Obsessive-Compulsive Disorder (OCD) is a psychological disorder affecting around 2.3 percent of American adults. A member of the anxiety disorder group of disorders, OCD is known for causing intrusive, distressing thoughts (obsessions), which force the sufferer to carry out ritualized behaviors (compulsions) to alleviate the intolerable anxiety that arises from the obsessions.

Signs and Symptoms of OCD

OCD has three primary components: obsessions, compulsions, and anxiety. Intrusive anxiety is the driving force behind OCD. Let’s take a look at obsessions first.

Obsessions may include:

• Harm. Worry and fear that they may cause serious or lethal harm to others, or even cause a disaster.
• Sexual thoughts. These thoughts may include inappropriate or taboo sexual behaviors.
• Religious themes. People may fear they are spiritually lacking, sinning, or otherwise offending God
• Loss of control. Fear of acting on an impulse to harm oneself or others.
• Contamination. These are intrusive thoughts of being dirty or “unclean,” and contaminated by germs or other materials that are harmful or offensive.
• Magical Thinking/Superstition. A fear that a failure to perform certain gestures or other behaviors will lead to harm to oneself or others, or that actions must be performed in a precise, particular sequence in order to prevent harm to oneself or others.

Compulsions

For a behavior to be considered compulsive in the context of OCD, it must be performed to reduce the anxiety related to a specific obsessive thought. OCD-type compulsions are time-consuming, repetitious, frequent, and can be ritualistic. The following are some of the more typical compulsions.

• Handwashing, showering, or bathing. Washers fear contamination or fear that they will contaminate others.
• Counting. The counting compulsion is exactly what it sounds like. Sufferers feel compelled to count objects in their environment. Usually, a specific type of object or even geometric shapes is the target of counters.
• Checking. Checkers need to check on locked doors, windows, and items such as stoves, to make sure they’re off, or locked before leaving home or going to bed. The person usually has a precise number of times to check and a certain order or way to perform the checking, as well.
• Arranging. Arrangers feel compelled to straighten or order items in their environment to fit their standards of symmetry (or asymmetry). This goes far beyond mere tidiness.
• Hoarding. People who hoard feel an uncontrollable drive to hang on to items, even though they’re useless or even harmful.
•   Self-monitoring. Self-monitors may check their bodies for signs of illness or disease dozens—or hundreds of times a day.
•   Repeating, tapping, or touching. For some, completing the same action repeatedly. Either tapping in a particular sequence, repeating certain phrases, or touching things in their surroundings temporarily relieves overwhelming anxiety.

History of OCD

Written records of OCD-like behavior date back to the 7th century AD. From the 18th through the late 19th centuries, obsessive-compulsive disorder was considered part of “neurotic melancholia.” Sigmund Freud believed OCD was a result of conflict between the ID and superego, but by the late 20th century, researchers developed a concept of OCD rooted in neurobiology and cognitive learning theory.

The Causes of OCD

Researchers believe that OCD may be caused by errors in the way certain areas of the brain respond to serotonin, a chemical brain cells use to communicate with each other. This leads to a person being unable to adequately regulate their behavior in relation to error-checking behavior.  OCD can also be caused by stressful early childhood experiences and often runs in families.

Worried About OCD? You Must Know…

1. There’s no such thing as a person being “a little obsessive-compulsive.” For a diagnosis of obsessive-compulsive disorder to be made, a person’s condition must be severe enough to present a threat to their ability to live life in a pleasing or satisfactory fashion. OCD is a serious impediment to a person having a manageable life.
2. OCD produces debilitating levels of anxiety. Unmanageable anxiety is the emotional force that creates and sustains OCD.
3. Obsessive-compulsive disorder isn’t controllable without professional treatment. A person can’t just “snap out of it.”
4. Both obsessions and compulsions are unpleasant, unwanted, and involuntary. If a person with OCD attempts to resist performing a compulsive behavior, their anxiety will escalate out of control.
5. Most people with OCD understand that their behavior is irrational, but that doesn’t alleviate the condition.
6. The cycle of obsession, anxiety, and compulsive behavior is exhausting and a significant impediment to a pleasing, fulfilling life.

Treatment for OCD

As with most other psychological disorders, OCD has no cure and will not go away on its own, but there are exceptionally effective treatments out there. Treatment for OCD typically centers on psychotherapy and medication, however newer treatments, like transcranial magnetic stimulation, are also finding success in alleviating OCD.

This blog post is meant to be educational in nature and does not replace the advice of a medical professional. See full disclaimer.

Works Cited

Attiullah, N., Eisen, J., & Rasmussen, S. (2005, June 29). Clinical features of obsessive-compulsive disorder. Psychiatric Clinics of North America. https://www.sciencedirect.com/science/article/abs/pii/S0193953X05701751.

Eisen, J., Coles, M. E., Shea, M. T., Pagano, M., Stout, R., & Yen, S. (2006, June 1). Clarifying The Convergence Between Obsessive Compulsive Personality Disorder Criteria And Obsessive-Compulsive Disorder. Journal of Personality Disorders. https://guilfordjournals.com/doi/abs/10.1521/pedi.2006.20.3.294.

Hanna, G., Himle, J., Curtis, G., & Gillespie , B. (2005, April 5). A family study of obsessive-compulsive disorder with pediatric probands. American journal of medical genetics. Part B, Neuropsychiatric genetics : the official publication of the International Society of Psychiatric Genetics. https://pubmed.ncbi.nlm.nih.gov/15635694/.

Murphy, D., Timpano, K., Wheaton, M., Greenberg, B., & Miguel, E. (2010, June 12). Obsessive-compulsive disorder and its related disorders: a reappraisal of obsessive-compulsive spectrum concepts. Dialogues in clinical neuroscience. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3181955/.

Norman, L., Taylor, S., Liu, Y., Radua, J., & Chye, Y. (2019). Error Processing and Inhibitory Control in Obsessive-Compulsive Disorder: A Meta-analysis Using Statistical Parametric Maps. Biological Psychiatry, 85(9), 713–725. https://doi.org/10.1016/j.biopsych.2018.11.010

Ruscio, A. M., Stein, D. J., Chiu, W. T., & Kessler, R. C. (2008, August 26). The epidemiology of obsessive-compulsive disorder in the National Comorbidity Survey Replication. Nature News. https://www.nature.com/articles/mp200894.

Williams, M., Mugno, B., Franklin, M., & Faber, S. (2013, April 20). Symptom Dimensions in Obsessive-Compulsive Disorder: Phenomenology and Treatment Outcomes with Exposure and Ritual Prevention. Psychopathology. https://www.karger.com/Article/FullText/348582.

Given that 1 in 5 adults in the US report living with a mental illness, it is no surprise that these adults are tasked with dealing with their mental health in the workplace. Among many contributing factors to common mental illnesses like anxiety and depression, work environments and workloads affect mental health.

For some employees, mental illness may be a pre-existing condition. Many deal with anxiety and depression in their daily lives because of situational, genetic, lifestyle, or biological reasons. These conditions, in turn, carry over into the workplace and affect how employees show up in their workspaces, as mental illness is not something that one can just “turn off” or “leave outside the office building.” The work environment and job stressors can then compound pre-existing anxiety and/or depression. 83% of US workers suffer from work-related stress, making the impacts of stress and anxiety at work an issue that can’t be ignored.

While some employees may begin employment with mental health challenges, others may develop these challenges throughout their professional careers. Stressful, unwelcoming, fast-paced, and sometimes even toxic environments typically do not foster good mental health at work. Employees may suffer from burn-out or not feeling seen or heard by the supervisors while feeling immense pressure to perform and provide with little support.

Anxiety at work and struggling with other mental illnesses affect employees on an emotional level and negatively impact many work-related areas. Anxiety at work can lead to:

•   Decreased productivity and performance
•   Decreased engagement with one’s work
•   Poorer communication with coworkers
•   Decreased physical capability and functioning

The effects of anxiety at work and other mental health challenges at work like depression are far-reaching in the workplace. This is why many employers are starting corporate wellness programs and implementing changes that foster mental wellness.

Ways companies are investing in corporate wellness:

1. Employee Assistance Programs (EAPs) – An EAP is a program that works to assist employees in coping with or resolving personal or mental health challenges they might be facing. These programs typically include coverage for a set number of counseling sessions with approved providers.
2. Changing company cultures – One way a company might invest in the mental wellness of their employees is by creating a culture of understanding and openness around mental health. This can mean HR programs taking steps to prevent burnout and build employee resiliency. It could also mean supervisors being mindful of and allowing employees to speak openly about mental health challenges.
3. Mental wellness days – Some companies have started allowing employees to take paid or unpaid mental health days from work. For these to be most effective, it’s important that employees feel empowered to use them before they begin to feel burnt out or severely mentally unwell. While feeling anxiety at work might be common, encouraging employees to take a step back can be helpful. These days are meant to be proactive, allowing employees to regularly take a break and engage in rest and self-care.
4. Improved access to mental health care – Providing good mental health coverage in insurance policies is a way to empower employees in taking their mental health into their own hands. This can allow people to proactively take care of their mental health consistently rather than reactively. Some companies may even have in-house therapists that their employees have consistent access to.

Investing in corporate wellness does not just benefit employees but also employers. By receiving proper mental health care, productivity increases, absenteeism decreases, and total medical costs decrease. Having a healthy workforce that shows up to work in a good frame of mind, ready to work benefits everyone.

Whether you are struggling with depression and/or anxiety in your daily life or struggling with depression and/or anxiety at work, there are many resources out there.

Corporate Wellness Resources

•   If you feel you may be experiencing job burnout, you can find a burnout quiz and resources here.
•   If you are curious about taking a mental health test, you can take a mental health quiz here, along with resources on symptoms of mental illness.
•   If you are an employer interested in learning more about what you can do to better support your employees and promote mental wellness, you can find resources here, as well as here.

 This blog post is meant to be educational in nature and does not replace the advice of a medical professional. See full disclaimer.  https://www.youtube.com/watch?v=qbo9Fe896QM

Works Cited

Milenkovic, M. (2019, September 25). 42 Worrying Workplace Stress Statistics. The American Institute of Stress. https://www.stress.org/42-worrying-workplace-stress-statistics. 

U.S. Department of Health & Human Services. (2019, April 10). Mental Health in the Workplace. Centers for Disease Control and Prevention. https://www.cdc.gov/workplacehealthpromotion/tools-resources/workplace-health/mental-health/index.html.

Everyone’s heard the expression “I’m a little OCD” or has used the term “perfectionist” as a compliment. While these are common terms and phrases that get plenty of use both in daily life and in the media, Obsessive-Compulsive Disorder (OCD) and perfectionism are serious conditions that cause lasting, significant problems for millions. OCD and perfectionism may influence one another, with one condition potentially driving the other, but they’re not the same.

What is Obsessive-Compulsive Disorder?

OCD is a psychological disorder that causes a person to have both compulsions and obsessions. Obsessions and compulsions involve thoughts (obsessions) and ritualistic behaviors (compulsions). Obsessions are recurring unwanted, intrusive or distressing thoughts that come out of nowhere and interrupt a person’s normal flow of thinking. These obsessive thoughts are both caused by anxiety and generate greater levels of anxiety that compel a person to perform repetitive actions. These repetitive, ritualistic behaviors reduce or briefly eliminate the anxiety. If a person doesn’t carry out their compulsions, their anxiety will increase dramatically.

For example, a person may check the locks on their doors before leaving a particular number of times. If they don’t check the precise number of times, their levels of anxiety will rise dramatically.

For OCD to be diagnosed, it must rise to the level of such severity that a person’s ability to live a satisfying, fulfilling life is impaired.

Is Perfectionism a Psychological Disorder?

Anyone, with or without a mental illness, can be a perfectionist, but it is not by itself a psychological disorder. Perfectionism is a personality trait that’s a mental health risk. It results from experiences and beliefs that start to become ingrained in a person during their childhood years. Perfectionism is a maladaptive (harmful) characteristic of faulty self-esteem and has many problems associated with it.

Characteristics of Perfectionism

Perfectionists strive for perfection and feel bad about themselves when they aren’t flawless in their performance. They equate their performance in life (high grades, flawless work performance, being the ideal parent, etc) as being the measure of their worth as a human being. For example, a perfectionist may find earning a 95 on an exam to be worthless in comparison to getting a 100 percent. Not being the top salesperson at work every quarter might be, for a perfectionist, a sign of being totally worthless—and not just as a salesperson. Perfectionists interpret being less than 100 perfect flawless in all types of measures as a sign of being an inferior person. A perfectionist’s self-worth is tied up in their ability to achieve flawless performance.

Perfectionism sees the world in a polarized light—things are either 100 percent of what the perfectionist aims for, and thus good, or less than the goal, and thus worthless. Naturally, no one is always flawless.

OCD and Obsessive-Compulsive Personality Disorder (OCD-P)

Although the terms are similar, Obsessive-Compulsive Disorder (OCD) and Obsessive-Compulsive Personality Disorder are not the same things at all. Obsessive-Compulsive Disorder is a psychological disorder in which a person has both obsessions and compulsions. These compulsions are ritualistic behaviors; for example, a person who must check their doors to make sure they’re locked exactly 5 times, or otherwise suffers a panic attack. Checking less or more than 5 times would cause the individual as much anxiety as not checking at all. Compulsions in OCD are highly precise and will be performed exactly the same way every time they’re triggered.

Obsessive-Compulsive Personality Disorder (OCD-P) refers to a person who is psychologically characterized by perfectionism, orderliness, tidiness, and structure. They are completely devoted to observing precise schedules, rule-following, and timeliness. They also often are prone to hoarding behaviors. People with Obsessive-Compulsive Personality Disorder do not have a psychological disorder per se and enjoy their lifestyle as it is. They often find employment where their personality traits are highly valued, although their personal and intimate relationships may suffer from unrealistically high expectations of others.

Although people with Obsessive-Compulsive Personality Disorder (OCD-P) are prone to frequent tidying, cleaning, and straightening items in their environment, these behaviors do not rise to the level of pathological compulsiveness. Typically, people with OCD-P enjoy their lifestyle and find it beneficial.

Perfectionism and OCD

Perfectionism is not the result of OCD or OCD-P and may exist completely independently of either condition. There is no cause-effect relationship among the three conditions. However, people with OCD tend to be slightly more perfectionistic than those without it. Researchers believe OCD and perfectionism tend to reinforce each other when they occur together, but not as strongly as anecdotal evidence would suggest.

In the final analysis, perfectionism and OCD may influence each other, but one doesn’t cause the other and they may exist independently.

Treatments for OCD

If you’ve had problems with OCD and are looking for a modern, effective solution, consider Transcranial Magnetic Stimulation (TMS). It’s an FDA-approved treatment for OCD that uses projected magnetic fields to stimulate under-active areas of the brain thought to be involved in Obsessive-Compulsive Disorder. TMS is non-invasive, requires no sedation, and each session lasts less than an hour in a doctor’s office.

Works Cited

Bieling, P., Israeli, A., & Antony, M. (2003, November 24). Is perfectionism good, bad, or both? Examining models of the perfectionism construct. Retrieved April 19, 2021, from https://www.sciencedirect.com/science/article/abs/pii/S0191886903002356

Frost, R., & Steketee, G. (1998, June 15). Perfectionism in obsessive-compulsive disorder patients. Retrieved April 19, 2021, from https://www.sciencedirect.com/science/article/abs/pii/S0005796796001088

Halmi, K. A., Tozzi, F., & Thornton, L. M. (n.d.). The Relation among Perfectionism, Obsessive-Compulsive Personality Disorder and Obsessive-Compulsive Disorder in Individuals with Eating Disorders. International Journal of Eating Disorders, 2005, vol 38: 371-374. Retrieved April 19, 2021

Obsessive-compulsive disorder. (n.d.). Retrieved April 19, 2021, from https://www.nimh.nih.gov/health/topics/obsessive-compulsive-disorder-ocd/index.shtml

What is obsessive-compulsive disorder? (n.d.). Retrieved April 13, 2021, from https://www.psychiatry.org/patients-families/ocd/what-is-obsessive-compulsive-disorder

Depression is a common mental illness that is both mentally and physically draining. Sometimes the signs and symptoms of depression may be obvious. However, sometimes it can be quite difficult to pick up on, especially in ourselves. Fortunately, there is a quick and simple questionnaire to help assess symptoms of depression. You may have heard of it or may have even taken it before; it’s called the PHQ-9.

What Is a PHQ-9 Form?

The PHQ-9 form is a brief, self-administered questionnaire that assesses depression symptoms. This shorter test is derived from the original and longer PHQ assessment that addresses multiple mental health concerns including depression, panic disorder, anxiety, sleep disorders, and others. 

The PHQ was derived from an assessment tool utilized by medical professionals called the PRIME-MD that addresses multiple mental health diagnoses. The PHQ-9 was developed and copyrighted by Drs. R.L. Spitzer, J.B.W. Williams, and K. Kroenke in 1999 with an educational grant from Pfizer, Inc. Pfizer holds the copyright to the PHQ-9, but is available for use and replication without needing permission to be granted. 

Since this assessment only addresses depression, the number 9 in the title is a reference to the nine questions to assess each criterion of depression according to the Diagnostic and Statistical Manual of Mental Disorders (or DSM). A self-administered test means that you can answer the questions and tally your result on your own, or by a health or mental healthcare professional. The PHQ-9 is commonly administered in doctor’s or therapist’s offices as a part of routine checkups, or as a way to monitor and evaluate your mental health.

What Does PHQ-9 Stand For?

PHQ-9 stands for Patient Health Questionnaire.

PHQ-9 Score

Your PHQ-9 score determines the severity of the depression according to the diagnostic criteria from the Diagnostic and Statistical Manual of Mental Disorders. Once again, there are 9 questions in this assessment; 8 questions directly assessing symptoms of depression and 1 question that assesses how any depressive symptoms have been impacting your ability to function. For each question, there are 4 choices to choose from in regard to how often you have been experiencing symptoms:

•   “Not At All”
•   “Several Days”
•   “More Than Half of the Days”
•   “Nearly Every Day”

Selecting “Not At All” will give you 0 points, “Several Days” is 1 point, “More Than Half of the Days” is 2 points, and “Nearly Every Day” is 3 points. Adding up each score will then give you your total score.

Take PHQ-9 Assessment

PHQ-9 Score Interpretation

Once you’ve taken the PHQ-9 questionnaire, your score will then be interpreted by a mental health professional to find out how severe your depression may be. A PHQ-9 score total of 0-4 points equals “normal” or minimal depression. Scoring between 5-9 points indicates mild depression, 10-14 points indicates moderate depression, 15-19 points indicates moderately severe depression, and 20 or more points indicates severe depression. The higher your score, the more symptoms of depression you experience, and the more severe your depression is.

According to the DSM, Major Depressive Disorder is diagnosed if 5 of 9 symptoms or more, have been present for “more than half the days” of the last 2 weeks, and one of those symptoms being depressed mood or anhedonia. If this criteria is not met, other unspecified depression can still be diagnosed if 2 to 4 symptoms have been present for “more than half the days” in the last 2 weeks, and one of those symptoms being depressed mood or anhedonia. Since each question in the PHQ-9 translates to a criterion of Major Depressive Disorder, it can be a good guide as to what level of depression you would be diagnosed with. Also, it is important to note that if your depression does not meet severe criteria, it does not make your symptoms any less valid.

One of the last questions in the PHQ-9, and a criteria for Major Depressive Disorder, (“thoughts that you would be better off dead or of hurting yourself in some way”) counts if given any score other than a zero, regardless of the duration of the symptom. The final question, found at the end of the symptom assessment portion of the PHQ-9, asks about the test taker’s functionality: “How difficult have these problems made it for you to do your work, take care of things at home, or get along with other people?” In order to accurately diagnose and treat depression, taking into consideration how symptoms impact you, not merely symptoms alone, give a better understanding of the severity.

PHQ-9 Validity and Reliability

The PHQ-9 test is widely used because of its high validity and reliability. Validity studies showed that those who scored a 10 or higher on the PHQ-9 were between 7% and 13.6% more likely to be diagnosed with depression by a mental health professional. Since it is also incredibly easy to administer, it can be given in many health and mental health care settings. This accessibility helps to give us quick and accurate information about the symptoms and severity of someone’s depression. It continues to be an accessible and reliable way to assess depression as it is free to use and is interpreted in over 30 languages. The PHQ-9 can be found in print form, such as this example of a PHQ-9, as well as digital versions, such as found on this website.

Your scores can be used as a way for you to individually monitor where your depression is at, or as a part of your treatment plan with a mental health professional. Since the test is so simple and quick to use, monitoring the severity of your symptoms has never been easier. The PHQ-9 is a fantastic tool to help assess and interpret the symptoms and severity of our depression, but these numbers alone will not provide treatment. It is still necessary to treat depression via therapy, medication, brain-stimulation therapies, self-reflection, or whatever treatment modality is right for you. Insight into our depression is vital, but that alone will not improve the depression. Knowledge is power, and the PHQ-9 helps you and your team to start that process of healing from depression.

Take PHQ-9 Assessment

Works Cited 

American Psychological Association. (2020, June). Patient Health Questionnaire (PHQ-9 & PHQ-2). Retrieved February 2, 2021, from https://www.apa.org/pi/about/publications/caregivers/practice-settings/assessment/tools/patient-health

Kroenke, K., Spitzer, R. L., & Williams, J. B. (2001). The PHQ-9: validity of a brief depression severity measure. Journal of general internal medicine, 16(9), 606–613. https://doi.org/10.1046/j.1525-1497.2001.016009606.x

Pfizer. (n.d.). phqscreeners. Retrieved February 2, 2021, from https://www.phqscreeners.com/

PHQ-9 Depression Test Questionnaire. (n.d.). Retrieved February 2, 2021, from https://patient.info/doctor/patient-health-questionnaire-phq-9

Psychiatric Times. (n.d.). Patient Health questionnaire, including PHQ, PHQ-9, PHQ-Brief, and PHQ-SADS. Retrieved February 2, 2021, from https://www.psychiatrictimes.com/view/patient-health-questionnaire-including-phq-phq-9-phq-brief-and-phq-sads

Stanford Medical. (n.d.). Patient Health Questionnaire (PHQ-9). Retrieved February 2, 2021, from https://med.stanford.edu/fastlab/research/imapp/msrs/_jcr_content/main/accordion/accordion_content3/download_256324296/file.res/PHQ9%20id%20date%2008.03.pdf