What are obsessive-compulsive disorders?

The term obsessive-compulsive disorder refers to a very heterogeneous set of symptoms. A distinction is made between pure obsessive thoughts and compulsive actions. Both are characterized by uncontrollable thoughts and/or impulses and repetitions.

Obsessive actions take up a lot of time in everyday life. They are also sometimes accompanied by physical consequences (e.g. skin problems caused by excessive washing). Those affected often have a strong need to make sure that everything is really okay. However, by repeatedly carrying it out, the associated insecurity usually increases instead of decreasing.

Obsessive thoughts often have similar content across cultures (sexual, aggressive or religious content). These are unpleasant for those affected, so they try to defend themselves against them. However, this usually makes these thoughts stronger instead of weaker.

Obsessive-compulsive disorder affects around 1-2% of the population. Women and men are affected in roughly equal numbers, with women more likely to develop compulsive cleaning, while men are more likely to develop compulsive thoughts and symmetry. There appears to be a genetic predisposition to obsessive-compulsive disorder, which is indicated by increased activity in brain regions for behavioral patterns and habits as well as increased error processing. Obsessive-compulsive disorders are often triggered by acute or long-term psychological stress.

Impairments associated with obsessive-compulsive disorder

A distinction is made between different symptom areas, which can occur individually or in combination:

• Cleaning and washing compulsions: here, fear of contamination leads to discomfort and this leads to washing and cleaning rituals; if interrupted, rituals often have to be performed all over again
• Control compulsions: here, fears of triggering a catastrophe often lead to the stove, taps, windows, doors and/or electrical appliances being checked repeatedly
• Repetition and counting compulsions: also out of fear that something bad could otherwise happen, certain (mental) actions must be carried out a certain number of times.
• Compulsions of order: those affected place a high value on symmetry and order
• Obsessive thoughts without compulsive actions

According to the latest DSM-5 diagnostic system, obsessive-compulsive disorders now belong to the area of obsessive-compulsive spectrum disorders, to which impulse control disorders such as trichotillomania (hair plucking), dermatillomania (skin plucking) and pathological hoarding (collecting) are also assigned in addition to obsessive-compulsive disorders. Body dysmorphic disorder (BDD) also belongs to the obsessive-compulsive spectrum disorders.

Obsessive-compulsive personality disorder is to be distinguished from this. Here, those affected adhere strongly to rules and appear quite rigid, but generally have neither obsessive thoughts nor actions.

As a rule, these symptoms do not disappear on their own, but tend to become more distressing over time, so that most sufferers need therapeutic help. As these symptoms are often accompanied by great shame, those affected often withdraw and only seek therapy at a late stage. However, the effectiveness of cognitive behavioral therapy for OCD is well documented. If you find yourself in these descriptions, we would like to encourage you to contact us. We can offer you the necessary counseling and, if necessary, psychotherapy.