Often when people think of a person with Obsessive-Compulsive Disorder (OCD) they picture a person hyper-focused on the need to be neat, almost to perfection. While cleanliness is next to godliness and this may be one aspect of OCD, it does not tell the entire story. In fact, OCD occurs along a spectrum similar to autism, which includes a wide range of obsessive and compulsive behaviors.
Currently, the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) defines OCD as having obsessions, compulsions, or both.
What Do Obsessive-Compulsive Spectrum Disorders Look Like?
Obsessions are defined as both:
- Unwanted recurring and persistent thoughts, urges, or images that cause anxiety or distress; and
- Attempts to overpower these thoughts, urges, or images, or to cancel them out with another thought or action (i.e., a compulsion).
Compulsions are defined as both:
- Repeated behaviors or mental acts were done in response to an obsession or rules that must be rigidly applied; and
- Behaviors or mental acts focused on preventing or reducing distress or a feared situation. However, these behaviors or acts are not really connected to the obsession it was meant to cancel out or are clearly excessive.
According to the American Psychiatric Association (APA), there are various types of typical obsessions and compulsions a person could experience.
| Examples of obsessions could include: | Examples of compulsions could include: |
| Fear of getting contaminated by people or the environmentDisturbing sexual thoughts or imagesFear of blurting out obscenities or insultsExtreme concern with order, symmetry, or precisionRecurrent intrusive thoughts of sounds, images, words, or numbersFear of losing or discarding something important | Excessive or ritualized hand washing, showering, brushing teeth, or toiletingRepeated cleaning of household objectsOrdering or arranging things in a particular wayRepeatedly checking locks, switches, or appliancesConstantly seeking approval or reassuranceRepeated counting to a certain number |
This means that several disorders could display very similar obsessive-compulsive behaviors while not quite fitting into the cookie-cutter mold of how the DSM-5 defines the diagnostic criteria for OCD. Sometimes the only difference between another related disorder and OCD is the specific focus of the obsessions and/or compulsions (i.e., physical appearance, skin, hoarding, or hair).
4 Different Types of OCD (Obsessive-Compulsive Spectrum Disorders)
Understanding that obsessive-compulsive behaviors vary in terms of range now expands the idea of obsessive-compulsive spectrum disorders including more than just Obsessive-Compulsive Disorder under its umbrella. The DSM-V considers related other OCD-related disorders to include:
- Body dysmorphic disorder: Obsession with perceived defects or flaws in physical appearance that leads to compulsions.
- Skin-picking disorder: Recurring skin picking that results in injuries with repeated attempts to decrease or stop skin picking.
- Hoarding disorder: Ongoing difficulty getting rid of or parting with items due to strong urges to save items/fear of distress, and the collection of so many items that it makes spaces non-functional.
- Hair-pulling disorder: Recurring hair-pulling from any part of the body leading to hair loss with repeated attempts to decrease or stop hair-pulling.
This illustration shows how obsessive-compulsive disorders include more than just OCD. Other related disorders include body dysmorphic, skin-picking, hoarding, and hair-pulling disorders.
Effective Treatment Options for Obsessive-Compulsive (OCD) Spectrum Disorders
Treatment for Obsessive-Compulsive Disorder and its related disorders includes a wide range of interventions that can be used singularly or in combination with other treatment forms. The selected treatment depends on the person, their preferences, and the severity of their disorder. Using guidance from the APA and the National Institute of Mental Health, treatment options include therapy, caregiver support, self-care, medication, and in more intense cases surgery.
- For those who tried medication first but it was not as effective, psychotherapy such as cognitive behavior therapy (CBT) may be an option. Specifically, exposure and response prevention have individuals spend time in a fearful situation that triggers their compulsion while instructing them to avoid doing their normal resulting compulsive behavior. By staying in a fearful situation without anything terrible happening, the individual learns to reduce their compulsive behaviors.
- For those who have the support of family and/or caregivers, they can be asked to help or support with home exposure and response prevention practice as discussed during therapy.
- For those who tried CBT first but it was not as effective, medication may be considered as an option. Selective serotonin reuptake inhibitors (SSRIs) are used to help reduce obsessive-compulsive symptoms. As a note, recommended SSRI dosages for OCD and its related disorders are usually higher than those used for depression and may take 6 to 12 weeks to start fully working. Additionally, if an individual does not respond to one SSRI medication, another SSRI may be used, or psychotic medication may be considered as a last option.
- For those who opt to take a more holistic route, maintaining a healthy lifestyle through effective exercise and nutrition may be beneficial. Additionally, stress-reducing techniques can be used such as mediation, yoga, visualization, and massage.
- For those not responsive to the previous interventions or those with more severe obsessive-compulsive spectrum disorder cases, brain surgeries such as deep brain stimulation or anterior capsulotomies may be considered. Due to the risks of brain surgery, these options should only be considered once the less invasive ones have been tried.
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