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          What OCD Is and Is Not

          June 03, 2003

          Although obsessive-compulsive disorder (OCD) can be a complex disorder, Dr. Phil believes that 50 percent of the solution lies in defining the problem. In order to do this, it’s important to know what OCD is and is not.

          OCD is:

          • Neurologically based
          • Anxiety driven
          • Fairly common
          • A coping mechanism
          • Responsive to medication
          • Responsive to cognitive behavior
          • Manageable

          OCD is not:

          • An all or none phenomenon
          • An indicator that you’re crazy
          • Worthy of the guilt you may feel
          • About the target of your focus
          • Schizophrenic behavior
          • Gender specific
          • Very efficient

          Obsessive Compulsive Disorder:
          The characteristic symptoms of OCD are the presence of obsessions and compulsions. Obsessions are repetitive and persistent thoughts, images, or urges. Importantly, obsessions are not pleasurable or experienced as voluntary: they are intrusive and unwanted and cause marked distress or anxiety in most individuals. The individual attempts to ignore or suppress these obsessions or to neutralize them with another thought or action. Compulsions (or rituals) are repetitive behaviors or mental acts that the individual feels driven to perform in response to an obsession or according to rules that must be applied rigidly. Most individuals with OCD have both obsessions and compulsions. Compulsions are typically performed in response to an obsession. The aim is to reduce the distress triggered by obsessions or to prevent a feared event (e.g., becoming ill). However, these compulsions either are not connected in a realistic way to the feared event or are clearly excessive. Compulsions are not done for pleasure, although some individuals experience relief from anxiety or distress.

          The obsessions and compulsions must be time-consuming (e.g., more than 1 hour per day) or cause clinically significant distress or impairment to warrant a diagnosis of OCD. This helps to distinguish the disorder from the occasional intrusive thoughts or repetitive behaviors that are common in the general population. The frequency and severity of obsessions and compulsions vary across individuals with OCD.

          Obsessive-compulsive and related disorders differ from developmentally normative preoccupations and rituals by being excessive or persisting beyond developmentally appropriate periods. The distinction between the presence of subclinical symptoms and a clinical disorder requires assessment of a number of factors, including the individual’s level of distress and impairment in functioning.

          Up to 30 percent of individuals with OCD have a lifetime tic disorder. This is most common in males with onset of OCD in childhood. These individuals tend to differ from those without a history of tic disorders in the themes of their OCD symptoms, comorbidity, course, and pattern of familial transmission.

          Diagnostic Criteria
          A. Presence of obsessions, compulsions, or both:

          Obsessions are defined by (1) and (2):
          1. Recurrent and persistent thoughts, urges, or images that are experienced, at some time during the disturbance, as intrusive and unwanted, and that in most individuals cause marked anxiety or distress.
          2. The individual attempts to ignore or suppress such thoughts, urges, or images, or to neutralize them with some other thought or action (i.e., by performing a compulsion).

          Compulsions are defined by (1) and (2):
          1. Repetitive behaviors or mental acts that the individual feels driven to perform in response to an obsession or according to rules that must be applied rigidly.
          2. The behaviors or mental acts are aimed at preventing or reducing anxiety or distress, or preventing some dreaded event or situation; however, these behaviors or mental acts are not connected in a realistic way with what they are designed to neutralize or prevent, or are clearly excessive.
          B. The obsessions or compulsions are time-consuming (e.g., take more than 1 hour per day) or cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
          C. The obsessive-compulsive symptoms are not attributable to the physiological effects of a substance or another medical condition.
          D. The disturbance is not better explained by the symptoms of another mental disorder.

          Source: DSM-5

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