What Is The OCD Spectrum?

Obsessive-compulsive disorder (OCD) is a mental health condition. Many people have only seen OCD representations on television and other media, which don’t always paint an accurate picture.

You may think OCD involves obsessively counting the peas on your plate or insisting on arranging everything perfectly on your desk. However, OCD can present in several ways. 

What is OCD?

Obsessive-compulsive disorder (OCD) causes obsessive thoughts, usually related to fear. Some people with OCD fear dirt and germs, while others fear harming their loved ones. To get rid of the obsessive thoughts, you feel compelled to perform specific actions, called compulsions. 

What are obsessions and compulsions?

You probably know the colloquial definition of obsessions and compulsions, but let's look at how the National Institute of Mental Health¹ (NIMH) defines them:

Obsessions 

Obsessions are repeated thoughts and urge that cause anxiety. This can include fear of germs, taboo or aggressive thoughts, and a desire to have everything perfectly ordered.

Compulsions

Compulsions are the behaviors that result from the thoughts and urges caused by obsessions. This may mean washing your hands more frequently than needed, compulsive counting, obsessively cleaning, and constantly checking on things such as door locks.

Does OCD fall on a spectrum?

People often use “OCD” casually to describe someone who may be particular about the way things are. However, an actual OCD diagnosis² requires that your obsessions and compulsions cause significant anxiety or distress and consume an hour or more of your day. 

Once you meet the threshold of an OCD diagnosis, there are levels of severity to the condition. The most common scale in use is the Y-BOCS,³ which rates the condition as subclinical, mild, moderate, severe, or extreme. 

What are OCD spectrum disorders?

Perhaps confusingly, in addition to the spectrum outlined by Y-BOCS, there is also a range of conditions known as OCD spectrum disorders.⁴ Although these disorders are distinct, they share core obsessive-compulsive features.

They also exist on a continuum of compulsivity to impulsivity. Some examples of OCD spectrum disorders include:

• Body dysmorphic disorder: Obsession over a perceived bodily defect that is either not observable to others or appears slight to others

• Pathological gambling: Lack of impulse control regarding gambling

• Sexual compulsivity: The compulsion to engage in sex acts at a frequency that may create problems in relationships or functioning

• Autism spectrum disorders: Although autism isn't an OCD spectrum disorder, OCD and anxiety disorders are more common among those with autism.

What are the types of OCD?

The stereotype of OCD obsessions with cleanliness or order only applies to some people. OCD can manifest itself in many ways. Broadly speaking, it has four dimensions:

Contamination/cleaning 

You have an excessive concern about germs, illness, or disease. You may go to great lengths to avoid potential exposure to contaminants, including avoiding certain public areas, cleaning compulsively, or avoiding contact with others.

Doubt about harm and checking 

You fear accidentally harming yourself or others. This may include fear that you left the stove on, which will cause a fire, or you left a door unlocked, allowing an intruder to come in. The fear results in an unhealthy obsession with checking to ensure the danger isn't present.

Symmetry/ordering 

You want everything to be in perfect order or symmetrical. This prompts you to rearrange items around your home or office obsessively.

Unacceptable thoughts/mental rituals 

You have obsessive thoughts of a religious, violent, or sexual nature. Often, you don't act on these thoughts, but the mental ritual of obsessing over them provides the anxiety that defines OCD.

OCD Treatments

If you're diagnosed with OCD, treatment can come in two forms: Medication and psychotherapy. In addition, your doctor may consider other mental disorders you may have when determining your treatment options. People with OCD often experience anxiety or depression, which may affect how your doctor selects your treatment.

Medication

The most common treatment for OCD is selective serotonin reuptake inhibitors (SSRIs). Doctors often prescribe these for depression and anxiety, but they can prescribe them at a higher dose for OCD. If SSRIs don't work, you may require other classes of medications.

Psychotherapy

Certain types of psychotherapy, such as cognitive-behavioral therapy (CBT), can reduce OCD symptoms. Your therapist may encourage you to engage in exposure and response prevention therapy (ERP), the most effective CBT type for OCD.

The lowdown

OCD is far more complex than its reputation. There are more forms than many people know about and a range of severities among them. In addition, related disorders also feature obsession and compulsion at their core.

If you feel you are experiencing any of the conditions discussed above, a doctor will be able to help you decide on the next steps.