Obsessions in Obsessive-Compulsive Disorder (OCD)

The Types of Obsessions in OCD

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Obsessive-compulsive disorder (OCD) is a mental health disorder in which a person experiences repeated thoughts (called obsessions) that drive them to perform certain actions (known as compulsions) to alleviate the anxiety the thoughts cause.

In a given year, approximately 1% of adults in the United States have a diagnosis of OCD. Males often show symptoms of OCD in childhood, but females are affected at a higher rate by adulthood.

OCD can appear in any person at any age, but the average age of onset is 19.5 years.

25% of people with OCD have symptoms by the time they're 14 years old.

OCD, Obsessions, and Compulsions Defined

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), outlines diagnostic criteria for “Obsessive-Compulsive and Related Disorders."

To be diagnosed with OCD, a person must meet the following criteria:

  • The presence of obsessions, compulsions, or both
  • The obsessions or compulsions are time-consuming (more than one hour per day) or cause significant distress or impairment in one’s daily functioning
  • The symptoms are not better accounted for by the physiological effects of a substance, medical condition, or other mental illness

Obsessions are recurrent, persistent, intrusive, and unwanted thoughts, images, or urges that cause anxiety or distress. People with OCD attempt to ignore or suppress obsessions, or have to neutralize them by performing a compulsion.

Compulsions, on the other hand, are repetitive behaviors or mental acts a person with OCD is driven to perform in response to an obsession or according to a rigid set of rules that govern them. Compulsions are clearly excessive or not connected in a realistic way to the problem they are intended to address.

Obsessions and Compulsions

Obsessions often involve a feared outcome, such as being responsible for harm to oneself or to others or being seen as unethical, immoral, or imperfect.

For example, someone with OCD may become obsessed with the worry that they will unintentionally cause a fire in their home due to carelessness. The fear may become so overwhelming that it drives them to perform compulsions to minimize the perceived potential for harm and decrease the anxiety and distress they feel.

A person dealing with a harm obsession related to fire might need to check all the outlets in their home before leaving the house to reduce the perceived risk that a fire will occur. Doing so drastically diminishes the anxiety associated with the obsession.

Compulsions are also commonly misunderstood and can vary from one person with OCD to the next.

Types of Obsessions

Contrary to common misunderstandings about OCD, being "obsessed" is not the same as thinking about something or someone often with fondness and deriving pleasure from the thoughts. Obsessions in OCD are distressing, time-consuming, and fear-driven.

Characteristics of OCD Obsessions

  • Internal experiences occur repeatedly, are unwanted, and feel as though they are outside of the individual’s control.
  • They cause a great deal of discomfort, such as anxiety, disgust, fear, and may be overwhelming.
  • The persistence of these ideas interferes with the person's ability to attend to other things of importance to them.

While the exact content and nature of obsessions will vary from one person with OCD to the next, there are some common themes.

Contamination

Common obsessions related to contamination can include dirt, germs, bodily fluids, disease, environmental contaminants, or chemicals.

Harm

People with harm obsessions may fear of harming themselves or others, be afraid of being responsible for something bad happening, or unintentionally causing harm.

When people with OCD have harm-related obsessions, they do not necessarily fear that they will intentionally do harm. Instead, they might fear unintentionally causing harm through carelessness, which can lead to checking compulsions (like needing to check all the outlets in their home before leaving).

Unwanted Sexual Thoughts

A person with OCD may have intrusive, unwanted, forbidden, or perverse sexual thoughts. These obsessions can take the form of images or impulses concerning homosexuality, sexual thoughts about children, incest, rape, or sexual aggression.

Religiosity/Scrupulosity

People with OCD may have obsessive thoughts, worries, or concerns about moral judgment and behaviors (or "being good"). If they are religious, they may be worried about offending God or blasphemy.

Losing Control

Some people with OCD fear that they will lose control. They worry about harming themselves or others through impulsive verbal acts, such as insulting someone or saying something taboo or forbidden, or physical acts like stealing or violence. The mental imagery of these obsessions may be aggressive or even horrific in nature.

Perfectionism

"Just right" OCD obsessions are concerned with evenness, exactness, symmetry, a need to know or remember, being driven to adhere to rigid routine or expectation, and an overall need for something to feel "just right."

Physical Illness

Separate from contamination obsessions related to germs, people with OCD can also have obsessions around illness and disease. They may be preoccupied with worries that they have a disease or that they will get one.

Sometimes, people with OCD are hyperaware of bodily processes like swallowing or breathing. These somatic obsessions can contribute to obsessions related to illness, pain, or disease.

Superstitious Beliefs

A person with OCD may believe that certain numbers, colors, words, or phrases are "lucky" or "unlucky." If the latter, they may go to great lengths to avoid them, or, if they are unable to do so, use compensatory compulsive behaviors to quell the anxiety.

A Word From Verywell

People who have OCD have unwanted, intrusive, and often distressing thoughts that preoccupy their minds much of the time. To deal with these thoughts, and the anxiety or fear they case, a person with OCD often needs to engage in compulsive behaviors. The obsessions and compulsions that define OCD can have a significant and negative impact on someone's life.

However, there are ways to manage the condition. Many people with OCD find relief with a combination of therapy and medication. Support groups, both online and in-person, can also be of enormous benefit for people with OCD (as well as their loved ones) by providing resources, information, or simply a compassionate, listening ear.

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Article Sources
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  1. The National Institute of Mental Health Information Resource Center. Obsessive-Compulsive Disorder (OCD). National Institute of Mental Health (NIMH). Updated November 2017.

  2. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). doi:10.1176/appi.books.9780890425596

  3. American Psychiatric Association (APA). What Is Obsessive-Compulsive Disorder? Updated July 2017.

  4. International OCD Foundation. What Is OCD?. Updated August 2019.

  5. Clark DA, Radomsky AS. Introduction: A global perspective on unwanted intrusive thoughtsJournal of Obsessive-Compulsive and Related Disorders. 2014;3(3):265-268. doi:10.1016/j.jocrd.2014.02.001

  6. Hershfield J. Navigating Hyperawareness Obsessions. OCD & Anxiety Center of Baltimore. Updated February 2019.

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