Clinical presentation

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As mentioned in Chapter A4, OCD was classified as an anxiety disorder in the DSM-IV-TR, but the DSM-5 has separated OCD (and related disorders) into a separate category of disorder.

A person with OCD may be significantly distressed by their symptoms, and their ability to function may be impaired. They are plagued with persistent thoughts or impulses that are intrusive and unwanted (obsessions) and they may feel compelled to perform repetitive, ritualistic actions that are excessive and time consuming (compulsions). Symptoms of obsessions may include:

  • Fear of germs, dirt, or poisons.
  • Harm from illness or injury to self or others.
  • Intrusive thoughts about sex or sexual acts.
  • Excessive concerns with symmetry or orderliness.
  • Needing to know or remember things.
  • Hoarding or saving and collecting things. 

Anxiety about obsessions may lead to vigilance about possible threats, and a compelling need for control. A person may feel annoyed, discomforted, distressed, or panic about their obsessions, and feel driven to perform repetitive mental or physical acts in response. Symptoms of compulsions may include:

  • Excessive hand washing, showering, tooth brushing.
  • Excessively checking locks, appliances, other safety items.
  • Repeating activities or routines (e.g., opening a door, switching a light on and off).
  • Applying rules to the placement of objects.
  • Inability to throw out excessive collections of items (e.g., newspapers, clothes).

OCD may often go under-detected among people with AOD conditions. This is thought to be due to both a lack of training for AOD workers in the detection of OCD, and a lack of disclosure by clients who may experience shame and embarrassment, and be intent on hiding their symptoms [757].