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 compassion when I learned that OCD affects over 1% of the population. I also thought about varieties of OCD. I imagined diverse kinds of OCD, for example cleanliness; imagine an individual who is very concerned about using Purell at highly frequent intervals throughout the day. Another kind could be concern at night that the oven was on or the doors and windows were unlocked; having to come and check multiple times. OCD manifests in many different ways.
I have heard of people who also suffer from hoarding disorder. Typically a hoarder’s house is cluttered with possessions they will not get rid of; there is no place to sit, and even walking around can be difficult. I found it interesting that the DSM links a temperament of indecisiveness to hoarding. 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.
The final type of OCD that I found interesting from the chapter was body dysmorphic disorder. Many people may suffer from this, at least in a minimal way. Imagine an individual obsessed with their figure and continually monitoring their weight and working out excessively. Trying very hard to reach < 8% body fat. Thinking they look fit and muscular, while others think they look too thin. Or even an obsession with strength, muscle dysphoria, which the chapter also mentions.
It appears that many, many people in society meet the criteria for OCD. 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. I am 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 I would like to see how OCD links to our more basic patterns of thought and behavior. For example, could OCD be an emergent behavior from the Anxiety-Depression spectrum?
