Obsessive-compulsive disorder (OCD) is a prevalent mental health diagnosis that often impacts multiple areas of functioning based on the presence of obsessions, compulsions, and avoidance behaviors (American Psychiatric Association, 2013). OCD often impacts the areas that someone values the most, which can make it even more upsetting and disruptive. The National Institute of Mental Health reports that in the US, 1.2% of the adult population is impacted. Of the 1.2%, 50.6% experienced severe disruptions, 34.8% experienced moderate disruptions, and 14.6% experienced mild disruptions (National Institute of Mental Health). Ruscio (2010) found that 65.3% experienced severe functional disruptions, and, in the severe cases, social andrelationships facets of functioning were considerably impacted. That is not to ne gate the fact that home life, vocational, recreational, and other areas of functioning are frequently impacted.
Ruscio (2010) found that roughly 5.9 hours a day were spent in obsessive thinking patterns, and 4.6 hours a day were spent in compulsive acts (Ruscio, 2010). Specific phobia, generalized anxiety disorder, panic disorder, major depressive disorder and obsessive-compulsive personality disorder are some of the comorbid conditions (American Psychiatric Association, 2013), which can contribute to or exacerbate disruptions in various areas of functioning. Some of the common areas of functioning where disruptions occur are at work, in relationships, and at school.
Work
Not only can the effects of living with obsessive-compulsive disorder impact work performance, there may be specific obsessions, compulsions, and avoidance behaviors that stem from someone's place of employment. An individual may have obsessional fears that their symptoms may impact their performance, and, at other times, it may have a legitimate impact on a person's ability to function in their assigned role. Considerable time and energy can be spent in an effort to conceal symptoms of OCD for fear of embarrassment, criticism, or judgment.
We will now explore some of the common obsessions, compulsions, and avoidance behaviors often seen at a place of employment.
Obsessions:
- Fear of emotionally/physically hurting someone else (harm OCD)
- Fear of vocalizing an insult
- Fear of accidentally or purposefully stealing items (stapler, personal items)
- Fear of being responsible for leaving a door unlocked, kitchen appliance on, lights on, etc.
- Concern about contamination (shared desk, common areas, public restroom)
- Fear of making the 'wrong' decision/questioning the 'right' way to handle a situation
- Desire to remember every detail of a presentation, meeting, or conversation
- Fear of imperfection or making an error
- Lucky numbers
- 'Just right' obsessions
- Fear of contracting an illness at work
Compulsions/Avoidance Behaviors:
- Avoiding contact with other people
- Seeking reassurance from superiors or co-workers
- Mentally replaying or analyzing conversations
- Repeatedly checking items (lights, locks, etc.)
- Repeatedly disinfecting desks, pens, etc.
- Excessive hand washing
- Avoiding public areas
- Rereading or re-writing emails or presentations
- Repeating a task a certain amount of times or until it feels right
- Avoiding social interactions/isolation
Impact:
- Losing minutes/hours
- Difficulty staying focused or remembering details
- Not meeting deadlines
- Limited social connections
- Mental/ physical exhaustion
- Frequent mistakes
- Calling off/missing work
Social
Often an individual's close relationships and the opportunities for a more expansive social life are impacted by intrusive thoughts and fears. These symptoms often lead to anxiety, inappropriate guilt or shame, and depression. It can cause someone to feel isolated and impact their engagement in meaningful, value-based activities.
Obsessions:
- Sexual intrusive thoughts and/or images
- Harm OCD thoughts (emotional/physical)
- Fear of saying the ‘wrong’ word, phrase or sentence
- Fear of making an offensive remark
- Contamination (fear of getting sick and/or fear of getting someone else sick)
- Fear of being responsible for something bad happening (being responsible for making the plans)
Compulsions/Avoidance:
- Seeking reassurance and/or accommodation from others
- Mentally replaying and analyzing conversations
- Avoid certain activities that trigger intrusive thoughts and/or images (going out to eat, certain activities, etc.)
- Repetitive hand washing
Impact:
- Limited social community/isolation
- Relationship turbulence (frustrations due to accommodations, etc.)
- Difficulty having a fluid or natural conversation
- Time/energy-consuming compulsions result in being late or canceled plans
School
Grades
Grades can often suffer when a student struggles with OCD. One obsession that contributes to this is perfectionism. Perfectionism obsessions can lead to excessive studying or time spent on an assignment. Although this may boost a student's grade at times, it can also make their grades suffer. Students with perfectionism obsessions will often get stuck on one assignment or even one particular problem, because OCD will lead them to believe it has not been done well enough. This can lead to other assignments being rushed or incomplete, because the student has not been able to allocate their time appropriately. Perfectionism can also cause students to avoid assignments altogether due to the fear that it cannot be done perfectly. Students experiencing OCD may also see a decrease in their grades due to obsessions unrelated to school and homework. Children and adolescents with OCD can become so preoccupied by their obsessions that they can spend several hours each day completing their compulsions. As a result, they often do not have the time or the energy to complete their school work. An example of this would be a student with a germ obsession who feels the need to shower for two hours after school each day. Regardless of the obsession, OCD can often cause students to see a drop in their grades.
Peer interactions
Students who are experiencing symptoms of OCD may have difficulty in interacting with peers inside and outside of the classroom. One obsession that can cause this is the fear of judgment from others or the fear of being disliked. This can lead to compulsions such as avoiding speaking to others, seeking reassurance from peers, and overcompensating in friendships. Students with OCD may avoid speaking to their peers, because they fear that what they say could be negatively viewed by others. They may believe that it is better for them to not speak at all rather than experience the feared outcome. Students with OCD may seek reassurance from their peers after a social interaction has taken place; this is an attempt to alleviate the anxiety they feel about whether or not the interaction went well. They may also ask for reassurance to ensure that others are not angry or upset with them.
Class interruptions
Teachers of students with OCD may notice the student’s difficulty with classroom engagement. For example, a teacher may notice a student that appears to be distracted rather than paying attention to the lesson. Although it may look like daydreaming, this could also be a student struggling with mental compulsions. Mental compulsions (as the name suggests) are compulsions that happen entirely in one's mind rather than the physical compulsions stereotypically associated with OCD. Mental compulsions can include counting, praying, mental review, and planning. Students with OCD may also have trouble paying attention in class if they are unable to perform their compulsions. For example, a student who fears germs may be unable to focus on the lesson if they feel their hands are contaminated. This preoccupation may also lead to disruptive behaviors, such as leaving in the middle of class to go wash their hands. OCD and anxiety in children and adolescents often presents differently than it does in adults. Teachers may notice students taking frequent or long bathroom breaks. Students may complain of headaches or stomach aches. They may isolate themselves from their friends or family. Children and adolescents with OCD may also display rigidity around certain behaviors or schedules.
Compulsions:
- Avoiding/taking excessive time on homework or tests
- Excessive hand washing or hand sanitizer use
- Avoiding touching objects or classmates
- Avoiding stepping on cracks in the floor or other superstitious acts
- Counting compulsions
- Avoiding speaking in class or to peers
- Excessive concern about appearance
- Excessive bathroom breaks
- Excessive rereading
- Excessive erasing and rewriting
As discussed, obsessive-compulsive disorder can have a significant effect on all important areas of functioning. This is why CBI's Center for OCD is passionate about disseminating information to assist with early identification and treatment and offer support for individuals and families who are impacted by symptoms of obsessive-compulsive disorder. If you are interested in learning more about OCD, please feel free to connect with us at Center for OCD - Pittsburgh, PA & Cranberry Twp, PA - Cognitive Behavior Institute (papsychotherapy.org).
-Savannah Straub, LPC & Nicole Gibson, LPC
References:
Abramson, C. (2023, April 9). Is OCD considered a disability? Here's what experts say. NOCD. Is OCD considered a disability? Here’s what experts say | NOCD (treatmyocd.com)
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.
Asnaani, A., Kaczkurkin, A.N., Alpert, E., McLean, C.P., Simpson, H.,B., & Foa, E. B ( 2016). The effect of treatment on quality of life and functioning in OCD. National Library of Medicine. doi: 10.1016/j.comppsych.2016.10.004The effect of treatment on quality of life and functioning in OCD - PMC (nih.gov)
Hoory, L. (2021, May 26). Work and OCD: The Ultimate Survival Guide. NOCD. Work and OCD: Should You Tell Your Employer — And How? (treatmyocd.com)
Jahangiri, K. (2021, April 22). Recognizing OCD at Work. International OCD Foundation. Recognizing OCD At Work | International OCD Foundation (iocdf.org)
Migala, J.(2024, April 30). 85 Must-read OCD statistics in 2024. NOCD.
85 Must-read OCD statistics in 2024 | NOCD (treatmyocd.com)
National Institute of Mental Health (NIMH). Obsessive-Compulsive Disorder (OCD). National Institute of Mental Health. Obsessive-Compulsive Disorder (OCD) - National Institute of Mental Health (NIMH) (nih.gov)
Ruscio, A., Stein, D., Chiu, W. et al (2010). The epidemiology of obsessive-compulsive disorder in the National Comorbidity Survey Replication, Mol Psychiatry, 15, 53–63. https://doi.org/10.1038/mp.2008.94
