Patients suffering from obsessive-compulsive disorder (OCD) present two main categories of symptoms: obsessions and compulsions. The disorder disrupts behaviour, thought and emotion, and in some severe cases can lead to major handicaps in patients’ daily lives, and even to significant social isolation, with obsessions preventing them from concentrating and compulsions keeping them ‘busy’ for up to 8 or 9 hours a day.
Obsessions in obsessive-compulsive disorder
Obsessions are repeated involuntary thoughts, images or impulses that occur regularly and unexpectedly, which the person with OCD cannot avoid and which cause intense anxiety. They are generally associated with suffering, risk to the sufferer or those around him or her, or death.
Obsessions are very often based on responsibility, or even guilt about the consequences of past, present or future wrongdoing, leading to pervasive doubts.
The most frequent obsessions concern :
- Risks of contamination, accident, aggression, harm suffered or inflicted on others, loss. For example, patients may be obsessed by the risk of viral contamination from a door handle or another person’s hand, and must therefore disinfect their hands with bleach after each contact with an object or another person.
- Risks associated with forgetting, for example forgetting to lock the door
- The disorder, lack of alignment, symmetry or regularity of things
Compulsions in obsessive-compulsive disorder
Compulsions involve repeated behaviours and rituals, the main aim of which is to soothe or even suppress the anxieties associated with obsessions. These behaviours are excessive, repetitive and have no real justification. They can be visible, such as washing hands for more than 2 hours a day or checking that a door is closed more than 30 times, or invisible, such as mental arithmetic or repeating words.
Rituals in compulsive behaviour disorder
Rituals generally have to be carried out in a strict order and patients are sometimes asked to repeat the ritual if it has been interrupted or if they think they have made a mistake. For example, some patients have to check the mail in their letterbox at least 20 times from left to right. This ritual has to be restarted if they lose count or start from the right.
Some rituals are directly linked to anxiety, such as washing hands after contact with objects, while others have nothing to do with obsession, such as counting to 50 before leaving the house, starting with the left foot.
Some patients are aware of the excessive nature of their behaviour, but are unable to avoid it and therefore hide from those around them in order to carry it out.
A majority of patients suffering from OCD have other associated mental disorders, with 75% suffering from anxiety disorders and 60% from major depressive disorder or bipolarity.