Obsessive Compulsive Spectrum: Everything You Need To Know

The Obsessive-Compulsive Spectrum consists of a range of conditions that share the hallmark of obsessive and compulsive behaviours.

An obsession is an unwanted and unpleasant thought, doubt, image or urge that repeatedly enters a person’s mind. A compulsion is a repetitive action that the person then carries out to temporarily relieve the anxiety brought on by the obsession.

There are many conditions that fall into this category – with Obsessive Compulsive Disorder (OCD) the most well-known. The different conditions share some similarities, however there are key differences.

Living with an Obsessive-Compulsive Spectrum disorder can be difficult – and cause significant impairment in multiple contexts.

However, treatment is available – and in many cases will lead to the individual attaining a full recovery.

Types of Obsessive Compulsive Spectrum Conditions

There are several different conditions within the Obsessive-Compulsive Spectrum. While these conditions contain many similarities, there are some crucial differences involved which help to differentiate each disorder from one another.

Obsessive-Compulsive Disorder (OCD): This is a debilitating condition that involves an individual having regular obsessions and compulsions. The individual involved will have repetitive thoughts, behaviours or urges. Unfortunately, OCD is a very, very misunderstood condition. It is a very difficult condition to live with, and can disrupt an individual’s life significantly.

Body Dysmorphic Disorder: Also known as Body Dysmorphia, this condition is characterised by an individual having intense worries about supposed faults in their appearance. While said faults aren’t normally noticeable to others, they will cause extreme distress to the patient. The individual will commonly go to great measures to try and rectify the apparent problem.

Hoarding Disorder: This is a condition that is closely related to Obsessive-Compulsive Disorder (OCD). It is characterised by an individual struggling to discard possessions, often causing them to excessively hoard items. This often leads to an unhealthy living environment, and often becomes a fire hazard. It also commonly affects an individual’s social life.

Trichotillomania: Trichotillomania is a condition which involves an individual being unable to resist the urge to pull out their hair. An individual may feel an intense urge to pull out hair, and experience a forceful build-up of tension until they complete the action. After pulling out their hair, an individual may feel a sense of relief – though this is only temporary. Overall, this is a very similar condition to OCD, only that it is limited to hair pulling.

Excoriation Disorder: Excoriation Disorder is characterised by a person having an irresistible urge to pick their own skin. This intense urge will be accompanied by an intense feeling of tension until the individual completes the act. A temporary feeling of relief will normally ensue, although this doesn’t last for long, and so the cycle continues. An individual puts themselves at acute risk of health problems due to their skin picking.

Primarily Obsessional OCD (Pure O): This condition is commonly seen as a subtype of OCD. An individual with this condition will have many obsessions, but few subsequent compulsions. Typical symptoms include excessive rumination, intense intrusive thoughts and a fear of possible actions. There are a range of different intrusive thoughts that may be involved.

Several other conditions, such as some Eating Disorders and Somatic Disorders, may also be considered to be part of the Obsessive-Compulsive Spectrum. However, these conditions have been included in alternate areas of our website.

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Symptoms of the Obsessive Compulsive Spectrum Conditions

The symptoms of each condition within this spectrum differ slightly. However, each contains an obsession, with each (minus Primarily Obsessional OCD) also being accompanied by a compulsion.

• An obsession is an unwanted and unpleasant thought, doubt, image or urge that repeatedly enters a person’s mind. As a result, the person experiences anxiety or general unease. Examples include fear of contamination, and a need to organise items symmetrically.
• A compulsion is a repetitive action that the person then carries out to temporarily relieve the anxiety brought on by the obsession. Examples include rituals, checking and reassurance.

The exact obsessions and compulsions exhibited differ from condition to condition. For instance:

• Someone with Obsessive-Compulsive Disorder may have an urge to wash their hands before touching anything – due to fears over cleanliness. They may feel unable to touch any surface prior to washing their hands.
• Someone with Body Dysmorphic Disorder may constantly check their appearance in the mirror, and obsess over an apparent fault. They may have the compulsion to use makeup or some other product in order to cover up the perceived flaw.
• Someone with Hoarding Disorder may be unable to discard of an item when they wish to. Whenever they are about to get rid of something, they may think about how one day they might need the item. Their compulsion will be to keep the item.
• Someone with Trichotillomania will commonly have the obsession to pull out their hair – especially in instances where they are highly stressed. The person will have endless thoughts about this until they complete the act and pull out their hair.
• Someone with Excoriation Disorder will often have the obsession to pick at their skin. The person will have persistent thoughts about this until they complete the act and pick at their skin.
• Someone with Primarily Obsessional OCD will commonly have an obsession over a fear of what they might do in a social situation. Instead of enjoying themselves in a social situation, they will fret over how the are acting. There are few, or mild, obsessions involved in this condition.  

These symptoms will cause many behavioural changes. An individual may neglect others due to their need to fulfil certain rituals, or will commonly develop low mood due to the impact the compulsions have on their life. Many people end up adopting harmful coping strategies like substance abuse.

As alluded to above, the exact symptoms that appear are dependent on the condition present.

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Causes of Obsessive Compulsive Spectrum Conditions

It isn’t entirely known what causes the disorders within the Obsessive-Compulsive Spectrum. They are all complicated conditions that appear to be caused by multiple factors.

Certain risk factors appear to exist, while some people may be more vulnerable to develop a condition. Potential risk factors include:

• Stress: Intense stress is a key factor in several conditions. When an individual is feeling stressed, it can often result in unpredictable behaviours, which may soon spiral into obsessions and compulsions. Major life events like divorce, losing a job or having a child, can all cause stress.
• Genetics: It appears that genetics also plays a role. Those with a family history of Obsessive-Compulsive Spectrum disorders are at heightened risk. The disorders can run in families. It doesn’t appear any certain gene is responsible. 
• Chemical Imbalance: It is possible that Obsessive-Compulsive Spectrum disorders are linked to a chemical imbalance in the brain. Chemicals like norepinephrine and serotonin may be unbalanced – which may contribute to the condition. This isn’t entirely understood however, but is linked to several mental health conditions.
• Brain Differences: Similar to the above, brain scans suggest that some areas of the brain are different in those with an Obsessive-Compulsive Spectrum disorder. These areas react differently to stimuli, with their abnormality a possible cause.
• Traumatic Event: A traumatic event, or physical, sexual or emotional abuse can all cause intense distress – which can lead to a mental health condition developing.
• Illness: Some illnesses may lead an individual to change their behaviour – which may result in an adoption of obsessive-compulsive behaviour. For instance, someone who often catches the common cold may start to batten down the hatches in their home – trying to keep outsiders out, and their rooms clean. They may start to spend excessive time washing their hands, and imploring others to do so.
• Personality Traits: Certain personality traits, such as high attention to detail, methodical ideas or a high level of organisation, low self-esteem or anxiety, can all contribute to a Obsessive-Compulsive Spectrum disorder developing. For example, someone with low self-esteem will be more vulnerable to developing Body Dysmorphic Disorder.

Many of these factors may accumulate, leading to the onset of a condition. But this isn’t entirely known, and some people may develop a condition for no clear reason.

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Diagnosis of Obsessive Compulsive Spectrum Conditions

Obsessive-Compulsive Spectrum disorders cannot be diagnosed through a laboratory test or any other medical examination. Instead, a Doctor will aim to make a diagnosis based on a meeting in an appointment.

The Doctor will ask the individual a range of questions pertaining to their symptoms. They may focus on the impact the symptoms have, when they started, a family history, and anything else relevant.

Sometimes, a blood test or physical examination could be ordered if the Doctor believes a physical condition has caused the symptoms.

Each Obsessive-Compulsive Spectrum Disorder has its own diagnostic criterion that needs to be satisfied. However, as a starting point – below are the general rules involved in a diagnosis of an Obsessive-Compulsive Spectrum disorder:

• Evidence of repetitive obsessions
• The individual then carries out a related compulsion
• If this doesn’t happen, the individual experiences emotional distress
• The individual will have attempted to ignore their obsessions
• The symptoms impact an individual’s day-to-day life
• The symptoms cannot be attributed to substance abuse
• The symptoms aren’t better explained by a different mental health condition

Seeking help for an Obsessive-Compulsive Spectrum disorder as soon as possible is important. These conditions don’t tend to clear up on their own, and typically get worse over time. The earlier treatment is sought, the sooner the road to recovery can begin.

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Treatment of Obsessive Compulsive Spectrum Conditions

Obsessive-Compulsive Spectrum disorders can all be treated successfully. The aim for each condition is recovery, and in many cases – this will be possible.

The exact treatment plans for each condition is slightly different. However, generally treatment will involve self-help, a form of talking therapy, and on occasion, medication.  

• Self-Help: Engaging in self-help materials on the internet and doing certain things can help. Regular exercise, a healthy diet and sleeping well can often help. There are several discussion groups available on the internet for Obsessive-Compulsive Spectrum Disorders, which can provide an individual with support, or contact with others going through similar experiences.

• Talking Therapy: Talking therapy is the most important part of treating Obsessive-Compulsive Spectrum disorders. A therapy like Cognitive-Behavioural Therapy is especially useful – due to its focus on the effect of thoughts. This is a key area in Obsessive-Compulsive Spectrum disorders. There are several different types of therapy that are available. Potentially useful ones include:

Cognitive Behavioural Therapy (CBT): CBT is a type of therapy that is used to treat a range of mental health conditions. CBT involves an individual talking face-to-face with a therapist, although sometimes CBT can be conducted in a group setting. CBT attempts to improve an individual’s wellbeing and mood. The therapy focuses on the link between thoughts, feelings and actions. This can be useful for those with low self-esteem, anxiety, unhelpful personality traits or intrusive thoughts. CBT can help an individual understand their feelings more, and in the long run should lead to an improvement in quality of life.

Schema Therapy: Schema Therapy is a talking therapy that combines aspects of Cognitive-Behavioural Therapy, Gestalt therapy and psychoanalytical thinking into one form. It can be useful in treating personality disorders due to its ability to help people change longstanding patterns of thought and behaviour. The therapy is normally based on the idea that childhood needs were not met, leading to deeply-held obstructive beliefs. The therapist will attempt to change long-standing patterns that have contributed to problems, and can be very useful. Schema therapy is mainly intended for use in the treatment of personality disorders.

• Medication: In cases where necessary, a doctor may choose to prescribe a medication. An antidepressant can help to make the intrusive thoughts seen in these conditions less prominent.

Antidepressants: Antidepressants can help to improve and regulate mood. They should improve motivation and restore energy. SSRI Antidepressants are the most commonly prescribed. They act on the brain chemical serotonin – which is thought to help in regulating mood and emotion. They may include side-effects such as a dry mouth, sexual problems and nausea, though these should hopefully be short-term. Other classes of antidepressants are available in the event of an inadequate reaction.

These conditions can be treated successfully – and many treatment options exist. The aim is for each individual to find a combination of treatment options that work, with the objective of recovery.  

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Living with Obsessive Compulsive Spectrum Conditions

Obsessive-Compulsive Spectrum disorders commonly have a big effect on the life of an individual. The conditions commonly interrupt the day-to-day life of its sufferers.

Treatment can help, but there are also certain things that an individual can do to try and maximise their chances of recovery. Exercising, sleeping well and entering treatment with an open mind are just some of the many areas that can help when living with an Obsessive-Compulsive Spectrum disorder.

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Prognosis

Obsessive-Compulsive Spectrum disorders are difficult conditions to live with. However, the prognosis is generally good for these conditions.

There are several factors that may affect this prognosis, but many people will be able to recover. Talking therapy and treatment can help significantly.

But, these conditions may cause suicidal thoughts, are stigmatised, and require long-standing behavioural traits to be changed. But most of the time, recovery is possible.  

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See Also

• Obsessive Compulsive Spectrum Homepage
• A-Z of Mental Health Conditions
• Therapy Home
• Mental Health General Homepage