Definition
OCD is an anxiety disorder in which the main features are the repeated occurrence of obsessions and/or compulsions of sufficient severity that they are time-consuming (> 1 hour per day) and/or cause marked distress or functional impairment Obsesiones
Obsessions
Obsessions can take the form of repetitive, distressing, and intrusive thoughts, images, or impulses, although obsessive thoughts are by far the most common symptom presentation. Obsessional content can be highly idiosyncratic and shaped by the individual’s personal experiences, sociocultural influences, and critical life incidents. However, certain themes are more common than others, such as:
- 1. A concern about dirt or contamination (e.g., “Did I soil this chair, thereby exposing others to my feces and possible contamination?”).
- 2. Disease and illness (e.g., “I can’t open this door because the doorknob is covered with germs that could inflict me with a deadly disease.”).
- 3. Doubts about security (e.g., “Did I lock the door when I left the office this evening?”).
- 4. Violence and injury (e.g., “Did I accidentally run over the pedestrian I just passed while driving?”).
- 5. Personally repulsive sexual acts (e.g., “Am I sexually attracted to children?”).
- 6. Immorality and religion (e.g., “Did I completely confess all of my sins to God?”).
- 7. Miscellaneous topics (i.e., persistent concerns about order, symmetry, exactness, routine, and numbers).
Compulsions
Compulsions are repetitive, stereotyped overt behaviors or mental acts that are associated with a strong subjective urge to perform even though the individual may desire to resist the response to varying degrees.
A compulsion usually involves some overt action such as repeated hand washing or checking, but it can also be a covert or cognitive response like a subvocal rehearsal of certain words, phrases, or a prayer.
Overt compulsions, however, like repeated checking (61%), washing/cleaning (50%), or reassurance seeking (34%) are most common, whereas symmetry/precision (28%) and hoarding (18%) are least common.
Compulsive rituals are usually performed in order to reduce distress (e.g., repeated handwashing reduces anxiety evoked by touching an object perceived as possibly contaminated) or to avert some dreaded outcome (e.g., a person repeatedly checks the stove to ensure the knob is off and the possibility of fire is prevented).
Often compulsions are followed in accordance with certain rules such as checking seven times that the light switch is turned off before leaving a room. Compulsions perform a neutralization function that is directed at removing, preventing, or weakening an obsession or its associated distress.
Even so, compulsions are clearly excessive and often are not even realistically connected to the situation they are intended to neutralize or prevent. With a strong sense of subjective compulsive and unsuccessful attempts to resist the urge, individuals with OCD usually feel a loss of control over their compulsions.
The Six Belief Domains of Obsessive–Compulsive Disorder
A number of cognitive themes have been identified that together constitute primal threat mode activation in OCD. The following are six belief domains that are thought to characterize the schematic content of OCD:
Inflated responsibility “ … the belief that one has power which is pivotal to bring about or prevent subjectively crucial negative outcomes”
Overimportance of thoughts “ … beliefs that the mere presence of a thought indicates that it is important”
Overestimation of threat “ … an exaggeration of the probability or severity of harm”
Importance of controlling thoughts “ … the overvaluation of the importance of exerting complete control over intrusive thoughts, images and impulses, and the belief that this is both possible and desirable”
Intolerance of uncertainty beliefs about the necessity of being certain, the personal inability to cope with unpredictable change, and difficulty functioning in ambiguous situations
Perfectionism “ … the tendency to believe there is a perfect solution to every problem, that doing something perfectly (i.e., mistake free) is not only possible but also necessary, and that even minor mi mistakes will have serious consequences”