Obsessive Compulsive Disorder Treatment Center - Miami, FL

So, the question becomes: what symptoms and characteristics are associated with the diagnosis of Obsessive Compulsive Disorder? According to the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM–5; American Psychiatric Association [APA], 2013):

OCD is characterized by the presence of obsessions and/or compulsions. Obsessions are recurrent and persistent thoughts, urges, or images that are experienced as intrusive and unwanted, whereas compulsions are repetitive behaviors or mental acts that an individual feels driven to perform in response to an obsession or according to rules that must be
applied rigidly.

The DSM-5 explains that the obsessions associated with OCD are unwanted and cause a considerable amount of distress for the person experiencing symptoms (American Psychiatric Association, 2013). As a result, the compulsions can arise in response to the obsessions. Thus, compulsions can become behaviors or acts that are performed in order to soothe the distress associated with obsessions, although the compulsions may not necessarily be related to the obsessions in a realistic manner (American Psychiatric Association, 2013). Pittenger, Kelmendi, Bloch, Krystal, & Coric (2005) highlight some examples of obsessions and compulsions:

Common Obsessions of OCD

Some common obsessions of obsessive compulsive disorder include:

• fear of contamination
• fear of harming self or others
• intrusive violent images
• recurrent forbidden or perverse sexual thoughts
• a need to save items of perceived value
• concern with sacrilege or morality
• a need for symmetry
• excessive concern about appearance

Common Compulsions Performed in Response to Obsessions

Some common compulsions performed in response to obsessions include:

• excessive hand washing
• ritualized bathing or grooming
• checking behaviors
• mental rituals
• need to repeat activities
• re-reading text
• hoarding behaviors
• superstitious behaviors

Accordingly, the DSM-5 states that most individuals who are diagnosed with OCD experience both the obsessions and the compulsions (American Psychiatric Association, 2013).

Another criterion necessary in order to be diagnosed with OCD is that “obsessions and compulsions must be time-consuming (e.g., more than 1 hour per day) or cause clinically significant distress or impairment to warrant a diagnosis of OCD” (American Psychiatric Association, 2013, p. 238). This is distinctly important because most, if not all, people experience intrusive thoughts. In my practice as a clinician, I refer to intrusive thoughts as “junk thoughts” that the brain sends out every once in a while.

Furthermore, when diagnosing OCD, it is important to remember that the amount of time someone spends related to their thoughts and/or compulsions can vary from person to person (American Psychiatric Association, 2013). Lastly, in order to diagnose OCD, the symptoms cannot be better explained by any substance, other medical condition, or other mental condition (American Psychiatric Association, 2013).

Although OCD is often misused within the media and within society, one of the movies that is a fairly accurate representation is Jack Nicholson’s performance in “As Good as it Gets”.

In the movie, Nicholson’s character (named Melvin) displays certain compulsions associated with his OCD.  He would perform rituals - such as turning the lights on and off a certain number of times as well as washing his hands repeatedly with scalding hot water - in order to alleviate what I can only assume are his obsessions.  Unfortunately, the audience does not hear the internal dialogue associated with the compulsions but it can be surmised that the behaviors/rituals are for a particular reason.  The movie, which is over 20 years old, still stands holds up until this day.

However, it is important to remember that movies do not always accurately represent what actual symptoms may look like; also, some of the behaviors displayed by Melvin may have had other underlying causes.