The following is a list of symptoms that may appear in an OCD (Obsessive-Compulsive Disorder) patient. It is important to note that one symptom does not make an illness.

Saving newspapers for many years

Handwashing more than ten times per day

Double-checking lights every night

Removing fingerprints from any visible surface

Clipping articles

Tapping your night table top several times at night

Doodling while talking on the phone

Making sure your shoelace are symmetrically tied

Always being on time

Being highly moral

Being a worrier

Being doubtful

Being unable to make decision

Overanalyzing everything

Organizing compulsively

Making lots of checklists

Questioning repetitively

Not tolerating sloppiness

Having a very clean kitchen

Hating dishes in the sink

Making the bed before leaving the house

Having difficulty tying your shoes

Dressing and undressing

Having an inability to tuck in your shirt

Having "magical" thinking

Being superstitious

Wiping down the shower door after taking a shower

Diagnosis is not a label but a procedure applied to identify, clarify, and make a disease more understandable. Without a diagnosis or with a wrong diagnosis, treatment is bound to fail. Diagnosing — calling things by their rightful name — is not labeling. Labeling patients is interpreted as putting a stigma on someone suffering from an emotional disorder. We don't label patients; we label goods. But we certainly give a diagnosis in order to obtain the best available treatment. If you are not satisfied with a doctor's diagnosis and recommendations, remember that you are always entitled to a second opinion.

Am I insane? OCD is not insanity; it is a disorder in which, on most levels, reason is preserved. Patients live within a real and whole world. It is true that, at times, symptoms are extremely bizarre, even senseless; obsessions can be strong and merciless, and those afflicted may dwell on abhorrent thoughts of man-slaughter, sexual aberrations, religious sins, or crimes that a "normal" being would never dream of entertaining. But these obsessive-compulsive ideations are never carried out. Patients are aware that their beliefs and feelings are abnormal. They fight symptoms; they want to be cured, and they are not insane. Rose was in her twenties and spent most of her time in the bathroom. For about eight hours each day she engaged in rituals of handwashing and showering. She also had the urge to splash water on the walls of the bathroom and to dry the walls and floor once the rituals were completed. This type of behavior began several years earlier and gradually increased in time and performance. She dedicated her life to ritualizing, and consequently she couldn't work, she had been homebound for over a year. Her family became concerned with her bizarre behavior. They wondered who in her right mind would spend all day in the bathroom washing her hands and body and splashing the walls with water. A psychiatrist was consulted, and a diagnosis of schizophrenia was made. The patient underwent intensive therapy with tranquilizer and antidepressants. Medication appeared to be ineffective, and the patient deteriorated rapidly. She became angry and experienced outbursts of violent behavior during which she would break objects and verbally abuse her family. Occasionally, she went into bouts of deep depression. All along, her compulsions to wash and to splash water remained unchanged. By this time, eight years had elapsed from the onset of her illness. Finally, psychosurgery (operation of the brain) was recommended. The surgery was followed by a recovery phase that lasted about four months, after which the symptoms recurred.

This is one of the unfortunate episodes that may occur when a patient is misdiagnosed. Rose had been diagnosed as schizophrenic because her behavior was extremely bizarre. Unfortunately, no one ever realized she was aware of her strangeness. She was in contact with reality. She didn't want to give in to her urges, but was unsuccessful in fighting back. Her sense of awareness of inner reality did not fit the criteria for a diagnosis of schizophrenia.

Quite often, the way symptoms are presented may lead the psychiatrist or psychologist to a misinterpretation of the information obtained, and thus a wrong diagnosis is made.

In one of our studies, we found that from a sample of one hundred cases of OCD, a previous diagnosis of OCD was made in only twenty-four cases. Of seventy-six wrongly diagnosed cases, sixteen were diagnosed as schizophrenic. In addition, since most patients have severe symptoms of anxiety and depression, these symptoms not only mask the presence of obsessions and compulsions, but they may also lead the professional to miss the diagnosis of OCD.

Richard was a twenty-eight-year-old married man who came for a consultation because he had recurring episode of depression. He had been hospitalized twice and even underwent electroshock therapy when drugs failed to relieve his depression. He was an electrical engineer working in a supervisory capacity at a factory. Now he was uncertain whether he should go to work. He had been married for the last two years. Since age fifteen, he had been unable to make a decision. When he was a single, his decisions were made by his parents. He was extremely dependent on his mother. His inability to decide was destroying his life. How should he choose a career? Where should he go on vacation?

Now he was married, and his wife was in charge of everything. He blamed his wife for many mistakes. Obviously he failed to realize that his wife made unilateral decisions because he couldn't make them. Even when he went to the supermarket to buy milk, he was unable to pick one of fifty available cartons.

Richard's marriage was shaky. He didn't know whether to have children. He felt overwhelmed, unable to be control. Life seemed worthless. He was depressed and fearful. He was unable to function as well as before.

Because of doubting or the inability to make decision, many patients lose their freedom to choose, and they must rely on others to make decisions. Usually, a family member becomes the thinking and decision-making brain.

Richard suffered from such intense depression that unless he was examined thoroughly, the diagnosis of OCD could have been easily missed.

Is OCD a fatal illness? OCD kills no one directly. Patients with OCD may have suicidal ideas, or even suicidal gestures. Suicide is rare among patients with OCD.

Am I dangerous? OCD does not make a person homicidal. Obsessive thoughts of violence are not carried out. A small group of patients may self-mutilate. Self-mutilation consists of cutting, pressing hard against sharp objects, pricking, burning the skin, hair pulling, nail biting, and mouth-wall biting.

Did I inherit OCD? There is no definite answer to this question. Few research protocols are being conducted to investigate genetic factors. We may say, though, that 8 percent of patients have parents with OCD.

Did I catch OCD? OCD is not a transmittable disease. It is not contagious. There is no direct proof that it comes from viruses. But it might be related — in some cases — to encephalitis (an inflammation of the brain).

Is my upbringing the culprit? In the homes of patients with OCD, anything is possible. Anxiety, fear, depression, and anger among family members are known to exist. OCD certainly may be learned, and this should be taken into account before outlining a treatment program.

Who is most vulnerable? No one is particularly vulnerable. Anyone may develop OCD.