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The relation between obsessions and severity of OCD was more clearly related to hoarding symptoms than with other symptom dimensions. The relative costs of hoarding obsessions were greater than the costs of other obsessions. In each of the top four categories of obsessions that make up the four "great" obsessions, the relative costs of the obsessions led to the same conclusion - that "obsessions that involve cleaning and/or checking are more frequent in OCD patients than in normal controls, and they are associated with greater functional impairment" [2].
In addition to obsessions and checking, OCD is characterized by elevated levels of obsessions and compulsions that entail contamination and illness-avoidance tactics. The presence of these symptoms is directly related to the severity of OCD. These compulsions tend to feature clinically severe obsessions with washing/cleaning, repeating, checking, and ordering as the primary cues, and are paired with rituals. The rituals are usually repetitive, excessive, and affective, and are designed to control obsessions or prevent feared outcomes. The majority of compulsions are directed toward one of the "primary" obsessions. However, some patients engage in a constellation of compulsions. These compulsions are initiated by obsessions but are not directly oriented toward controlling those obsessions. These less-specific rituals (or response prevention) are primarily diagnostic activities performed as part of the symptom itself. They are a marker of OCD rather than a symptom of OCD. Examples of these response-driven rituals include hand-washing/cleaning rituals, rigid routines, count rituals, excessive praying, and phobic exposures to illness-causing situations. Some rituals are initiated because obsessions which are associated with rituals were thought by the subject to be unbearable. Others are initiated because obsessions are considered frightening when general obsessions are not.
Generalized fears about harm or other emotionally significant events also contribute to OCD. These fears usually center on such subjects as death, illness, or injury. Misapprehensions about the intensity of the harm associated with a feared outcome are common in OCD. Punishing oneself, however, is particularly common. One symptom usually included in the discussion of generalized fears is supervisory compulsions. These are repetitive, excessive, and affectively intense rituals performed to ensure another person's compliance with a rule or limit. d2c66b5586