Formal diagnosis may be performed by a psychologist or a psychiatrist. To be diagnosed with OCD, a person must have obsessions, compulsions, or both, according to the Diagnostic and Statistical Manual of Mental Disorders (DSM).
The Quick Reference to the 2000 edition of the DSM suggests that several features characterize clinically significant obsessions and compulsions. Such obsessions, the DSM says, are recurrent and persistent thoughts, impulses, or images that are experienced as intrusive and that cause marked anxiety or distress.
These thoughts, impulses, or images are of a degree or type that lies outside the normal range of worries about conventional problems. A person may attempt to ignore or suppress such obsessions, or to neutralize them with some other thought or action, and will tend to recognize the obsessions as idiosyncratic or irrational.
Compulsions become clinically significant when a person feels driven to perform them in response to an obsession, or according to rules that must be applied rigidly, and when the person consequently feels or causes significant distress. Therefore, while many people who do not suffer from OCD may perform actions often associated with OCD (such as ordering items in a pantry by height), the distinction with clinically significant OCD lies in the fact that the person who suffers from OCD ''must'' perform these actions, otherwise they will experience significant psychological distress.
These behaviors or mental acts are aimed at preventing or reducing distress or preventing some dreaded event or situation; however, these activities are not logically or practically connected to the issue, or they are excessive. In addition, at some point during the course of the disorder, the individual must realize that their obsessions or compulsions are unreasonable or excessive. Moreover, the obsessions or compulsions must be time-consuming (taking up more than one hour per day) or cause impairment in social, occupational, or scholastic functioning.
OCD is often confused with the separate condition obsessive–compulsive personality disorder. The two are not the same condition, however. OCD is ''ego dystonic'', meaning that the disorder is incompatible with the sufferer's self-concept. Because disorders that are ego dystonic go against a person's self-concept, they tend to cause much distress. OCPD, on the other hand, is ''ego syntonic''—marked by the person's acceptance that the characteristics displayed as a result of this disorder are compatible with his or her self-image. Ego syntonic disorders understandably cause no distress. People with OCD are often aware that their behavior is not rational and are unhappy about their obsessions but nevertheless feel compelled by them. People with OCPD are not aware of anything abnormal about themselves; they will readily explain why their actions are rational, and it is usually impossible to convince them otherwise. People with OCD are ridden with anxiety; by contrast, people with OCPD tend to derive pleasure from their obsessions or compulsions.
Equally frequently, these rationalizations do not apply to the overall behavior but to each instance individually; for example, a person compulsively checking the front door may argue that the time taken and stress caused by one more check of the front door is much less than the time and stress associated with being robbed, and thus the check is the better option. In practice, after that check, the person is ''still'' not sure and deems it is ''still'' better in terms of time and stress to do one more check, and this reasoning can continue as long as necessary.
Some OCD sufferers exhibit what is known as ''overvalued ideas''. In such cases, the person with OCD will truly be uncertain whether the fears that cause them to perform their compulsions are irrational or not. After some discussion, it is possible to convince the individual that their fears may be unfounded. It may be more difficult to do ERP therapy on such patients because they may be unwilling to cooperate, at least initially. For this reason OCD has often been likened to a disease of pathological doubt, in which the sufferer, though not usually delusional, is often unable to realize fully which dreaded events are reasonably possible and which are not. There are severe cases in which the sufferer has an unshakeable belief in the context of OCD that is difficult to differentiate from psychosis.
OCD is different from behaviors such as gambling addiction and overeating. People with these disorders typically experience at least some pleasure from their activity; OCD sufferers do not actively want to perform their compulsive tasks and experience no pleasure from doing so. OCD is characterized as an anxiety disorder, but like many forms of chronic stress it can lead to clinical depression over time. The constant stress of the condition can cause sufferers to develop a deadening of spirit, a numbing frustration, or sense of hopelessness. OCD's effects on day-to-day life—particularly its substantial consumption of time—can produce difficulties with work, finances, and relationships. There is no known cure for OCD, but a number of successful treatment options are available.
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