How to Diagnose Your Friends with OCD

Obsessive-Compulsive Disorder ("OCD") is a pretty fascinating disorder. One in 50 people are said to have it and if you've ever taken a class in Abnormal Psychology, you probably diagnosed yourself with it too. Here's the nuts and bolts of the disorder, including some tips for identifying it.

DSM-IV Criteria

The predominant guide to diagnosing psychological disorders is called the Diagnostic and Statistical Manual, Fourth Edition (or just "DSM-IV"). It's a the psychologist's version of the Bible, just not as depressing. If you ever find yourself bored in life and in need of something to worry about, skim the DSM-IV and I promise you'll find at least 3 disorders to keep your mind busy.

The DSM-IV offers 5 criteria for diagnosing OCD, but as an Amateur Psychologist, you can collapse them into 3 to make it easier to remember.

1. Recurring obsessions, compulsions, or both. (Imagine that!)
   
2. The obsessive behavior is severe enough that the person recognizes their unreasonableness and it bothers them.
3. The person isn't on drugs and the obsessive thinking isn't part of another disorder. For example, if a person with an eating disorder obsessed about her weight, we wouldn't say she's OCD.

What are obsessions and compulsions?

People with OCD begin to have certain thoughts. Common thoughts include aggressive impulses, contamination concerns, and inappropriate sexual imagery. The person thinks something is wrong with having that thought and start to worry and stress out about it. For example, a person at one of my sites recently wrote in about having sexual thoughts about children, despite a long history of defending and caring for them. She thought it made her a pedophile and she freaked the fuck out.

Then comes the compulsion. The compulsion is used to drown out the obsessive thoughts. Common compulsions include whispering, praying, sorting, cleaning, thinking certain thoughts, performing strange, unconnected behaviors (like breathing in a certain way or touching a lamp 3 times). When the person engages in the compulsive behavior, the intrusive thinking goes away temporarily.

Personal Observations and a New Diagnostic Criteria

I've noticed a few features of OCD that I think might create a better understanding of the disorder. (I used to have some OCD-like behaviors when I was a kid, by the way.) First, the intrusive thought is always seen as uncontrollable and automatic. Second, the person always attaches special significance to the thought and see it as arising from their true self. For example, if they have aggressive impulses, they might think that they are serial killers. Sexual impulses? Pedophiles or fiends. Even contamination concerns are viewed as serious and legitimate.

The thing that people with OCD are not doing is recognizing that sometimes thoughts are random and just come and go, and other times, it's the things we worry about that our minds like to tease us with. Rather than being a sign that we're deviants, it's a sign of strictly held values. The more one freaks about the implications and significance of the though, the more they worry, and the more their mind teases them about having it. Therefore in my opinion, the best way to combat OCD is to have the person consider that the thoughts are only there because out minds like to tease us with stuff we find inappropriate or just send us random or even paranoid information. The thing to remember is that there is NOTHING THAT NEEDS TO BE DONE. At that point, the person can stop worrying and the obsessive thoughts won't be triggered as often.

With that in mind, here's how I would reformulate the diagnostic criteria:

1. The persistence of a thought that is viewed as uncontrollable.
2. Considerable distress that arises out of the interpretation and meaning attached to the thought (e.g., I must be a pedophile, that must be dirty, I must be a serial killer).
3. A desire to erase the thought and control the mind.
   

And there you have it folks. I know trust that you have a pretty good understanding of OCD, how to identify it, and how to give it to people like an STD. So go! Diagnose and be merry.