Obsessions are recurrent, intrusive thoughts, impulses, or images that are perceived as inappropriate, grotesque, or forbidden. The obsessions, which create anxiety and marked distress, are quite unlike the thoughts that the person usually has. Obsessions are perceived as uncontrollable, and the sufferer often fears that he or she will lose control and act upon such thoughts or impulses. Common themes of obsessions include contamination with germs or body fluids, doubts (i.e., the worry that something important has been overlooked or that the sufferer has unknowingly inflicted harm on someone), order or symmetry, or loss of control of violent or sexual impulses.
Compulsions are repetitive behaviors or mental acts that reduce the anxiety that accompanies an obsession or are believed by the individual to “prevent” some dreaded event from happening. Compulsions include both overt behaviors, such as hand washing or checking, and mental acts including counting or praying. Not uncommonly, compulsive rituals take up long periods of time, even hours, to complete. For example, repeated hand washing, intended to remedy anxiety about contamination, is a common cause of contact dermatitis.
Obsessive-compulsive disorder typically begins in adolescence to young adult life (males) or in young adult life (females). For most, the course is fluctuating and symptom exacerbations are usually associated with life stress. It frequently co-exists with other disorders, such as major depressive disorder, Tourette’s disorder, and other anxiety disorders. Although once thought to be rare, obsessive-compulsive disorder has now been documented to have a 1-year prevalence of 2.4 percent. Obsessive-compulsive disorder is equally common among men and women.
Other mental disorders that may fall within the spectrum of obsessive-compulsive disorder include trichotillomania (compulsive hair pulling), compulsive shoplifting, gambling, and sexual behavior disorders. The latter conditions are somewhat discrepant because the compulsive behaviors are less ritualistic and yield some outcomes that are pleasurable or gratifying. Body dysmorphic disorder is a more circumscribed condition in which the compulsive and obsessive behavior centers around a preoccupation with one’s appearance (i.e., the syndrome of imagined ugliness).
An excerpt from Mental Health: A Report of the Surgeon General, U.S. Department of Health & Human Services.
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