clinical features

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Patients with OCD is characterised by the presence of either obsessions or compulsion but commonly both:

  • obsessions
    • are recurrent intrusive, troubling thoughts or images which results in an increase in anxiety and distress
    • are distressing and ego-dystonic (that is, they are repugnant or inconsistent with the person’s values)
    • patients usually  identifies them as unreasonable or excessive and tries to resist them
    • minority may be considered as overvalued ideas and, rarely, delusions.
    • examples of common obsessions include:
      • aggressive impulses e.g. - images of hurting a child or parent
      • contamination e.g. – becoming contaminated by shaking hands with another person
      • need for order e.g. – intense distress when objects are disordered or asymmetric
      • religious e.g. – blasphemous thoughts, concerns about unknowingly sinning
      • repeated doubts e.g. – wonder if a door was left unlock
      • sexual imagery e.g. – recurrent pornographic images
  • compulsions
    • are repetitive ritualistic activities which help in reducing the anxiety/distress caused by the obsession
    • are largely involuntary and are seldom resisted.
    • can be
      • overt and observable by others e.g. - checking that a door is lock
      • covert or mental compulsions that cannot be observed e.g. - repeating a certain phrase in the mind, generally more difficult to resist or monitor than overt ones (2)
    • examples of common compulsions include:
      • checking e .g. – repeatedly checking locks, alarms, appliances
      • cleaning e.g. – hand washing
      • hoarding e.g. – saving trash or unnecessary items
      • mental acts e.g. – praying, counting, repeating words silently
      • ordering e.g. – reordering objects to achieve symmetry
      • reassurance seeking e.g. – asking others for reassurance
      • repetitive actions e.g. – walking in and out of a doorway multiple times (1)

It is important to remember that patients often are ashamed and embarrassed by their condition and may find it very difficult to discuss their symptoms with healthcare professionals (1).

Patients are likely to terminate a compulsion when he or she feels “comfortable” or “just right” (2). 

Note:

  • obsession do not include day to day worries (seen in  in generalised anxiety disorder), perceived defects in appearance (present in body dysmorphic disorder) or fear of having a serious disease (occurs in health anxiety) (2)

Reference:

Last reviewed 01/2018

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