What does it really mean to be 'OCD' and how does OCD relate to anxiety?
Jason Brien.
The phrase “oh, I’m so OCD” or “It’s normal, I’m just a little OCD” has become an increasingly common catch phrase to explain away perfectionistic tendencies. So, what is OCD and how does it differ from an obsessive-compulsive personality (OCP) and obsessive-compulsive personality disorder (OCPD)? Before I begin to differentiate between these three terms, it is first important to understand 2 key concepts.
- Egosyntonic
Thoughts, behaviours, feelings, dreams, wishes, desires, compulsions etc., that do not cause distress or cognitive dissonance (anxiety) and are thus acceptable and in harmony with one’s sense of self and being.
- Egodystonic
Thoughts, behaviours, feelings, dreams, wishes, desires, compulsions etc., which lead to marked distress, displeasure, cognitive dissonance (anxiety) and significant conflict with one’s sense of self and being.
Obsessive-Compulsive Disorder (OCD) is clinically defined within the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM- 5) as an anxiety disorder marked by the presence of obsessions and compulsions. This condition is EGODYSTONIC in that the individual realises that their thoughts and compulsive acts are irrational however they are unable to break the distressing cycle. For a formal diagnosis of OCD, the obsessions and compulsions must be experienced to such a degree that they cause significant distress and unhappiness and significantly interfere and impair normal daily living. Given that this condition is Egodystonic, an individual is likely to seek therapy in order to regain control of their life.
Obsessions:
Recurrent, persistent, intrusive, and unwanted thoughts, feelings, sensations and/or images. The most common obsessions are those related to contamination (e.g., germs, illnesses etc), thoughts of violence towards self or others, blasphemy or excessive focus on morals or religious ideas, fear of loss of control, order and symmetry, and or excessive focus on superstitions and lucky charms.
Compulsions:
Behaviours, acts or rituals aimed at eliminating the obsessions and alleviating the associated anxiety. Common compulsions include re-checking doors, locks and stoves, counting or tapping rituals, excessive hand/body washing, excessive time spent on cleaning, washing, arranging and ordering, excessive praying, or any other act designed to ward of intrusive thoughts and anxiety.
Whilst Obsessive-Compulsive Personality (OCP) is generally referred to only in terms of its disordered type (OCPD), there are always two sides to every coin. Therefore, I will start by describing OCP in it’s healthy form before moving onto a description of Obsessive-Compulsive Personality Disorder (OCPD). Individuals with an obsessive-compulsive personality manifest their inherent desire for control, order and perfection in healthy, controlled, adjusted and socially acceptable ways. OCP is EGOSYNTONIC. That is, the need for individuals with OCP to control their environment, arrange objects according to strict criteria, or cross every t and dot every i FEELS right to them. Given that they are Egosyntonic, they are unlikely to seek help as they inherently believe that they are pursing the right course of action.
Arranging books on a shelf in a particular order or fixing a slightly crooked picture hanging on a wall FEELS inherently right to the OCP individual in the same way that a parent protecting their child from danger or someone helping another in need FEELS inherently right. The feeling experienced after the re-arrangement of books or the fixing of the picture is of having restored balance and harmony. The ‘perfectionism’ in OCP and OCPD does not cause distress as in OCD, rather it brings inner peace and happiness. Additionally, unlike OCD, an individual with OCP does not engage in compulsive acts or rituals in an attempt to ward of intrusive thoughts, feelings or anxiety. They simply go with their flow and do what feels right to them without much thought.
Although OCP is characterised by rigidity, a need for control, high standards, strong work ethics, and anal retentiveness, individuals with a healthy obsessive-compulsive personality are socially adept, achieve high grades in school and university/college and can be strong and effective leaders in the work place and community. It is only when their high standards, need for control etc becomes excessive does the obsessive-compulsive personality become disordered.
Obsessive-Compulsive Personality Disorder (OCPD) is characterised by overly rigid and excessive manifestations of OCP. Unlike most of the personality disorders (PD) described in the DSM-5, this PD causes significant distress to others rather than to the ‘sufferer’. This is because this PD is EGOSYNTONIC. The individual sees no problem with their actions and behaviours and is unlikely to seek treatment as they believe with all of their being that they are doing the ‘right’ thing and that everybody else is wrong.
The Egosyntonic nature of this PD is not the same as lacking self-awareness or theory of mind such as that which occurs in narcissism, autism spectrum disorder etc. The OCPD individual is aware of their affect on others but rather than not caring or showing empathy and continuing on with their actions regardless, they are inherently driven to act in the obsessive-compulsive manner in which they do and thus see nothing significantly wrong with what they are doing. Take sneezing for example. People know that sneezing can be disruptive or frowned upon in some social situations (i.e., in a library or other quiet setting) however nobody believes that their sneezing is inherently wrong. That is, if people in the library are disrupted by your sneeze and complain then so be it. It is beyond your control and just a part of nature. In most cases, you would think the other person was wrong for complaining about something you do which you know inherently to be the right thing to do…sneeze.
This inherent and overwhelming belief in being right can lead individuals with OCPD to become overly controlling to the point of being abusive, overly rigid to the point of excluding any and all input from others and are thus socially, educationally and occupationally inept. In the disordered form, the individual becomes rigidly perfectionistic rather than simply high achieving. They become controlling and authoritarian. In educational settings, their perfectionism and over focus on details causes them to fail to submit assignments on time or fail to finish exams within the allotted time. They may demand high expectations with regards to behaviours from peers and/or may constantly criticize or correct the teacher for actual or perceived mistakes or errors.
In the workplace they become ineffective and harmful leaders as they are inclined to micro-manage. They pick apart and criticise anything and everything. They set unrealistic targets/goals/expectations and demand complete and unquestioned authority and control over all group work. As managers, they may demand their underlings work unrealistic, long, and unhealthy work hours. Alternatively, they may be overly fixated on rules and regulations to the point of being unproductive choosing instead to continually email corporate office about perceived offences and violations of rules/regulations rather than completing work assigned to them. Individuals with OCPD tend to be workaholics working excessively long hours to the detriment of children, spouses, families and friends.
On the social side, OCPD individuals struggle to maintain relationships. Their low tolerance for ‘mistakes’ and ‘imperfections’ alienates friends and family alike. Excessive criticism, demands and desire for control over others ultimately drives people away from them. The unhealthy manifestations of ordering and symmetry may lead an individual to spend countless unproductive hours ordering and aligning books on a shelf rather than actively working to maintain social and familial relationships. Again, the individual derives inherent pleasure from these acts and sees no reason to stop.