Obsessive-Compulsive Disorder (OCD) - DSM Reference & Spectrum Overview

What is OCD?

Obsessive-Compulsive Disorder (OCD) is a chronic mental health condition characterized by the presence of obsessions, compulsions, or both. According to the DSM-5-TR (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision), OCD involves:

• Obsessions: Recurrent and persistent thoughts, urges, or images that are intrusive, unwanted, and cause significant anxiety or distress.

• Compulsions: Repetitive behaviors or mental acts that an individual feels driven to perform to neutralize distress or prevent a feared event, even if the actions are not connected in a realistic way to the feared outcome.

OCD is an ego-dystonic disorder, meaning the individual recognizes that their thoughts and behaviors are irrational, yet they struggle to stop them due to overwhelming anxiety. The severity of symptoms can vary from mild (manageable but distressing) to severe (crippling and time-consuming, affecting daily life).

Fixation in OCD: Image, Impulse, Urge, and Thought

1. Fixation on an Image: Disturbing or distressing mental pictures, such as violent, sexual, or blasphemous imagery.

2. Fixation on an Impulse: Fear of acting on an unwanted impulse, such as shouting an inappropriate word in public or harming a loved one.

3. Fixation on an Urge: A strong, distressing need to do something, even if the action itself is not desirable. For example, feeling an overwhelming urge to touch an object repeatedly.

4. Fixation on a Thought: Repetitive, distressing ideas, such as a belief that one has sinned or made a mistake that will cause disaster.

Causes of OCD

While the exact cause of OCD is unknown, multiple factors contribute to its development:

• Biological Factors:

  • Abnormal activity in the cortico-striato-thalamo-cortical (CSTC) circuit, responsible for habit formation and response inhibition.

  • Serotonin dysregulation, affecting impulse control and anxiety regulation.

  • Genetic predisposition—first-degree relatives have a higher likelihood of developing OCD.

• Psychological Factors:

  • Cognitive distortions, such as thought-action fusion (believing thinking about harm is as bad as doing it).

  • Maladaptive learning, where neutral stimuli become associated with fear.

• Environmental Triggers:

  • Stressful life events, trauma, or significant changes (e.g., childbirth, loss of a loved one).

  • Infections like PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections) in children.

Types of OCD (Obsessive-Compulsive Spectrum Disorders)

OCD exists on a spectrum, meaning different individuals experience different subtypes. The DSM-5-TR recognizes related disorders under the Obsessive-Compulsive and Related Disorders category.

Common OCD Subtypes

1. Contamination OCD (Fear of germs, dirt, or illness → Compulsion: excessive cleaning, handwashing)

2. Checking OCD (Fear of causing harm due to negligence → Compulsion: repeated checking of locks, appliances, or memories)

3. Symmetry and Order OCD (Distress over asymmetry or disorder → Compulsion: arranging, counting, or aligning objects)

4. Harm OCD (Fear of causing harm to oneself or others → Compulsion: seeking reassurance, avoiding sharp objects)

5. Intrusive Thought OCD (Disturbing, unwanted thoughts about taboo topics → Compulsion: mental rituals, prayer, avoidance)

6. Hoarding Disorder (Persistent difficulty discarding possessions due to fear of loss)

7. Pure-O (Pure Obsessional OCD) (Obsessions without visible compulsions → Compulsion: mental rituals, reassurance-seeking)

8. Scrupulosity OCD (Religious or moral obsessions → Compulsion: excessive prayer, confession, avoidance of 'sinful' behavior)

9. Relationship OCD (ROCD) (Obsessive doubts about relationships → Compulsion: excessive reassurance-seeking, mental rumination)

OCD Fixation Types and Examples of Actions

Fixation Type	Examples of Actions
Thought	Did he check my messages?
Thought	Did I lock the door before leaving?
Thought	Did I offend someone in a conversation?
Thought	Did I accidentally run over someone while driving?
Thought	Did I say something inappropriate in public?
Image	Unwanted mental images of accidents.
Image	Disturbing images of a loved one in danger.
Image	Graphic violent scenes appearing suddenly.
Image	Blasphemous or religiously inappropriate images.
Image	Sexual images about inappropriate scenarios.
Impulse	Fear of yelling something inappropriate in a meeting.
Impulse	Sudden urge to slap a stranger.
Impulse	Feeling like you might push someone off a ledge.
Impulse	Impulse to drive into oncoming traffic.
Impulse	Desire to throw an object at someone despite no anger.
Urge	Overwhelming need to tap an object until it feels right.
Urge	Need to blink a specific number of times.
Urge	Compulsion to repeat a word or phrase mentally.
Urge	Needing to rewrite notes until they feel 'perfect'.
Urge	Re-reading a message multiple times before sending it.

OCD is often referred to as the "Doubting Disorder" because it thrives on uncertainty and the inability to trust one's own thoughts, memories, or actions. While fear-based obsessions are common, not all OCD symptoms are rooted in fear. OCD can manifest in any form of repetitive thought or behavior driven by an internal need for certainty, correctness, or relief from distress.

Can OCD be only fear-based?

No, OCD is not always about fear. It can be driven by various emotions and mental experiences, including:

1. Fear-Based OCD (Most Common)

   • Fear of contamination → Excessive handwashing

   • Fear of harming someone → Avoiding sharp objects

   • Fear of forgetting → Repeated checking of locks, stoves, etc.

2. Perfectionism & Just-Right OCD

   • Compulsion to write, type, or arrange objects until they feel "just right"

   • Feeling internal discomfort rather than fear if things aren’t in a specific way

   • Repeating actions (walking, blinking, tapping) until it feels correct

3. Moral or Ethical OCD (Scrupulosity)

   • Obsessing over whether one lied, cheated, or sinned

   • Excessive confession, apologizing, or seeking reassurance

4. Existential or Philosophical OCD

   • Obsessing over deep, unanswerable questions ("What if life isn’t real?")

   • Constantly questioning reality and needing certainty

5. Sensory or Symmetry OCD

   • Distress over asymmetry or uneven sensations

   • Repeating actions (e.g., touching something on both sides)

6. Compulsive Counting or Mental Repetitions

   • Needing to count in patterns to feel safe

   • Mentally repeating words or prayers to prevent harm

OCD is not only about fear. Any kind of repetition—whether driven by fear, discomfort, incompleteness, or a need for certainty—can be considered OCD if it is intrusive, repetitive, and affects daily life.

Love itself is not OCD, but certain obsessive patterns related to love and relationships can manifest as Relationship OCD (ROCD) or Obsessive Love Disorder (OLD).

1. Relationship OCD (ROCD) - A Subtype of OCD

ROCD is a specific form of OCD where individuals experience intrusive doubts and compulsions related to their romantic relationships. These doubts are irrational, persistent, and cause significant distress.

Symptoms of ROCD:

• Obsessing over whether they truly love their partner (e.g., “Do I really love them?”)

• Doubting their partner’s love and compatibility (e.g., “Are they the right one?”)

• Constantly comparing their partner to others (e.g., “Are they attractive enough?”)

• Seeking reassurance from the partner or others (e.g., “Do you think we are meant to be?”)

• Performing mental compulsions (e.g., reanalyzing past interactions to “check” if they love their partner)

ROCD can affect both single individuals (obsessing over finding the ‘right’ partner) and those in relationships (obsessing about their partner’s flaws or feelings).

2. Obsessive Love Disorder (OLD) - A Different Condition

Obsessive Love Disorder is not OCD, but it involves extreme, uncontrollable preoccupation with a person, leading to jealousy, possessiveness, and emotional dependence.

Symptoms of OLD:

• Obsessively thinking about the person all the time

• Feeling an uncontrollable need to be around them

• Extreme jealousy and possessiveness

• Fear of abandonment, leading to controlling behaviors

• Disregarding personal well-being for the sake of the relationship

OLD is often linked to attachment disorders, personality disorders (such as borderline personality disorder), or even delusional disorders.

Key Differences Between ROCD and OLD

Feature	Relationship OCD (ROCD)	Obsessive Love Disorder (OLD)
Root Cause	Anxiety and intrusive thoughts	Extreme emotional dependency
Nature of Obsession	Doubts about love, partner’s compatibility	Intense, possessive love
Emotional Impact	Fear of making the wrong choice	Fear of losing the person
Behavior	Seeking reassurance, mental compulsions	Controlling, stalking, or emotional manipulation
Relationship Type	Can happen in a relationship or when single	Usually occurs in a one-sided or codependent relationship

How SEVEE Can Help Individuals with OCD

SEVEE provides specialized online therapy for individuals struggling with OCD. Our expert counselors and therapists offer:

• Personalized CBT & ERP sessions to help clients gradually confront their fears while reducing compulsive behaviors.

• Culturally sensitive therapy tailored to Indian and NRI clients, considering cultural influences on OCD.

• Guidance from experienced psychologists and psychiatrists to determine the best treatment plan.

• Confidential, stigma-free virtual counseling accessible from anywhere.

• Support for families and caregivers in understanding and managing OCD-related challenges.

OCD is not just about "liking things clean or organized"—it is a serious disorder that can significantly impact life.

SEVEE helps individuals regain control, reduce distress, and live a fulfilling life beyond compulsions.

If you or a loved one is struggling with OCD, book a session today at www.sevee.care and take the first step toward healing.