The diagnosis of obsessive-compulsive disorder includes the presence of obsessions and/or compulsions. Unlike obsessions, compulsions are repetitive, stereotypic overt (observable) behaviors or covert (mental) acts that are typically performed in response to an obsession in order to (1) temporally lessen emotional distress such as anxiety, disgust, or guilt brought on by the obsessive thought, image or impulse and (2) prevent some type of harm from occurring to the patient, a loved one, or a perfect stranger. A compulsion is typically accompanied by a particularly strong urge to carry out a specific set of behaviors resulting in a diminished sense of voluntary control over the performance of the ritual. Subjective resistance is often present, but the person eventually gives in to the overpowering urge to perform the ritual. Overt rituals (compulsions) may include behaviors such as washing, checking, repeating specific behaviors or phrases, ordering, etc. (e.g., rearranging objects to restore balance or symmetry). Covert (mental) rituals (compulsions) may also occur, such as repeating certain words, phrases or prayers, counting, visualizing particular colors, etc. Note that covert compulsions are quite common, and sometimes are not directly reported by the patient. Also note once again that the diagnosis of OCD states that there does not need to be the presence of BOTH obsessions and compulsions. Which is why the formal diagnosis of OCD includes the term "and/or" when referring to these symptoms. However, current research tends to indicate that obsessions and compulsions do, in fact, co-occur in the majority, if not all, cases of OCD. For more information on Obsessive-Compulsive Disorder and Obsessions, please visit the Obsessive-Compulsive Foundation and the Anxiety & Depression Assocation of America web sites.
THE NATURE OF COMPULSIONS
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