Obsessive-compulsive disorder

What it is

Obsessive compulsive disorder is an Axis I diagnosis with true obsessions and compulsions. Obsessions are intrusive, repetitive thoughts; compulsions are ritualistic behaviors. The usual are contamination, doubt, and recurrent washing and checking behaviors. Obsessions are recurrent thoughts, described in full as recurrent and persistent thoughts, urges or images that are experienced as intrusive and unwanted and that cause marked anxiety or distress; compulsions are recurrent acts. The obsessive thought causes the anxiety, and the compulsion is a way of temporarily relieving it, but because the relief is only temporary the compulsion is performed repeatedly. The common obsessions are cleanliness and contamination, so washing hands; doubt; symmetry, with elaborate rituals for entering doorways or arranging books; and counting.

How it is diagnosed

The trap is obsessive compulsive personality disorder, which is close in name only.

• It is an Axis II, Cluster C diagnosis
• It is a lifelong pattern of perfectionism and inflexibility, typically with over conscientiousness and constricted emotions, and excessive time consumption in finishing tasks
• No obsessions and no compulsions are present

The two are easily distinguished in that only the disorder, not the personality disorder, is associated with true obsessions and compulsions. So a patient who is perfectionistic, inflexible and slow to finish work, but who has no intrusive thoughts and no rituals, has the personality disorder. The patient should be disturbed by the obsessions and should recognize their absurdity, in contrast to the personality disorder, where the patient sees nothing wrong with the compulsion. Thoughts of killing one's own children belong here when they are ego-dystonic and she is in fact quite distressed by them: there is then no need to inform the police or child protective services, nor to admit her to hospital.