Obsessive-compulsive disorder (OCD) is a disorder in which people have recurring, unwanted thoughts, ideas or sensations (obsessions) that make them feel driven to do something repetitively (compulsions). The repetitive behaviours, such as hand washing, checking on things or cleaning, can significantly interfere with a person’s daily activities and social interactions.
The English term obsessive-compulsive arose as a translation of the German word Zwangsvorstellung meaning ‘obsession’. The term was used in the first conceptions of OCD by Carl Westphal. Westphal’s description went on to influence Pierre Janet, who further documented features of OCD.
In the early 1910s, Sigmund Freud attributed obsessive–compulsive behaviour to unconscious conflicts that manifest as symptoms. Freud describes the clinical history of a typical case of “touching phobia” as starting in early childhood, when the person has a strong desire to touch an item. In response, the person develops an “external prohibition” against this type of touching. However, this “prohibition does not succeed in abolishing” the desire to touch; all it can do is repress the desire and “force it into the unconscious”. Freudian psychoanalysis remained the dominant treatment for OCD until the mid-1980s, even though medicinal and therapeutic treatments were known and available, because it was widely thought that these treatments would be detrimental to the effectiveness of the psychotherapy. In the mid-1980s, this approach changed and practitioners began treating OCD primarily with medicine and practical therapy rather than through psychoanalysis.
From the 14th to the 16th century in Europe, it was believed that people who experienced blasphemous or other obsessive thoughts were possessed by the devil. Based on this reasoning, treatment involved banishing the “evil” from the “possessed” person through exorcism. The vast majority of people who thought that they were possessed by the devil did not suffer from hallucinations or other “spectacular symptoms” but “complained of anxiety, religious fears, and evil thoughts.” In 1584, a woman from Kent, England, named Mrs. Davie, described by a justice of the peace as “a good wife”, was nearly burned at the stake after she confessed that she experienced constant, unwanted urges to murder her family.
What exactly are obsessions and compulsions?
Obsessions are thoughts, images or impulses that occur over and over again and feel outside of the person’s control. Individuals with OCD do not want to have these thoughts and find them disturbing. In most cases, people with OCD realize that these thoughts don’t make any sense. Obsessions are typically accompanied by intense and uncomfortable feelings such as fear, disgust, doubt, or a feeling that things have to be done in a way that is “just right.” In the context of OCD, obsessions are time consuming and get in the way of important activities the person values. This is extremely important to keep in mind as it, in part, determines whether someone has OCD — a psychological disorder — rather than an obsessive personality trait.
Compulsions are the second part of obsessive-compulsive disorder. These are repetitive behaviours or thoughts that a person uses with the intention of neutralizing, counteracting, or making their obsessions go away. People with OCD realize this is only a temporary solution but without a better way to cope they rely on the compulsion as a temporary escape. Compulsions can also include avoiding situations that trigger obsessions. Compulsions are time consuming and get in the way of important activities the person values.
There’s no cure for OCD. But it may be able to manage how the symptoms affect your life through medicine, therapy, or a combination of treatments.
- Psychotherapy: Cognitive behavioural therapy can help change the thinking patterns. In a form called exposure and response prevention, the doctor will put you in a situation designed to create anxiety or set off compulsions. The patient will learn to lessen and then stop their OCD thoughts or actions.
- Relaxation: Simple things like meditation, yoga, and massage can help with stressful OCD symptoms.
- Neuromodulation: In rare cases, when therapy and medication aren’t making enough of a difference, the doctor might suggest devices that change the electrical activity in a certain area of your brain. One kind is transcranial magnetic stimulation. It uses magnetic fields to stimulate the nerve cells. A more complicated procedure, deep brain stimulation, uses electrodes that are implanted in your head.
- TMS (transcranial magnetic stimulation). This unit is a non-invasive device that is held above the head to induce the magnetic field. It targets a specific part of the brain that regulates OCD symptoms.
Notable people with OCD
British poet, essayist and lexicographer Samuel Johnson (1709–1784) also suffered from OCD. He had elaborate rituals for crossing the thresholds of doorways, and repeatedly walked up and down staircases counting the steps. He would touch every post on the street as he walked past, only step in the middles of paving stones, and repeatedly perform tasks as though they had not been done properly the first time.
The American aviator and filmmaker Howard Hughes (1905-1976) was known to have OCD. Friends of Hughes have also mentioned his obsession with minor flaws in clothing.