Obsessive compulsive disorder is a mental illness characterized by intrusive obsessions, which then lead to compulsive behaviors. Although the individual may realize that their obsessive thoughts are irrational, they may find it very difficult if not impossible to ignore them.

Obsessions are repetitive and persistent thoughts (e.g., of contamination), images (e.g., of violent or horrific scenes), or urges (e.g., to stab someone). Importantly, obsessions are not pleasurable or experienced as voluntary: they are intrusive and unwanted and cause marked distress or anxiety in most individuals.

The individual attempts to ignore or suppress these obsessions (e.g., avoiding triggers or using thought suppression) or to neutralize them with another thought or action (e.g., performing a compulsion).

Compulsions (or rituals) are repetitive behaviors (e.g., washing, checking) or mental acts (e.g., counting, repeating words silently) that the individual feels driven to perform in response to an obsession or according to rules that must be applied rigidly.

Most individuals with obsessive compulsive disorder have both obsessions and compulsions.

Compulsions are typically performed in response to an obsession (e.g., thoughts of contamination lead to washing rituals or that something is incorrect leading to repeating rituals until it feels “just right”). The aim is to reduce the distress triggered by obsessions or to prevent a feared event.

However, these compulsions either are not connected in a realistic way to the feared event (e.g., arranging items symmetrically to prevent harm to a loved one) or are clearly excessive (e.g., showering for hours each day). Compulsions are not done for pleasure, although some individuals experience relief from anxiety or distress.

Individuals with obsessive compulsive disorder vary in the degree of insight they have about the accuracy of the beliefs that underlie their obsessive-compulsive symptoms. Many individuals have good or fair insight (e.g., the individual believes that the house definitely will not, probably  will not, or may or may not burn down if the stove is not checked 30 times).

Some have poor insight (e.g., the individual believes that the house will probably burn down if the stove is not checked 30 times), and a few (4% or less) have absent insight/delusional beliefs. Poorer insight has been linked to worse long-term outcome.

(American Psychiatric Association, 2013, p. 238)

Symptoms of obsessive compulsive disorder

Symptoms for obsessive compulsive disorder are comprised of either obsessions or compulsions. Obsessions are the repetitive and intrusive thoughts that inflict pain and anxiety within the individual. A compulsion is the urge that is associated with the obsession in an attempt to relieve the painful anxiety that the obsession has manifested. Some common symptoms are:

Obsessions

  • Fear of germs or becoming contaminated
  • Having unwanted, repetitive thoughts that evoke anxiety
  • Inability to ignore thoughts
  • Needing things to be symmetrical
  • Denoting certain numbers or letters as “good” or “bad”
  • Overbearing fear of other people’s judgments
  • Fear that if you don’t perform a compulsion something very terrible will happen
  • Replaying experiences in your mind over and over
  • Overthinking situations/obsessing over details
  • Difficulty with making decisions

Compulsions

  • Checking repeatedly if things are turned off
  • Cleaning things that are already clean (i.e. your hands, dishes, etc.)
  • Rereading words or lines in a book because you “may” have overlooked them
  • Checking repetitively if the doors are locked
  • Having to perform a task a “certain” number of times
  • Hoarding things that will never get used
  • Constantly having to arrange things a certain way
  • Nervous ticks (e.g. cracking neck, wrist, fingers, etc.)
  • Touching things a certain number of times

Causes of obsessive compulsive disorder

About 3.3 million adults and about 1 million children and adolescents in the U.S. have obsessive compulsive disorder. The exact cause of obsessive compulsive disorder is unknown. However, there are several risk factors which may indicate a predisposition for developing this mental illness. Obsessive compulsive disorder develops due to a chemical imbalance in the brain where the individual gets “stuck” in thought. Abnormalities, or an imbalance in the neurotransmitter, or brain chemical, serotonin, could also be to blame [1].

Environmental factors are very significant as there are sometimes correlations with obsessive compulsive disorder and past abuse. People who have experienced abuse (physical or psychological) in childhood or other trauma are at an increased risk for developing obsessive compulsive disorder [2]. Genetics also play a part in someone developing this illness. If you have a family history of this mental illness or another anxiety disorder, then this may increase your risk for developing this condition.

Diagnostic Criteria

A. Presence of obsessions, compulsions, or both:

Obsessions are defined by (1) and (2):

  1. Recurrent and persistent thoughts, urges, or images that are experienced, at some time during the disturbance, as intrusive and unwanted, and that in most individuals cause marked anxiety or distress.
  2. The individual attempts to ignore or suppress such thoughts, urges, or images, or to neutralize them with some other thought or action (i.e., by performing a compulsion).

Compulsions are defined by (1) and (2):

  1. Repetitive behaviors (e.g., hand washing, ordering, checking) or mental acts (e.g., praying, counting, repeating words silently) that the individual feels driven to perform in response to an obsession or according to rules that must be applied rigidly.
  2. The behaviors or mental acts are aimed at preventing or reducing anxiety or distress, or preventing some dreaded event or situation; however, these behaviors or mental acts are not connected in a realistic way with what they are designed to neutralize or prevent, or are clearly excessive.

Note: Young children may not be able to articulate the aims of these behaviors or mental acts.

B. The obsessions or compulsions are time-consuming (e.g., take more than 1 hour per day) or cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

C. The obsessive-compulsive symptoms are not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition.

D. The disturbance is not better explained by the symptoms of another mental disorder (e.g., excessive worries, as in generalized anxiety disorder; preoccupation with appearance, as in body dysmorphic disorder; difficulty discarding or parting with possessions, as in hoarding disorder; hair pulling, as in trichotillomania; skin picking, as in excoriation; stereotypies, as in stereotypic movement disorder; ritualized eating behavior, as in eating disorders; preoccupation with substances or gambling, as in substance-related and addictive disorders; preoccupation with having an illness, as in illness anxiety disorder; sexual urges or fantasies, as in paraphilic disorders; impulses, as in disruptive, impulse-control, and conduct disorders; guilty ruminations, as in major depressive disorder; thought insertion or delusional preoccupations, as in schizophrenia spectrum and other psychotic disorders; or repetitive patterns of behavior, as in autism spectrum disorder).

Specify if:

With good or fair insight: The individual recognizes that obsessive compulsive disorder beliefs are definitely or probably not true or that they may or may not be true.

With poor insight: The individual thinks obsessive compulsive disorder beliefs are probably true.

With absent insight/delusional beliefs: The individual is completely convinced that obsessive compulsive disorder beliefs are true.

Specify if:

Tic-related: The individual has a current or past history of a tic disorder.

(American Psychiatric Association, 2013, p. 237)

Treatments of obsessive compulsive disorder

Fortunately, there are many different types of treatments for someone who has been diagnosed with this disorder. While some people may significantly benefit from behavior therapy and others are helped by medication therapy, it may be very beneficial for someone with obsessive compulsive disorder to engage in both forms of therapy simultaneously. Medication can be very helpful for individuals looking to experience some relief from their symptoms.

Selective Serotonin Re-uptake Inhibitors (SSRI’s) are the types of medications that are typically used to help treat obsessive compulsive disorder. They are also sometimes given to individuals who suffer from other mental illnesses, such as depression or social anxiety disorder as these drugs may be able to help with many different symptoms. Some common medications to help relieve symptoms of this condition are Paxil, Luvox, and Zoloft, among many others.

Cognitive behavioral therapy (CBT) is often the type of therapeutic technique used to help individuals who suffer from this disorder. Essentially, this type of therapy helps you to have a better understanding of the many thinking-errors that are associated with this illness. Besides CBT, mindfulness meditation can also be effective at helping you to relieve your symptoms and anxiety too.

Scrupulosity OCD

Scrupulosity OCD is a facet of obsessive compulsive disorder characterized by obsessing about religion, sinning, and morality. This illness is not restricted to one single religion. Someone with scrupulosity OCD may be in constant fear of angering god or of going to hell. This constant fear of sinning brings forth immense anxiety, guilt, and self-loathing.

Though much of their inability to decipher which way they should live their lives and what is considered a sin and what isn’t is partly due to the vagueness of the thousands of different religious doctrines that exist, the majority of their despair comes from their inability to think rationally.

Someone with scrupulosity OCD may take extreme measures in a desperate attempt to help them ease the amount of anxiety they constantly experience. If scrupulosity OCD is left untreated, then self-hatred may develop, as well as suicidal thoughts. This is a very insidious form of obsessive compulsive disorder that can cause other disorders to develop such as major depression for example.

Someone who has developed scrupulosity OCD may walk around in their day to day life in constant fear and worry that god is angry with them or that they are worthless. Regardless of there being no scientific evidence that a god exists, their disorder makes it very difficult for them to consider these other possibilities.



With any form of obsessive compulsive disorder, for every obsession, there is an equally painful compulsion that evokes them constantly. Such compulsions may be to not wear clothes with mixed fabrics, to grow their beard no shorter than the length or their fist (both of which are professed rules in the bible), to shut out friends and family who don’t think exactly as they do, to isolate themselves from the world, to harm or punish themselves, etc.

Though these compulsions give them some relief of their anxiety, this relief is only momentary. Giving into their obsessions by following through with their compulsions only justifies their scrupulosity OCD and makes their illness worse.

Causes of Scrupulosity OCD

The exact reason as to why someone would develop scrupulosity OCD is not entirely understood. However, one’s environment and family history may both play significant roles in someone developing this disorder, especially if they already have a genetic predisposition for developing it. Someone who is religious or who actively practices their religion and has obsessive compulsive disorder may naturally develop scrupulosity OCD.

Obsessive compulsive disorder typically intertwines itself into important aspects of one’s life for whatever reason. So, someone who is already religious or who is a theist and develops obsessive compulsive disorder may develop scrupulosity OCD simply due to their religion being something they already think a good deal about throughout the day.

Symptoms of Scrupulosity OCD

Someone who has scrupulosity OCD may experience crippling anxiety that greatly hinders their ability to experience joy and even contentment in life. They may live their day to day life with an underlying feeling or belief that regardless of what they do in this life, they are inevitably doomed to burn in hell forever.

They may spend much of their time thinking about their morality. For instance, if someone with scrupulosity OCD does something wrong or commits a “sin”, regardless of how minuscule it may be, then they will often blow it out of proportion and believe that from that one event, they are now doomed for eternal torment in hell.

If someone with scrupulosity OCD does not carry out the painful, and often embarrassing compulsion, then they will often remain in constant fear that something of catastrophic proportions will happen to them. So, with this irrational logic, they are then able to convince themselves that they must perform the compulsion in order to keep god’s wrath at bay. Scrupulosity OCD is not that different from traditional obsessive compulsive disorder in that it is just a more specific type of OCD.

  • Constant fear of sinning
  • Fear that god is unhappy with them
  •  Self-loathing/self-hatred
  • Obsessing about morals
  • Constant fear of going to hell
  • Extremely judgmental and self-critical

References

BetterHelp

MayoClinic

OCDUK

NIH.gov