window latches and need to check on that lock just in case.
In some cases, this compulsive behaviour is associated with other obsessive thoughts, as in the case of the fear of harming themselves or other people. They always need to make sure they are not causing harm to other people by chance. Thus, they would need to check if they have not performed damage to others, as in checking their bodies to see if they got any cut or sore, or stopping the car to check if the bump they felt while driving is not a small child or someone they could have run over.
Physical symptoms
Motor and vocal tics
In some cases, patients with obsessive-compulsive disorder would also have a motor or vocal tic disorder. Motor tics can be simple or complex. They are often repetitive movements in the eyes, a sudden jerking movement or shrug, or a complex motor tic as in brushing the hair with the hands without noticing. These tics should be distinguished from compulsive behaviour because the latter is associated with an obsessive thought that is not present when patients have a motor tic.
On the other hand, vocal tics may appear as well, usually as constant throat clearing or sniffing, and it is often associated with speech. In some cases, patients would suddenly grunt, and they don’t even realise they are making awkward sounds. Tics appear to be more common in obsessive-compulsive children, but they are also seen in adults.
Obsessive-compulsive disorder is a very wide array of signs and symptoms that are uniquely adopted by every patient. There’s no clear cut to say that all obsessive-compulsive patients do this or that. Instead, what they have in common is an obsessive thought that is translated into a compulsive behavior meant to solve the problem. When the compulsive behavior is rendered not sufficient, or it is not performed, the obsessive thoughts haunts the patient and would not let him do anything else.
If you have found this behaviour in yourself or your loved one, do not hesitate and do not be afraid of a psychiatrist. They are meant to help you relieve these symptoms and avoid them to become worse over time.
References
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