Obsessive-Compulsive Disorder, known as OCD, is an anxiety disorder that includes the presence of obsessions or compulsions or both that hamper daily life and cause major distress. Everybody who suffers from OCD has different experiences and the symptoms can be divided into different types depending on the nature of the symptoms.
Most of us have some sort of daily routine that we stick to. We wash our hands before meals or check we have locked the house. We make sure that our cups are all together in the same cupboard and our books are arranged in a certain way. All these routines and compulsions are considered normal and are quite harmless.
It is when we feel we have to wash our hands even when we have done it half a dozen times already or we avoid touching other people because we think their skin and breath is filled with germs that these compulsions become excessive and start to interfere with our work, education and social lives.
About 2% of the population is affected by OCD. The behaviour of OCD sufferers is caused by an irrational fear and a sense of danger, risk or harm that gives them the compulsion to perform unnecessary, intentional, repetitive actions.
Types of OCD
OCD can be differentiated into five different types based on the underlying fear that causes the obsessions.
Fear of Contamination
These are the “Washers and Cleaners” and their irrational fear is of becoming contaminated by germs and dirt. This is the most well-known type of OCD and the most common. These people are the ones who repeatedly wash their hands, take showers several times a day and for long periods, wash their clothes repeatedly and take showers frequently. They are obsessively scared of illness and death and debilitating problems such as blindness.
“Washers and Cleaners” work out a list of the most dangerous things down to less dangerous things. The contamination fear can become so bad that the sufferer feels that there is only a small safe are that isn’t contaminated as the contamination spreads. They also feel that they need to protect others from the contamination. This can cause tension and stress as the sufferer will insist that friends and family avoid the contaminations too as they can either become contaminated or spread the germs to the safe areas.
It isn’t always fear of illness that is the cause of the contamination obsession. Some sufferers are worried about sticky or greasy matter. They can’t even say why they are worried by this matter, just that it makes them feel uncomfortable.
Fear of Catastrophe
These individuals are called “Checkers”. They fear that if they don’t keep re-checking things such as doors being locked or electrical items switched off, then they will cause harm to themselves and others. So they have time-consuming and elaborate rituals that mean they check things over and over again and so they can’t complete other tasks. They can also be afraid that they can cause harm even with things that are outside of their control. Sufferers say that they doubt their own memories of what they have done.
They are afraid of accidentally hitting a pedestrian whilst they are driving, that they will cause a fire by leaving the iron, the hair straighteners or the cooker on, or that there will be a burglary if they leave the windows or a doors unlocked.
Fear of Disorder
People who spend lots of time making sure things are organised and become very upset when things are rearranged, moved or touched are called “Orderers”. They repeatedly arrange, organise and line up objects until they meet certain conditions or until they feel that the end result is “just right”. Sufferers will carefully line up their shoes so they form a straight line or write letters over and over again until they look right to them. They also engage in touching, tapping and counting behaviours.
Fear of Horrifying Thoughts
“Obsessionals” are frightened by the fear of acting on unwelcome violent thoughts of hurting a loved one or themselves and have to count or repeat certain words over and over again to banish these thoughts. This is the most upsetting type of OCD for the sufferer. They are usually people who have no history of violence and never actually act on their thoughts. They think that just having these thoughts is as bad as committing the act and put in a large amount of mental effort to control the thoughts but this only makes them worse.
Violent or horrific images pop into their heads with no warning such as mutilated bodies or cemeteries. Sufferers are scared they will do something embarrassing or shocking such as blurting out obscenities, insults or swear words even when they aren’t angry. They are afraid they will do something embarrassing such as writing nasty emails or that will steal things or shoplift.
Fear of Throwing Things Away
These people are termed “Hoarders”; they have a terrible fear that they will need something that has been thrown away, so they keep everything, even junk and rubbish that there can be no need for ever. They also hoard useful items but excessively.
Sufferers can become trapped in their own homes as the clutter takes up more and more room and they use showers and ovens as extra storage space. They carefully read junk mail and collect old newspapers; they sort through rubbish to save useful items and collect useless and free things.
This type of OCD sufferer is more likely to suffer from anxiety and depression and social isolation problems. They have a very strong emotional attachment to their possessions, are worried they will forget things and have problems with decision making.
Overlapping OCD Types
It is possible to experience of other types of OCD at the same time as each other even thought most of the symptoms are mainly consistent with one type. Symptoms tend to be very stable over time but the focus and nature of the symptoms can change.
OCD is a neurotic behaviour and could be caused by chemical and brain dysfunction, disturbances in early development, infection, depression and genetics. As the cause is different for each individual treatment is different for each one and could include medication, therapy or a mixture of the two.
When looking at treatment there are several factors to be considered. The doctor will look at what has worked for the patient in the past and their attitude towards medication. The severity of the symptoms the sufferer is experiences and whether they have any other problems such as depression are present.
The choice of therapy for the OCD sufferer includes Cognitive-Behaviour Therapy (CBT) and Exposure Response Prevention (ERP). Most OCD types respond well to a combination of both these therapies and medication. Hording is the only type that doesn’t respond to mediation but sufferers find relief through psychotherapy.