Obsessive-Compulsive Disorder (OCD) is a mental health condition characterised by persistent, intrusive thoughts (obsessions) and repetitive behaviours (compulsions) aimed at reducing the distress caused by these thoughts.
While the term "OCD" is often used colloquially to describe a preference for cleanliness or order, this usage significantly downplays the reality of Obsessive-Compulsive Disorder. Unlike casual references to being "a little OCD" about something, the actual disorder can severely impact daily functioning and quality of life. Understanding the distinction between colloquial use and clinical reality is important for fostering empathy and accurate awareness of the challenges faced by those with OCD.
OCD Criteria
The diagnostic criteria for OCD, according to the DSM-5, include:
Presence of Obsessions, Compulsions, or Both:
Obsessions are recurrent and persistent thoughts, urges, or images that are experienced as intrusive and unwanted. Common types include, but are limited to:
Aggressive Obsessions: Fear of harming oneself or others.
Contamination Obsessions: Fear of germs, dirt, or environmental contaminants.
Religious Obsessions: Concerns related to blasphemy or religious morality.
Sexual Obsessions: Intrusive thoughts about inappropriate sexual acts.
Hoarding and Saving: Difficulty discarding items, regardless of their value.
Symmetry and Exactness: Need for objects to be arranged in a particular order.
Compulsions are repetitive behaviours or mental acts that a person feels driven to perform in response to an obsession. Common compulsions include:
Checking: Repeatedly verifying things (e.g., locks, appliances) to prevent harm.
Cleaning and Washing: Excessive hand washing or cleaning to reduce contamination fears.
Repeating and Counting: Performing actions a specific number of times or in a certain way.
"Just Right" Compulsions: The need to do things until they feel "just right."
Time-Consuming and Interfering: These obsessions and compulsions are time-consuming (taking more than an hour a day) and cause significant distress or impairment in social, occupational, or other important areas of functioning.
OCD and Neurodivergence
As with many mental health diagnoses, people with ADHD and/or autism have higher rates of OCD. It is hard to find figures, but the ranges I have seen suggest that OCD is many times more likely to occur in people with ADHD and/or autism than in the general population. In the case of autism, the presence of repetitive behaviours and rules and routines can blur the edges between what is autism and what is co-occurring OCD.
Effective Treatments for OCD
Treatment for OCD generally involves a combination of medication and therapy:
Medication
Selective Serotonin Reuptake Inhibitors (SSRIs): These are the most commonly prescribed medications for OCD and include drugs such as fluoxetine, sertraline, and citalopram.
Therapy
Cognitive-Behavioural Therapy (CBT): This is the most effective psychological treatment for OCD. A specific form of CBT, called Exposure and Response Prevention (ERP), involves gradually exposing individuals to their fears and helping them resist the urge to perform compulsions.
Acceptance and Commitment Therapy (ACT): This therapy focuses on accepting obsessive thoughts without acting on them and committing to behaviours that align with one's values.
I have treated many people over the years with exposure and response prevention for OCD. Some people have already been on an antidepressant, and some have chosen to start one to aid in OCD treatment. What I generally tell my clients is that treatment is about shrinking down the compulsive behaviours, which in turn reduces the frequency and intensity of obsessive thoughts and reduces the time taken to perform compulsions, with an increase in quality of life.
OCD doesn't tend to go away. It just gets smaller. Symptoms can ramp up again in times of stress or higher anxiety, and new obsessions and compulsions can always arise and can latch onto almost anything. Knowing how to treat oneself with therapy interventions can help prevent OCD from becoming significant and troublesome again if obsessive thoughts start to increase. Some people return for refresher therapy sessions to help reduce symptoms if they haven't been able to do this on their own adequately.
Conclusion
Being aware of the higher incidence of OCD in people with ADHD and/or autism is important when people are presenting for assessment or treatment of either OCD or neurodivergence. OCD can expand and attach to new fears and behaviours, particularly when anxiety and stress levels are raised, and requires specific treatment. Non-specific talking therapy will seldom be an effective treatment. Combining medication with evidence-based therapies like CBT and ACT can help to shrink OCD obsessions and compulsions, and learning these skills can help prevent additional obsessions and compulsions from developing in the future.
Clinical psychologist Dr Roberto Olivardia explores the links between OCD and ADHD in this ADDitude article.
The International OCD Foundation does a good job of describing OCD in autistic people and how it can be more difficult to detect due to repetitive behaviours that can be part of autism.
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