Causes of OCD Obsessions and compulsions

Repeaters | Cleaners | Checkers | Orderers | Hoarders | Washers

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The causes of OCD obsessions and what the disorder generally consist of are recurrent and intrusive ideas, thoughts, impulses or images; whereas compulsions generally consist of recurrent, persistent, purposeful and intentional ritualistic motor behaviors, although recent research has made the case that compulsions can be mental (covert) as well as overt behavioral activities.

The most frequent cause of obsessions are fears of contamination, being harmed or harming others, ruminations, often with aggressive or sexual content, doubting and unacceptable impulses. The most frequent compulsions include washing/cleaning, checking, counting, repeating, hoarding and ordering.

Several attempts to subtype Obsessive Compulsive Disorder patients according to symptoms have been attempted, and surely more will follow. In treating OCD, the following descriptive categories are used: washers and cleaners, checkers, repeaters, orderers, hoarders, thinking ritualizers, worriers and pure obsessionals.

OCD Washers and cleaners are concerned with contamination and engage in washing or cleaning rituals to gain a sense of cleanliness or reduce the likelihood of contamination.

OCD Checkers are concerned that harm may come to themselves or others if certain checking rituals are not performed.

OCD Repeaters engage in repetitive rituals to prevent feared outcomes but, unlike those of washers and checkers, the rituals bear no realistic relationship to the feared outcomes.

OCD Orderers are characterized by the urge to arrange things in certain patterns. Their need is less to prevent harm than to make things feel right to them.

OCD Hoarders are patients who collect things. Hoarding is defined as `the acquisition of, and failure to discard, possessions which appear to be useless or of limited value'. Hoarding differs from simple collecting. Collectors are proud of their collections and enjoy having other people observe them. Hoarders, on the other hand, tend to be ashamed of their collections and try to hide them from others. The motivation for such pathological collecting tends to be the desire to not be caught without a needed object.

OCD Thinking ritualizers are those whose compulsive rituals are covert, occurring as mental images or thoughts, such as counting or highly ritualized praying, rather than overt behaviors. As is the case with overt behavioral rituals, thinking rituals are performed to decrease anxiety associated with uncomfortable obsessive thoughts or images.

In OCD worriers and pure obsessionals, no repetitive, fixed rituals are apparent. Instead of performing mental rituals, as the thinking ritualizers do, this group counters distressing thoughts with reassuring thoughts or arguments, and these can vary from one episode to the next.

Some authors have argued that patients who have obsessions without compulsions form a distinct subgroup. Arts et al. (1993) found that the two groups differ in marital status, level of education, age at onset of complaints, psychoactive medication taken when admitted for treatment, severity of OC complaints, depression and intelligence. Patients with both obsessions and compulsions are much more common than those with obsessions alone.ONLINE OCD TEST