What are Obsessive-Compulsive Spectrum Disorders?

Obsessive-Compulsive spectrum disorders, OCSD, is a term used to describe disorders that resemble and are related to obsessive-compulsive disorder OCD as they have a similar obsessive-compulsive component. There is a difference of opinion concerning which illnesses should be included in this category, for the purpose of this web site I will only mention a few of the more generally understood conditions with which most people are familiar. However please bear in mind that I have a personal experience with only a few of these disorders and I am not a mental health professional. The brief explanations below are to provide background information only, for  more expert information concerning the conditions included on this web site please visit the web sites listed inuseful links and refer to the appropriate books included in therecommended books page.

The best method to understand an illness is always from the perspective of the sufferer. To this end anyone suffering with any of the illness included on this page and indeed this web site are welcome to send in their own personal stories. Contact.

 

OCSDs are illnesses which present with behaviours that resemble obsessions and compulsions and indeed some of these conditions are often so similar in nature that they could very well be considered as a type of OCD, this is particularly the case with, for example, hypochondriasis and body dysmorphic disorder BDD.

 

Hypochondriasis often involves the afflicted person in checking compulsions such as inspecting parts of the body for the evidence of disease, such as lumps for cancer, ruminating about every spot and pimple, and checking through medical dictionaries for evidence that he or she may have some life threatening illness.  These and similar compulsions arise as the result of repetitive tormenting thoughts; obsessions, that he or she has a serious illness.
BDD involves obsessive ruminating upon imagined body imperfections. The sufferer is plagued by anxious thoughts, much the same as the type of obsessive thoughts described for OCD, concerning perceived imperfections and consequently becomes involved in compulsions to mitigate this anxiety. Such compulsions include the repetitive checking of one’s appearance in the mirror to, in extreme cases, undergoing plastic surgery. The condition varies in intensity but similarly to OCD the sufferer can find his or herself confined to the house or unable to socialise. In some ways anorexia nervosa and other eating disorders may appear as a type of BDD when the sufferer sees a fat person reflected in the mirror instead of the emaciated individual that everyone else sees.

 

Other types of OCSD may appear more as involuntary impulses, such as trichotillomania, which manifests as an irresistible urge to pull out ones hair from just about anywhere on the body but particularly from the head. The compulsive urge may arise from feelings of depression, tension or stress which gives rise to an uncontrollable and irresistible impulse to engage in hair pulling. Conversely such powerful urges can also occur when the sufferer is relaxed. Such impulsive behaviour may even surface without any recognisable precipitating emotion. And feelings of pleasure or relief may occur after a hair-pulling episode. Most often though such urges appear habitual without the thoughts, obsessions, that occur with OCD. There seems to be no specific obsessions resulting in the compulsion as there is in OCD and the suffer needs to become aware of situations that may exist which may precipitate this overwhelmingly powerful and compulsive urge. The similarity between Trichotillomania and OCD lies in fact that this behaviour is repetitive and uncontrollable and seemingly beyond the volition of the sufferer.

 

Like trichotillomania compulsive skin picking CSP involves a similar irresistible and powerful urge to pick ones skin. Again the reason for the compulsion is not always clearly defined. CSP can occur as a response to stress or depression, perhaps a subconscious need to mitigate the resulting negative feelings of emotional pain by inflicting physical pain or discomfort. As a child I had a period in which I experienced the urge to scratch my skin until large scabs appeared, the reason for doing so is obscure, the impulse to do so merely presented itself. Pleasurable feelings often occurred during the throes of this compulsion. Similarly with CSP the reason or the obsessive thought is not as clearly defined as it is in OCD or anorexia nervosa and as with trichotillomania the compulsion appears be precipitated by tension and an overwhelming urge, and pleasure or relief often follows the compliance with the compulsion to pick ones skin even though pain and damage to the skin result.  This impulse often emerges as an unconscious and habitual compulsion. The usual targets for skin picking may be spots, pimples, blemishes scabs and so on. Again social isolation may occur in extreme cases due to embarrassment concerning resulting skin disfigurement.

 

Tourett’s syndrome is sometimes included in the OCSDs categorisation. It is a genetic neurological disorder so named after Dr. Georges Gilles de la Tourette a neuropshychiarist . The disorder is characterised by uncontrollable movements referred to as motor and vocal tics. Motor tics manifest with sudden uncontrolled jerking movements such as blinking, facial twitching, head jerking, neck stretching and so on. These manifestations can vary from mild to extreme involuntary impulses with more complex movements, the sufferer suddenly seemingly compelled to spin round, change direction even jump, also hand movements, head shaking, twisting or bending along with a compulsive urge to touch others. The type of behaviours presented can change as time goes on. Vocal tics include compulsive swearing of obscenities which is in fact rare but is however more associated with Tourett’s syndrome due to thesensationalisation of this manifestation by the media. Mostly vocal tics concern more simple and less dramatic vocal impulses such as throat clearing, grunting, sighing, tongue clicking, sniffing or snorting. These may not appear to be as dramatic as the swearing of obscenities, and such manifestations may appear less bizarre however these more usual presentations can indeed be very embarrassing and unpleasant. I recall an unfortunate child at school who in retrospect clearly suffered from vocal tics and snored and sniffed very loudly and frequently causing her to be subjected to ridicule, derision and outright bullying from both teachers and pupils alike. Thankfully today the condition is more understood and hopefully teachers and others involved with children’s welfare are better informed. More complex tics can involve repeating the lasts words of ones self or others or phrases may be repeated out of context. Often Tourette’s Syndrome occurs co-morbidly with OCD and there are similarities between the two disorders. The tics of Tourtettes bear a similar likeness to the compulsions of OCD inasmuch as both present as unwanted and intrusive and seemingly beyond the sufferers volition or control. It has been established that a genetic link exists between the two disorders showing that both of these illnesses may be an expression of the same malady but with different manifestations.

 

Eating disorders such as bulimia and anorexia nervosa
 what is anorexia nervosa are often included in the OCSDs as such eating disorders present as problems clearly related and similar to OCD. A large percent of people presenting with anorexia nervosa also suffer with OCD. Thoughts clearly recognised as obsessive, such as intrusive thoughts that one is fat, are followed by actions that can be described as compulsive, for example, extreme dieting, excessive exercising, fanatical and precise calculation of calorie intake. Unlike OCD however the sufferer is not always aware that a problem exists, the sufferer may not have the insight into the irrationality of this type of behaviour and may consider it not only appropriate but also desirable. Sufferers may even consider that they are superior to others by virtue of their ability to control their weight whilst failing to see the reality of the situation as they become emaciated and endanger their health, even bringing about their premature death.

 

Often OCD and OCSDs, manifest comorbidly. For example OCD is my main manifestation of this type of obsessive-compulsive illness however other illness of a similar nature classified as OCSDs also present in varying degrees such as BDD and hypochondriasis. My sister had anorexia nervosa as her main presenting obsessional illness however she also manifested quite severe hypochondriasis along with OCD type ruminative thoughts. It is my opinion that most people who present with any one of these disorders suffer several other OC manifestations comorbidly and from my own experience and from what I have learnt from fellow suffers, it appears that one particular illness such as my OCD is the dominant presentation while the other illnesses exist comorbidly but to a lesser degree.