A Conversation About Obsessive Compulsive Disorder (OCD)

February 1, 2023

Studio Talk Podcast: Real Conversations About Mental Health

A Conversation About Obsessive Compulsive Disorder (OCD)

Season 2 Episode 6

In this episode our co-hosts discuss Obsessive Compulsive Disorder (OCD). The discussion covers this wildly misunderstood condition and makes an effort to clear up some basic misinformation about it. Mental Health Counselor Victoria Lockridge discusses her personal experience with OCD and how she has learned to manage it effectively. She provides tips on how to recognize OCD in yourself or in a loved one and provides resources to find support and treatment for it.

The co-hosts, Xiomara A. Sosa and Victoria Lockridge have an honest and open discussion regarding OCD and invite the listeners to share their stories with them in the comments.

As always, Studio Talk Podcast encourages their listeners to provide feedback, comments as well as their opinions and experiences about their own experiences with major life transitions that impacted their mental health. The discussion offers resources and references for listeners to review and examine and listeners are encouraged to do their own research and draw their own conclusions about the issues discussed. As with most issues, there are negatives and positives found and the co-hosts recognize that as reality and have an honest conversation about it.

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Following are some points for reference:

• OCD is one of the most misdiagnosed mental health disorders (Takes approximately 14 years of treatment services until someone is accurately dx with OCD)
• OCD can be incredibly disabling
• Important not to make jokes about being “OCD” because you are organized or clean.
• OCD is more than excessive hand washing and checking behaviors
• Compulsions do not have to be behaviors- often compulsions are “hidden” mental acts (ie. avoidance, mental rituals, reassurance seeking, rationalizing).

Clinical Definition of OCD

The DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition) provides clinicians with official definitions of and criteria for diagnosing mental disorders and dysfunctions. Although not all experts agree on the definitions and criteria set forth in the DSM-5, it is considered the “gold standard” by most mental health professionals in the United States.

DSM-5 Diagnostic Criteria for Obsessive-Compulsive Disorder (300.3)

A. Presence of obsessions, compulsions, or both:

Obsessions are defined by (1) and (2):

1. Recurrent and persistent thoughts, urges, or impulses 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 (e.g., hand washing, ordering, checking) or mental acts (e.g., praying, counting, repeating words silently) 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.

Note: Young children may not be able to articulate the aims of these behaviors or mental acts.

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 (e.g., a drug of abuse, a medication) or another medical condition.

D. The disturbance is not better explained by the symptoms of another mental disorder (e.g., excessive worries, as in generalized anxiety disorder; preoccupation with appearance, as in body dysmorphic disorder; difficulty discarding or parting with possessions, as in hoarding disorder; hair pulling, as in trichotillomania [hair-pulling disorder]; skin picking, as in excoriation [skin-picking] disorder; stereotypies, as in stereotypic movement disorder; ritualized eating behavior, as in eating disorders; preoccupation with substances or gambling, as in substance-related and addictive disorders; preoccupation with having an illness, as in illness anxiety disorder; sexual urges or fantasies, as in paraphilic disorders; impulses, as in disruptive, impulse-control, and conduct disorders; guilty ruminations, as in major depressive disorder; thought insertion or delusional preoccupations, as in schizophrenia spectrum and other psychotic disorders; or repetitive patterns of behavior, as in autism spectrum disorder).

Specify if:

With good or fair insight: The individual recognizes that obsessive-compulsive disorder beliefs are definitely or probably not true or that they may or may not be true.

With poor insight: The individual thinks obsessive-compulsive disorder beliefs are probably true.

With absent insight/delusional beliefs: The individual is completely convinced that obsessive-compulsive disorder beliefs are true.

Specify if:

Tic-related: The individual has a current or past history of a tic disorder.

The previous edition of the DSM (DSM-IV) categorized Obsessive-Compulsive-Disorder (OCD) under ‘Anxiety Disorders’. However, some experts controversially suggested that the revised edition of the DSM remove OCD from this category and group it with loosely related conditions under the heading of ‘Obsessive-Compulsive and Related Disorders‘, which is what they did indeed do for DSM-5.

The most frequent reason for supporting a move out of the anxiety disorders section was that obsessions and compulsions, rather than anxiety are the fundamental features of the disorder. The main reasons for disagreeing with such a move were that OCD and other anxiety disorders respond to similar treatments and tend to co-occur.

DSM-5 Categorisation

In DSM-5, Obsessive-Compulsive Disorder sits under its own category of Obsessive-Compulsive and Related Disorders and within that the following subcategories were placed:

• Obsessive Compulsive Disorder (OCD)
• Body Dysmorphic Disorder (BDD)
• Hoarding Disorder
• Trichotillomania
• Excoriation (Skin Picking) Disorder
• Substance/Medication-induced Obsessive-Compulsive and related Disorder
• Obsessive-Compulsive and Related Disorder due to another medical condition
• Other specified Obsessive-Compulsive and Related Disorder
• Unspecified Obsessive-Compulsive and Related Disorder

OCD is characterized by the presence of obsessions and/or compulsions. Obsessions are recurrent and persistent thoughts, urges, or images that are experienced as intrusive and unwanted, whereas compulsions are repetitive behaviors or mental acts that an individual feels driven to perform in response to an obsession or according to rules that must be applied rigidly. Some other obsessive-compulsive and related disorders are also characterized by preoccupations and by repetitive behaviors or mental acts in response to the preoccupations. Other obsessive-compulsive and related disorders are characterized primarily by recurrent body-focused repetitive behaviors (e.g., hair pulling, skin picking) and repeated attempts to decrease or stop the behaviors.

OCPD versus OCD

What is obsessive-compulsive personality disorder (OCPD)? Obsessive-compulsive personality disorder (OCPD) isa mental health condition that causes an extensive preoccupation with perfectionism, organization and control. These behaviors and thought patterns interfere with completing tasks and maintaining relationships.

People with OCPD have rigid beliefs and specific ways of doing different tasks. They don’t allow for any flexibility and are unable to compromise with others. People with OCPD often don’t realize their behavior and way of thinking are problematic.

OCPD is one of a group of conditions called “Cluster C” personality disorders, which involve anxiety and fear.

Even though they sound similar, obsessive-compulsive personality disorder (OCPD) and obsessive-compulsive disorder (OCD) are different conditions.

OCD is an