Obsessive-Compulsive Disorders
I wrote this reflection for my problem identification class at the University of Rochester. The professor asked us to reflect on a particular reading, the reading for this reflection the chapter on Obsessive-Compulsive and Related Disorders (OCD) from the DSM-5. I have included my reflection below.
Obsessive-Compulsive Disorders
This week, I read Obsessive-Compulsive and Related Disorders (OCD) from the DSM-TR. The chapter opens by describing several types of OCD: body dysmorphic disorder, hoarding disorder, trichotillomania (hair-pulling disorder), excoriation (skin-picking) disorder, and other generalized OCD types. The chapter explains that, overall, OCD is really about obsessions and compulsions. Obsessions are recurrent and persistent thoughts that are unwanted and intrusive. Compulsions are repetitive behaviors (or mental acts) that people feel driven to perform in response to an obsession. OCD varies in each individual, but commonalities exist, such as themes of cleaning, symmetry, or forbidden thoughts. A person with OCD will typically spend at least 1 hour a day in servicing their OCD. Also, OCD comes with varying levels of insight; individuals may not be aware at all that they have OCD, or they may have some or full insight.
My initial reaction was sadness when I learned that OCD affects over 1% of the population. I was also very much interested in particular kinds of OCD, as I feel I have had personal experiences with individuals who may have OCD. One kind I have had experience with is cleanliness; my partner used to be very concerned about using Purell at highly frequent intervals throughout the day, but it has since gotten a lot better over the last year or so. She also had an issue where she was concerned at night that the oven was on or the doors and windows were unlocked; she would have to come downstairs and check multiple times. After this reading, I felt that her behavior could be considered OCD, and I also recognize it linked to anxiety, but in her case, the behavior came about as a response to grief, and I did not see in the chapter that OCD could come about via grief so I was left a little unsatisfied here.
The other type I am familiar with is hoarding. I do have an extended family member who suffers from hoarding disorder, and it is a big problem for her and her direct family. Her house is cluttered with possessions she will not get rid of; there is no place to sit, and even walking around is difficult. No one in the family has the courage to force the removal of the items. I found it interesting that the DSM links a temperament of indecisiveness to hoarding, and I found this to be true because this individual does appear avoidant and indecisive. I feel the individual I know who hoards may also have ADHD, but I was surprised not to see any links between ADHD and hoarding behavior. Lastly, I was very interested in the hoarding section to hear that it begins in adolescence and can worsen as the individual ages. Hoarding typically does not go away unless the individual receives treatment. In the case of the person I know, she is in her early 60s, and it seems to be worsening. I fear things may need to deteriorate until the situation forces her to act.
The final type of OCD that I found interesting from the chapter was body dysmorphic disorder. After reading about this, I felt that many people I know suffer from it, at least in a minimal way. One particular acquaintance of mine is obsessed with her buttocks-to-waist ratio and continually monitors her weight and works out excessively in order to keep her figure a certain way; she fears that her boyfriend will leave her if she does not maintain a certain ratio. She also recently got liposuction to further these goals, yet from all accounts, she looks no different afterward to onlookers, yet she perceives an effect. She is only 26, obsesses over herself continually, and often compares herself to people on Instagram. I have known many young ladies like this, which makes me quite sad. When I was younger, I was too obsessed with my fitness, and I tried very hard to reach < 8% body fat. At the time, I thought I looked muscular, but now I look back on these photos and feel I looked ill and far too thin. I am glad I no longer obsess about this anymore. Another friend of mine, though, is obsessed with his strength, and he reminds me of muscle dysphoria, which the chapter also mentions.
Overall, the reading about OCD was quite sad for me. I believe many, many people in society meet the criteria for OCD, including people I know. Compared to other diagnoses, it was a relatively straightforward chapter; it clearly spelled out what criteria an individual should meet, and I feel we could easily spot someone with OCD and communicate with them about it. However, as the reading said, some people's lack of insight into their behavior is a problem. I wish the chapter offered more insights, though; its straightforward nature told me little I could not have already surmised. I am more interested in OCD behavior, which is potentially less obvious. For example, I wonder if individuals who work too much actually have OCD in relation to work, or if people who are on social media too much have OCD, or potentially in relation to sexual preoccupation, people may have OCD. It would have been nice if the chapter explored these areas, too.
The reading left me with questions, such as what other kinds of behavior could be considered OCD? How do we measure it? Is it possible that behaviors are causing distress in lives, but either because of lack of insight or cultural acceptance, they are not identified as problematic? In my work as a counselor, I would like to broaden the conception of OCD. I really would like to think more deeply with my clients about behaviors they are having that may be unconscious responses to unconscious obsessions. For example, is watching Netflix for 3 hours each night OCD? I also would have liked the chapter to offer more connections to other behaviors or conditions because, as the chapter stands, I am struggling to see how the reading links OCD to our more basic patterns of thought and behavior. For example, could OCD be an emergent behavior from the Anxiety-Depression spectrum? I was left wanting more, I would like to see OCD situated better in our constellation of diagnoses.
