Introduction
Of the many known mental afflictions, obsessive-compulsive disorder (OCD) has garnered particular celebrity. OCD has become the object of scientific study and popular stigma; thus, it’s academic discussion must be multiform. This entry will consider the historical framework, contemporary context, social controversy, and political significance of OCD to provide it a comprehensive definition.
Definition of OCD
The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) is the standard reference for clinical psychologists (American Psychological Association, 2013). According to this industry-embraced text, OCD is defined by four criteria: (1) the presence of obsessions and/or compulsions; (2) said obsessions or compulsions exhaust more than one hour per day, or significantly disturb one’s social or vocational functioning; (3) obsessive-compulsive symptoms cannot be explained as the result of some medication; and (4) the catalog of symptoms is not more indicative of another defined mental disorder (APA, 2013). More specifically, the DSM-5 describes obsessions as “repetitive and persistent thoughts, urges, or images” that induce distress or anxiety, and compulsions as repetitive behaviors or mental acts “aimed at preventing or reducing anxiety or distress, or preventing some dreaded event or situation” (APA, 2013). Importantly, obsessions or their resultant compulsions are often illogical—and are recognized as such by their performers (APA, 2013).
Many characteristics associated with OCD sufferers are actually trademark of a related condition: obsessive-compulsive personality disorder (OCPD) (International OCD Foundation, 2010). OCPD is identified in the DSM-5 by “an enduring and pervasive maladaptive pattern of excessive perfectionism and rigid control” (APA, 2013). OCD varies from OCPD in many respects (IOCDF, 2010). For instance, individuals with OCD are discomforted by their perturbing thoughts and compulsory actions, while people with OCPD are comfortable with their customs; OCD-related thoughts and acts are often without realistic basis, while OCPD practices involve normal daily routine; and OCD disturbs personal and professional tasks, while OCPD mannerisms often enhance work productivity (IOCDF, 2010). Despite the muddied public distinction between OCD and OCPD, a definitional approach will only be applied to the former—even if often by contrast with the latter.
Unlike the linear rule-following of OCPD, OCD is considered to be cyclic in nature (Fig. 1). Initiation of the cycle is not fully agreed upon, with environmental, genetic, and trauma-related factors all plausible (APA, 2013). There is similarly no diagnostic list of obsessions or compulsions, but many fall into common categories: cleaning, symmetry, forbidden or taboo thoughts, and harm (APA, 2013). Oftentimes, patients experience obsessive-compulsive symptoms in more than one of these motifs (APA, 2013). Understanding these intricacies of OCD requires analysis of its historical roots.
Figure 1. The OCD cycle. Obsessive thoughts induce anxiety, which compulsions are thought to nullify. Temporary relief is obtained after the compulsion’s performance, but obsession again returns. (Cognitive Behavior Therapy Center, 2018).
Historical Context
The first recognition of OCD symptomology—namely obsessive thoughts, anxiety, and compulsive actions—began in 17th-century England (Stanford Medicine, 2018). Obsessions and compulsions were considered a result of “religious melancholy” (Stanford Medicine, 2018). After centuries of this spiritual explanation, the symptom set of OCD became recognized as a form of insanity in the 1830s (Berrios, 1989). Continuing into 1900, OCD was labeled a type of neurosis, then psychosis, and lastly as a constituent of the new neuroses category; all terms denoted OCD as a disease of the autonomic nervous system (Berrios, 1989). Within this time period, the primary psychological impairment involved in OCD was highly contested (Berrios, 1989). French psychologists argued that OCD resulted from volitional or emotive impairment, while intellectual disorder was the dominant hypothesis in Germany (Berrios, 1989). By the early 1900s, the emotive explanation had prevailed—bolstered in part by Freud’s support (Berrios, 1989). In addition to the understanding of OCD as a disease of emotion, degeneration of neural tissue was also a well-accepted basis (Berrios, 1989). This interpretation of OCD as a physical deficit explained the personality similarities and familial relatedness of afflicted individuals (Berrios, 1989).
The DSM-I (the American Psychology Association’s 1952 installment of their diagnostic manual) listed obsessive-compulsive reaction as a psychoneurotic disorder (Crocq, 2015). More descriptively, the term was applied “when the anxiety was associated with the persistence of unwanted ideas and of repetitive impulses to perform acts” (Crocq, 2015, p. 323). OCD (under various pseudonyms) was categorized as an anxiety disorder until the most recent DSM-5, in which it was granted its own chapter (Crocq, 2015). Placed under the obsessive-compulsive umbrella were disorders such as OCD, body dysmorphic disorder, trichotillomania (hair pulling), and hoarding disorder (Crocq, 2015). The DSM-5 marked the first time that neuroscientific and genetic information were considered in the disorder divisions, suggesting a more biological understanding of OCD (Crocq, 2015).
Contemporary Context
While OCD clinically affects less than 2% of the global population, many others have experienced its sociocultural weight (APA, 2013). Particularly, entertainment and social media platforms have distorted the real OCD sufferer into an absurd caricature. Pavelko and Myrick (2015) note that OCD is often depicted as comedic in film and television portrayals—despite the representation of most other mental disorders as scary or creepy. OCD patients in media often perform compulsions with mock intensity, without expression of an urging obsession, or without awareness of their unnecessity; all such representations make OCD behaviors appear funny to general audiences (Pavelko & Myrick, 2015). In a study by Fennell & Boyd (2013), it was found that characters with identified or unidentified OCD most often expressed ordering, washing, checking, counting, or repeating compulsions; such symptoms are not fully representative of the compulsions performed by afflicted individuals. While displaying OCD behaviors like cleaning and counting might stigmatize the disorder, some interviewed patients stated that they felt such portrayals might be preferable to the revealing of darker topics (Fennell & Boyd, 2013).
In addition to the stigmatization of OCD within entertainment media, social media serves as a unique forum for its discussion. Pavelko and Myrick (2015) clarify that “disease trivialization involves three components: oversimplification of symptoms or causes, skepticism about the severity of the disease, and/or mockery/levity” (p. 252). These factors can all be found in the broad use of the hashtag “#OCD” on social media sites (Pavelko & Myrick, 2015). It was found that Twitter users mentioning OCD in a clinical context were better received than those who integrated the term jokingly (Pavelko & Myrick). Additionally, social media audiences were likely to consider OCD a primarily female disorder, probably due to its similarities with anxiety and depression; this perception contradicts statistical data, which states that men and women are diagnosed at near-equal rates (Pavelko & Myrick, 2015). Social media further encourages such mistaken beliefs through the circulation of quizzes that gauge one’s degree of OCD (Fig. 2). These seemingly innocent posts reinforce several incorrect notions about OCD, like that it exists on a gradient (someone can be “more” OCD than another), all compulsions are related to order or symmetry, and that one’s OCD (or OCPD) tendencies should be public knowledge.
Figure 2. Thumbnail of a social media OCD quiz. The picture illustrates an out-of-place yellow marshmallow, implying that the quiz measures one’s sensitivity to uniformity. Quizzes like this are problematic in that they reinforce false notions of OCD’s seriousness (MyDailyQuizz, 2018).
Beljan and colleagues (2006) expanded upon the popular idea of OCD-diagnosed individuals as neat and intellectual. Children and adults with OCD “organize people and things into complex frameworks, and are often seen as perfectionistic and ‘bossy’” (Beijan et al., 2006, p. 84). These characteristics shared between many gifted and OCD-diagnosed people often contribute to a joint stereotype.
Perspectives
Three perspectives of OCD dominate its dialogue: that of psychological and research professionals, that of OCD sufferers, and that of the general public. Clinical professionals maintain a rigid depiction of OCD, classifying it specifically in the DSM-5 and searching for concrete neural mechanisms. As previously mentioned, a biological focus has been applied by this population in recent years. Genetic components of OCD have been researched, and studies have suggested a relationship between juvenile OCD onset and exposure to a streptococcal infection (Stanford Medicine, 2018). Furthermore, scientific professionals advocate drug treatment of OCD (via SSRIs or other antidepressants) in combination with cognitive-behavioral therapy (Decloedt & Stein, 2010).
Individuals diagnosed with OCD have been noted to experience self-stigma, societal stigma, and anticipated stigma (Fennell & Liberato, 2006). As such, a great deal of the sufferer’s contribution to OCD discussion is influenced by other voices. Those with OCD have, however, unified over internet sources, finding understanding and motivation in one another (Fennell & Liberato, 2006). The collective advocacy of OCD patients has focused on combating professional and popular misconceptions—particularly that OCD is a disease of mental frailty, diagnosed individuals are unable to work efficiently, or that people with OCD are “insane” (Fennell & Liberato, 2006).
Discussed previously, many of the popularized notions of OCD are actually better representative of OCPD (e.g. particularity, self-imposed rule obedience, attention to detail, etc.). Such misconstructions are not remedied by entertainment and social media outlets, which introduce other stereotypical components of OCD (e.g. cleaning compulsions, negligence of an obsession’s nonsense, etc.). Public perspectives also include that of psychological skeptics, who pose that mental ailments are a personality weakness that can somehow be avoided (Fennell & Liberato, 2006).
Relation to Politics of Health
The understanding of OCD in modern society is a classic example of medicalization, described by Conrad (2005) as “defining a problem in medical terms, usually as an illness or disorder, or using a medical intervention to treat it” (p. 3). The term OCD colloquially qualifies an individual as particular or perfectionistic; thus, these characteristics are replaced with medical vocabulary. The medicalization of OCD is problematic in that it obscures the clinical definition from its informal counterpart, complicates the understanding of individuals with a real diagnosis, and may discourage some people from seeking needed treatment.
Adding OCD to the popular lexicon has also charged the debate on political correctness. Mental health terminology has been central to the discussion of language sensitivity, and frivolous use of the term OCD has been considered offensive by many; however, a participant of Fennell and Liberato’s (2006) study suggested that OCD has yet to be protested enough for retraction of the term’s popular use.
Individuals with OCD were more likely to utilize health care, face unemployment, and be labeled as disabled in the workplace than people without OCD (Storch et al., 2009). Because of gaps in the Obamacare legislation (as well as in the adjusted system of the Trump administration), certain individuals with OCD are vulnerable to lacking care (Verzemnieks, 2016). The national economic demands of OCD, as well as the productivity lost when this structure fails, make this disorder politically and publicly relevant.
Additional links
TEDx Talk: Living with #OCD
Target OCD marketing mishap
References
American Psychiatric Association (2013). Obsessive-Compulsive and Related Disorders. Retrieved from https://dsm.psychiatryonline.org/doi/full/10.1176/appi.books.9780890425596.dsm06
Beljan, P., Webb, J. T., Amend, E.R., Web, N.E., Goerss, J., & Olenchak, F.R. (2006). Misdiagnosis and dual diagnoses of gifted children and adults: ADHD, bipolar, OCD, Asperger’s, depression, and other disorders. Gifted and Talented International, 21(2), 83-86.
Berrios, G.E. (1989). Obsessive-compulsive disorder: Its conceptual history in France during the 19th century. Comprehensive Psychiatry, 30(4), 283-295.
Cognitive Behavior Therapy Center (2018). Obsessive Compulsive Disorder (OCD) Therapy and Counseling. Retrieved from http://cognitivebehaviortherapycenter.com/ocd-obsessive-compulsive/
Crocq, M-A. (2015). A history of anxiety: from Hippocrates to DSM. Dialogues in Clinical Neuroscience, 17(3), 319-325.
Decloedt, E.H., Stein, D.J. (2010). Current trends in drug treatment of obsessive-compulsive disorder. Neuropsychiatric Disease and Treatment, 2010(6), 233-242.
Fennell, D. & Boyd, M. (2013). Obsessive-compulsive disorder in the media. Deviant Behavior, 35(9), 669-686.
Fennell, D. & Liberato, A.S.Q. (2006). Learning to live with OCD: Labeling, the self, and stigma. Deviant Behavior, 28(4), 305-331.
International OCD Foundation (2010). Obsessive Compulsive Personality Disorder (OCPD). Retrieved from https://iocdf.org/wp-content/uploads/2014/10/OCPD-Fact-Sheet.pdf
MyDailyQuizz (2018). How OCD Are You Really? Retrieved from http://mydailyquizz.com/how-ocd-are-you-really/
Pavelko, R.L. & Myrick, J.G. (2015). That’s so OCD: The effects of disease trivialization via social media on user perceptions and impression formation. Computers in Human Behavior, 49(1), 251-258.
Stanford Medicine (2018). Obsessive-compulsive and related disorders: History. Retrieved from http://ocd.stanford.edu/treatment/history.html
Storch, E.A., Abramowitz, J.S., & Keeley, M. (2009). Correlates and mediators of functional disability in obsessive-compulsive disorder. Depression and Anxiety, 26(9), 806-813.
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