What are the symptoms of OCD and how do they manifest?

Howard Hughes' character in the biographical film "The Aviator" convincingly illustrates how OCD symptoms can manifest and become devastating in a person's life. The film vividly depicts the challenges Hughes faces as he struggles with the overwhelming impact of his disorder. Howard Hughes, "The Aviator" powerfully demonstrates the distressing and disabling ways in which OCD symptoms can manifest, highlighting the profound impact this disorder can have on an individual's life and well-being.

The symptoms of Howard Hughes' obsessive-compulsive disorder are described as all-consuming and deeply distressing. His incessant need for cleanliness and his fear of contamination lead him to spend hours rubbing his hands, often until they bleed. His compelling need for order and control pushes him to meticulously repeat certain actions, such as lining up his peas on a plate or constantly checking and rechecking locks and switches. These behaviors dominate his thoughts and actions, causing significant distress and hindering his ability to function in his personal and professional life. The film highlights the debilitating nature of Hughes' symptoms. His fight is often greeted with skepticism and incomprehension by those around him, including his colleagues and partners, who fail to understand the seriousness of his condition. This lack of empathy and support only exacerbates his suffering, reinforcing the feelings of isolation and hopelessness that accompany his OCD.

How to distinguish OCD from other similar disorders?

Obsessive-compulsive disorder (OCD) is defined by the presence of intrusive and unwanted thoughts or images, as well as an irresistible compulsion to perform behaviors or thoughts in a repetitive and ritualized manner. OCD usually involves obsessions and compulsions. Obsessions are distressing thoughts, images, or urges that cause significant anxiety or distress. Compulsions are repetitive behaviors or mental acts performed in response to an obsession, with the aim of reducing anxiety or preventing a feared event or situation, such as excessive hand washing, checking, counting, or counting. arrangement of objects. However, compulsive behavior can also be practiced to obtain a specific feeling of pleasure (Nardone, Portelli, 2005, 2016). Compulsivity is not only a central feature of OCD, which is often fear-based, but it is also crucial for addictions, which are pleasure-based. OCD has been proposed to be part of the concept of behavioral addictions (Figee et al., 2015), including compulsive buying, pathological gambling, skin picking, trichotillomania, compulsive eating, and new addictions ( Papantuono, Portelli, 2017). Compulsive behaviors are driven by repetitive urges with limited voluntary control, a reduced ability to delay or inhibit these behaviors, and a tendency to perform repetitive acts in habitual or stereotyped ways. In pleasure-based compulsion, the compulsion becomes the obsession, as in the case of binge-watching, online shopping, selfie mania, and other addictive behaviors. It is therefore important to determine whether the compulsion is based on fear or pleasure, as this can help to better understand the problem and choose the most appropriate intervention.

Distinguishing obsessive-compulsive disorder 

Distinguishing obsessive-compulsive disorder from other anxiety-related problems can be difficult, because obsessive-compulsive disorder has some similarities with other anxiety disorders , such as generalized anxiety disorder (GAD), anxiety disorder. social anxiety and specific phobias. However, there are key differences that can help distinguish OCD from other anxiety-related problems. OCD is characterized by intrusive and unwanted thoughts, images, or urges (obsessions) that lead to repetitive behaviors or mental acts (compulsions). These obsessions and compulsions take time and cause significant distress, unlike other anxiety disorders, which may involve excessive worry or fear of specific situations or objects, with avoidance behaviors, and do not involve the same type of specific , repetitive rituals seen in obsessive-compulsive disorders.

People with OCD may have very specific fears and use compulsions to manage the underlying fear. For example, a person may fear contamination and engage in intensive hand-washing rituals. In contrast, other anxiety disorders may involve more general fears or worries, but do not rely on compulsive behaviors or specific rituals to reduce the underlying fear. People with OCD are often very hampered in their daily functioning due to the time-consuming nature of their obsessions and compulsions. These rituals can interfere with work, school, relationships, and other activities. Anxiety disorders can also cause impairment, not because of how time consuming they are, but because they paralyze the person and prevent them from functioning properly.

Often, patients and professionals are misled by the term "pure OCD", also known as "pure obsessive OCD" or "pure obsessive OCD", which are subtypes of OCD. While traditional OCD involves both obsessions and compulsions (observable or mental acts), pure OCD is characterized by obsessions without obvious external compulsions. In a 2011 study, Williams and her colleagues found that people who suffer from "pure obsessions" also engage in mental rituals to manage their distress. These rituals may involve mentally reviewing memories or information, mentally repeating certain words, or mentally undoing or redoing certain actions. People distressed by obsessive thoughts may also seek reassurance compulsively. Recognition of compulsions performed by people previously considered purely obsessive may help improve the diagnosis and treatment of people with obsessive-compulsive disorder. A thorough operative diagnosis is imperative to reveal the presence of compulsions, their function and the way in which they manifest, in order to choose the most appropriate treatment (Portelli, 2005).

How can compulsions manifest?

In my 2004 article "Advanced brief strategic therapy for obsessive-compulsive disorders", I explored the different ways in which compulsions or rituals can manifest. Fear-based compulsions can be behavioral or mental. Mental compulsions can range from simple repetition of words to actual mental calculations and formulas. Compulsions can be rational, such as washing your hands to remove dirt or contamination, but also magical, such as repeating specific words to ensure that nothing will happen to loved ones. Compulsions may have a specific sequence that must be followed exactly or be numerical, needing to be repeated a certain number of times for reassurance. Compulsions may be carried out at specific times or be present at various times when the person is overwhelmed by fears or obsessions. They can be carried out by the person themselves or involve other people to reassure them further. In OCD, rituals can have a restorative function (e.g., washing away dirt, correcting a mistake, redeeming oneself from a sin), a preventive function (e.g., avoiding contamination, checking that the door is closed properly) or a propitiatory function (for example, wearing the yellow t-shirt for good luck and passing an exam). Thus, when working with OCD, in addition to an in-depth diagnosis to distinguish it from other disorders, it is imperative to carry out an operational diagnosis to understand the function (preventive, propitiatory or restorative), the modality (numerical or sequential) and the support (action or mental) in order to find the most adequate means to interrupt the compulsion which still fuels the obsessions. A comprehensive assessment by a mental health professional is necessary to make an accurate diagnosis and plan effective treatment to help the person break out of the obsessive-compulsive cycle.

Caught in a vicious cycle: when the current reassuring compulsion exacerbates the obsession

Compulsion gives the illusion of control, and is what drives the person to “do more of the same.” Suppose we analyze the mental prison that obsessive-compulsive disorder represents. In this case we observe that the very attempt to reassure oneself to manage fear or the irrepressible tendency to feel a specific sensation structures a very rigid and persistent problem (Nardone, Portelli, 2005, 2016).

In conclusion, obsessive compulsive disorder (OCD) can actually create a vicious cycle of intrusive thoughts and compulsive behaviors. People with OCD have persistent, unwanted thoughts (obsessions) and feel driven to perform repetitive actions or rituals (compulsions) in an attempt to relieve their anxiety or avoid a feared event or situation. However, these compulsions usually provide only temporary relief and can reinforce obsessive thoughts, leading to a cycle of escalating anxiety and compulsive behaviors. OCD patients often describe themselves as a hamster spinning on a wheel in a cage. The hamster may run, but he does not escape the cycle. Similarly, people with OCD are often stuck in a cycle of obsessions and compulsions, unable to break free. They feel stuck in a relentless and unproductive cycle, trapped in a seemingly hopeless situation.

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