50-2 What is OCD?

As with the anxiety disorders, we can see aspects of obsessive-compulsive disorder (OCD) in our everyday behavior. We all may at times be obsessed with senseless or offensive thoughts that will not go away. Or we may engage in compulsive behaviors, perhaps lining up books and pencils “just so” before studying.

Obsessive thoughts and compulsive behaviors cross the fine line between normality and disorder when they persistently interfere with everyday living and cause distress. Checking to see you locked the door is normal; checking 10 times is not. Washing your hands is normal; washing so often that your skin becomes raw is not. (TABLE 50.1 offers more examples.) At some time during their lives, often during their late teens or twenties, 1 to nearly 3 percent of people cross that line from normal preoccupations and fussiness to debilitating disorder (Kessler et al., 2012). An analysis of 14 twin studies showed that OCD has a strong genetic basis (Taylor, 2011). Although the person knows them to be irrational, the anxiety-fueled obsessive thoughts become so haunting, the compulsive rituals so senselessly time-consuming, that effective functioning becomes impossible.

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Former professional basketball player Royce White, who is open about his obsessive-compulsive disorder, said that his wealth allowed him to purchase a large house. What was the most difficult part of his transition to mansion living? “The toughest thing is going around and seeing that dust has collected in a room [I] don’t use often. And then I’ve got to spend 30 minutes dusting that thing” (Wrenn, 2012).

OCD is more common among teens and young adults than among older people (Samuels & Nestadt, 1997). A 40-year follow-up study of 144 Swedish people diagnosed with the disorder found that, for most, the obsessions and compulsions had gradually lessened, though only 1 in 5 had completely recovered (Skoog & Skoog, 1999).