OCD Symptoms: Is It More Than Just Obsessive Thoughts?

Obsessive-Compulsive Disorder (OCD)?

Hello, doctor.
I have been experiencing some symptoms for over three years, with fluctuations in severity.
The symptoms are as follows: I seem to have a diminished ability for abstract thinking, such as understanding simple probabilities.
At one point, I couldn't comprehend what 1 or 2 meant, feeling as if I were looking at a word for too long and it became unrecognizable, making it very difficult to clarify what it originally looked like.
I struggle to remember sounds and cannot memorize English vocabulary because I don't know how to recall them.
I feel that movies are fake and question why I should watch them.
I find it hard to relate to many things, such as why boys love girls.
I have a heightened sense of vigilance towards others; I often feel anxious and fear that others might harm me.
I worry that there could be colorless and odorless poisons that could lead to chronic poisoning, so after any minor unpleasant interactions, I feel compelled to wash all my clothes thoroughly when I get home.
Recently, I've even started to suspect that my father might harm me and my mother and remarry to form another family, which intensifies my worries after any argument.
I previously sought medical help for about a year, and the doctor diagnosed me with obsessive-compulsive disorder, stating that my brain is stuck in a loop, which prevents me from understanding everything.
However, my symptoms have not improved.
I have read many books and feel that my symptoms resemble those of schizophrenia.
I am very concerned and wonder if the diagnosis was incorrect.
Therefore, I would like to ask for your detailed explanation.
Thank you very much!

ppzi, 20~29 year old female. Ask Date: 2003/10/29

Dr. Ye Baozhuan reply Psychiatry

You only refer to yourself as "little brother," and I don't know your actual age, which is an important factor in assessing your condition.
However, I believe you are likely young.
Although you complain about a decrease in abstract thinking ability, your organizational thinking skills should still be intact.
In fact, many people may have similar issues; suddenly, 1 is no longer 1, and what was once familiar has become strange.
I boldly speculate that the reason lies in many people continuously redefining old concepts, so 1 could mean first, unique, or even a lonely telephone pole.
Over time, this can lead to confusion, and your brain, like a computer, may suddenly crash.
At that point, you can take a moment to close your eyes and reset, and everything should be fine again.

Another issue you face is a lack of security and self-confidence, which makes you particularly vigilant.
The physician's diagnosis of "obsessive-compulsive disorder" is likely accurate.
Therefore, I need to "force" you to shut down once more and organize your "computer." Eliminate unnecessary data, remove any viruses, and store some pleasant images or information.
You are likely not suffering from schizophrenia; you already have "obsessive-compulsive disorder." Don't be greedy for more, okay?

Reply Date: 2003/10/29

More Info

Understanding the distinction between obsessive-compulsive disorder (OCD) and other mental health conditions, such as anxiety disorders or psychotic disorders, is crucial for effective diagnosis and treatment. Your symptoms, as described, suggest a complex interplay of obsessive thoughts, anxiety, and possibly some cognitive distortions that can be characteristic of OCD but may also overlap with other conditions.

OCD is primarily characterized by the presence of obsessions (intrusive, unwanted thoughts) and compulsions (repetitive behaviors or mental acts performed to reduce the distress associated with the obsessions). In your case, the obsessive thoughts seem to revolve around fears of contamination, harm, and distrust towards others, which are common themes in OCD. The compulsive behaviors, such as washing clothes thoroughly after a disagreement, indicate an attempt to alleviate the anxiety caused by these obsessions.

However, the cognitive symptoms you describe—such as difficulty with abstract thinking, memory issues, and a sense of detachment from reality (e.g., feeling that movies are fake)—may suggest a more complex picture. These symptoms can sometimes be associated with anxiety disorders, where excessive worry can lead to cognitive impairments, or even with psychotic disorders, where there may be a disconnect from reality.
Your concerns about being poisoned or harmed by others, particularly in the context of interpersonal conflicts, can also indicate a heightened state of anxiety or paranoia, which may not be typical of OCD alone. It's important to note that while OCD can include elements of paranoia, the level of distrust and fear you describe may warrant further evaluation to rule out other conditions, such as generalized anxiety disorder (GAD) or even a psychotic spectrum disorder.

Given that you have previously been diagnosed with OCD and have undergone treatment without significant improvement, it may be beneficial to seek a second opinion or a comprehensive reevaluation from a mental health professional. This could involve a thorough assessment of your symptoms, including their duration, intensity, and impact on your daily functioning.
In terms of treatment, cognitive-behavioral therapy (CBT), particularly exposure and response prevention (ERP), is considered the gold standard for OCD. This approach helps individuals confront their fears in a controlled manner while refraining from engaging in compulsive behaviors. If your symptoms are more aligned with anxiety or another disorder, different therapeutic strategies may be more effective.

Additionally, medication can play a significant role in managing OCD and anxiety disorders. Selective serotonin reuptake inhibitors (SSRIs) are commonly prescribed for OCD and can help reduce the intensity of obsessive thoughts and compulsive behaviors. If you have not responded to previous medications, discussing alternative options or dosages with your psychiatrist may be necessary.

In conclusion, while your symptoms align with OCD, the presence of cognitive difficulties and heightened anxiety may suggest a more complex condition that requires a nuanced approach to treatment. It is essential to work closely with a mental health professional who can provide a comprehensive assessment and tailor a treatment plan that addresses all aspects of your mental health. Remember, seeking help is a vital step towards understanding and managing your symptoms effectively.

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