As mentioned in Chapter A4, previously classified as an anxiety disorder, OCD (and related disorders) is now a separate category of disorder in the DSM-5-TR and ICD-11.
A person with OCD may be significantly distressed by their symptoms, and their ability to function may be impaired. They may be plagued with persistent thoughts or impulses that are intrusive and unwanted (referred to as obsessions or ruminations) and they may feel compelled to perform repetitive, ritualistic actions that are excessive and time consuming (referred to as compulsions or rituals). A person with OCD may present with either obsessions or compulsions alone, or a combination of both. 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 panicked about their obsessions, and may feel driven to perform repetitive mental or physical acts in response to alleviate their anxiety. 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).
- Repeating mental acts (e.g., counting, and repeating words silently).
- 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 recognition of OCD, and a lack of disclosure by clients who may experience shame or embarrassment and be intent on hiding their symptoms [1223–1226].