Which of the following would not be considered a symptom of obsessive-compulsive disorder?

Obsessive-Compulsive Disorder

Welcome

Dear Reader,

IndoPsyCare is committed to delivering psycho-educational material to increase your understanding of a vast array of mental health conditions. 

Whilst we invite you to research this material, we do caution you to refrain from self-diagnosis. If at any point you feel that you may be experiencing the condition discussed on this page, please do not hesitate to reach out to IndoPsyCare. We have professionals who are here to help.

Definition

Obsessive-Compulsive Disorder vs. Transient Thoughts or Impulses

Members of the general population occasionally experience intrusive thoughts and images and feel the compulsion to repeat a behaviour. For instance, it is not uncommon for one to double-check that their home appliances are off or that the door is locked behind them. Worried that their hands are dirty, one may feel the need to use hand sanitizer. Bothered by the mess, one may spend time tidying or rearranging their room. Further, one may occasionally, seemingly out of nowhere, envision violent crime scenes. The rare, transient experience of these thoughts and urges is not in itself a sufficient indicator of the presence of obsessive-compulsive disorder.

Individuals with obsessive-compulsive disorder endure recurrent, distressing thoughts, images and urges. To temporarily alleviate anxiety, individuals typically respond to these with ritualistic and repetitive behaviours. Compared to transient thoughts and impulses, the symptoms of obsessive-compulsive disorder are detrimental to one’s day-to-day life. The symptoms of the condition are typically time-consuming, taking up more than an hour of their day or collectively lead to considerable distress and impairment across important life domains, interfering with functioning (social, occupational or otherwise).

Obsessive-Compulsive Disorder is a mental health condition in which individuals experience the presence of intrusive, seemingly ubiquitous obsessions. Obsessions may be defined as persistent, unwanted and intrusive thoughts and mental images that usually induce feelings of anxiety and distress. 

To escape or neutralize the discomfort initiated by these intrusive thoughts, individuals with OCD engage in compulsions. Compulsions may be defined as repetitive, ritualistic mental acts and/or behaviours that individuals feel as though they must perform in response to an obsession. These compulsions typically follow strict rules, or are performed to achieve a sense of “completeness”. 

Obsessions and Compulsions are idiosyncratic in nature. Some examples of obsessive thoughts include:

• I’m supposed to go on holiday next week, yet I have a terrible feeling. I should cancel my trip.
• What if my stomach ache is indicative that I have cancer? What if my previous doctors did not detect my illness?
• Something terrible will happen if I don’t count to a certain number.
• What if I did something awful and I can’t remember I did it?
• Why is he not replying to my text? Does he not love me anymore? Am I not his priority? Has he been in an accident?
• If I go to the kitchen and see a knife, I worry I might lose control and stab myself. 
• If I go into the kitchen, there’s a chance I may stab my family.

As previously mentioned, compulsions are performed to neutralize anxiety-provoking thoughts. Nevertheless, compulsions may or may not relate to the nature of an obsession.

For instance, 

• Repeatedly counting up to a certain number, so one’s mother does not fall ill.

• Excessive, ritualistic cleaning, including washing one’s hands, showering or brushing one’s teeth.
• Repeatedly checking and rechecking appliances, switches or locks. 
• Arranging and rearranging items several times until it feels “just right.”
• Constant seeking out reassurance that one’s partner loves them.
• Refraining from completing an assignment until it feels “just right.”

Obsessions and compulsions are time-consuming and typically take over an hour of an individual’s day. Otherwise, the condition commonly leads to considerable distress regarding the experience of anxiety symptoms, or considerable impairment in everyday functioning. Notably, the symptoms of the condition are not better attributed to other medical or mental conditions, and symptoms are not the byproduct of medicine and substances on the central nervous system. 

Symptoms

For a comprehensive list of obsessive-compulsive disorder symptomatology, we recommend you visit the ICD-11 webpage. 

Comorbidities

Amongst individuals with OCD, comorbidity with an anxiety disorder appears to be the norm rather than the exception. Unfortunately, comorbidity with other psychiatric conditions has been observed to increase both distress and disability, increasing the severity and chronicity of the course of the condition.

• Eating disorders
• Mood disorders (depression is particularly prevalent)
• Anxiety disorders
• Borderline personality disorder (BPD)
• Attention Deficit Hyperactivity Disorder (ADHD)
• Substance use

Development and Course

Below, we present research findings as reported within the ICD-11. Nevertheless, we would like to emphasize that each person is unique and, as such, the development and course that the condition follows in one individual may differ greatly in another. The information is intended, therefore, to address the condition in generalized terms and should not be considered definitive.

• The condition typically appears in one’s late teens or early twenties. OCD appearing age of 35 is considered a late-onset, and it is rare for the disorder to appear after this. 
• The condition typically occurs gradually. Sudden or late-onset may, in some cases, be indicative of the interplay of other factors, including medical conditions. 
• Most individuals who endure the condition during childhood experience remission in early adulthood. 
• There are significant differences in symptom severity. Some individuals may only experience obsessions for a shorter time, whilst others may endure them for extended periods to the point that symptoms become incapacitating. 

Variability

There are variations in the way this condition presents. Below, we present findings reported within the ICD-11.

• Approximately a quarter of males experience childhood-onset (before the age of 10)
• Whereas females report more urges to clean and contaminated related thoughts and urges, males endure more thoughts regarding symmetry and taboo topics (such as violence)

• The content of obsessions may vary across one’s life. In childhood, most individuals endure obsessions that involve adverse events befalling their loved ones, whereas during adulthood one may endure obsessions about inappropriate sexual or aggressive acts. 
• Many children with OCD experience complete remission.

Etiological Risk Factors

OCD comprises a vicious cycle of mutually reinforcing symptoms. It is difficult to identify a singular cause or establish a sole generating factor that begins this cycle. 

The factors contributing to the onset and maintenance of this condition are heterogeneous and multifactorial in nature. In most cases, the condition is a result of several precipitating factors interacting together in concert. For instance, dispositional factors typically interact with the environment in which the condition develops. 

Nevertheless, we remind you that whilst a correlation exists between these variables and the manifestation of the condition, its onset, prognosis, and outcome are not definitively based upon the presence of one or several of the variables. 

• High levels of Neuroticism
• Low levels of extraversion
• Perfectionist tendencies
• Rigidity and inflexibility
• Intolerance to uncertainty
• Self-criticism
• Impulsivity
• Indecisiveness 

Twin and sibling studies find that genetics may elevate the risk of OCD onset by 23% and account for 59- 80% of the persistence and stability of symptoms over time.

Neurobiological factors

Neuroimaging studies demonstrate changes to brain circuits, and ensuing deficits in neural functioning may contribute to OCD manifestation.

 OCD has been associated with PANS, a clinical situation originating from infection or inflammation. Children experience a sudden (sometimes overnight) onset or exacerbation of OCD symptoms and/or severe food restriction.

• Authoritarian parenting, abuse, familial dysfunction, and traumatic life events have been implicated in OCD development and persistence. 
• Drastic changes in responsibility: Changes in life circumstances (such as pregnancy) that bring on dramatic increases in responsibility are believed to increase the risk of developing OCD.

Consequences

Studies have suggested that many individuals with obsessive-compulsive disorder may have a compromised, lower, quality of life compared to community samples. Whilst not everyone experiencing this condition will experience functional disruptions, studies have associated the condition with several consequences. Individuals with obsessive-compulsive have been observed to be at heightened risk for disruptions across several domains. 

Research finds individuals with OCD are less likely to:

• Pass all core and additional courses at the end of compulsory school
• Access a vocational or academic program in upper secondary education
• Complete high school
• Start an undergraduate university degree
• Finish an undergraduate university degree
• Start and finish postgraduate education

Research finds individuals with OCD were more likely to fulfil at least one of these objective outcomes: 

• Receiving disability pensions (early retirement)
• Long-term absence from work due to mental illness
• Long-term unemployment

• Impaired or fractured friendships 
• Resistance to emotional and physical intimacy
• Increased likelihood of separations and divorce
• Relational maladjustment and dissatisfaction
• Avoidance of social contacts and occasions 
• Difficulty taking trips or holidays
• Neglect of hobbies

Epistemological studies find that experiencing OCD significantly increases the chances of experiencing suicide ideations. 

A Gentle Reminder

We sincerely appreciate your dedication; you have made it through this section of our IndoPsyCare library. We trust that you have gleaned valuable information from this page. Before we part ways we would like to reiterate the importance of refraining from diagnosing yourself, or other individuals, based on the information provided. If you feel as though you or others are experiencing this condition, we implore you to seek professional help. 

Sources and Recommended Readings

Disclaimer 

We would like to emphasize that the information presented herein was derived from external sources. IndoPsyCare does not claim ownership of any information or research within these pages. For your convenience, our team has constructed a list of the sources utilized and included further research and reading

World Health Organization. (2019). ICD-11: International Classification of Diseases (11th revision). Retrieved from https://icd.who.int/

Code for Obsessive Compulsive Disorder: 6B20

Franklin, M., & Foa, E. (2011). Treatment of Obsessive Compulsive Disorder. Annual Review Of Clinical Psychology, 7(1), 229-243. doi: 10.1146/annurev-clinpsy-032210-104533

Pérez-Vigil, Ana; Mittendorfer-Rutz, Ellenor; Helgesson, Magnus; Fernández de la Cruz, Lorena; Mataix-Cols, David (2018). Labour market marginalisation in obsessive–compulsive disorder: a nationwide register-based sibling control study. Psychological Medicine, (), 1–10. doi:10.1017/S0033291718001691 

Pérez-Vigil, A., Fernández de la Cruz, L., Brander, G., Isomura, K., Jangmo, A., Feldman, I., Hesselmark, E., Serlachius, E., Lázaro, L., Rück, C., Kuja-Halkola, R., D’Onofrio, B. M., Larsson, H., & Mataix-Cols, D. (2018). Association of obsessive-compulsive disorder with objective indicators of educational attainment: A nationwide register-based sibling control study. JAMA Psychiatry, 75(1), 47–55. https://doi.org/10.1001/jamapsychiatry.2017.3523

Schwartzman, C. M., Boisseau, C. L., Sibrava, N. J., Mancebo, M. C., Eisen, J. L., & Rasmussen, S. A. (2017). Symptom subtype and quality of life in obsessive-compulsive disorder. Psychiatry Research, 249, 307–310. https://doi.org/10.1016/j.psychres.2017.01.025

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