Obsessive-Complusive Disorder (OCD)
OCD is a mental health disorder characterized by obsessions and compulsions. Obsessions are recurring, unwanted, and distressing thoughts, images or impulses. Compulsions are repetitive mental and physical behaviors (rituals) used to reduce the anxiety and doubt brought on by obsessions. While rituals provide short-term relief, the relief is temporary and only reinforces the cycle that is OCD. For a diagnosis of OCD to be made the obsessions are persistent and feel uncontrollable. They create significant anxiety and distress and the rituals interfere with normal daily life.
Millions of people worldwide have OCD. The exact cause of OCD is not known, however studies show there is a genetic component and it often runs in families. Environmental stressors may trigger OCD in those with a predisposition for the condition or cause OCD symptoms to get worse. OCD is often misdiagnosed because it involves symptoms that overlap with other conditions.
Untreated OCD can be associated with many symptoms including difficulties with work or school, impaired concentration, panic attacks, social isolation, physical and/or mental exhaustion, depression, suicidal thoughts, and substance abuse.
It’s important to know that OCD is treatable.
Common Themes in OCD
Common obsessions – Fear of germs, bodily fluids, chemicals or other “contaminants”
Common compulsions – Excessive hand washing, excessive cleaning and showering, avoidance of triggering objects, places or people, mental rumination about contamination, asking for reassurance
Sexual Orientation OCD
Common obsessions – Fear of being of a different sexual orientation than one thought, intrusive sexual thoughts about orientation, fear of being in denial of sexual orientation
Common compulsions – Excessive researching/Googling about sexual orientation, avoidance of triggering situations, excessive mental review of sexual themes, checking for arousal in triggering situations
Common obsessions – Fear of violently hurting others or oneself, fear of losing control and causing harm to others or oneself
Common compulsions – Mental review/mental checking of violent thoughts, asking for reassurance, avoidance of triggering people and places, avoidance of objects that could cause harm, avoidance of triggering media
Common obsessions – Fear of accidentally hurting someone or causing a tragedy
Common compulsions – Excessive checking behaviors to prevent potential harm to others, mental review in attempt to get certainty if someone was hurt
Hypochondria/Health Anxiety OCD
Common obsessions – Fear of having a serious medical condition, fear of exposure to disease
Common compulsions – Repeatedly going the doctor and having medical tests/procedures, avoidance of doctors and/or medical tests/procedures, repetitively checking body for symptoms, excessive researching of symptoms, asking for reassurance
Post Partum OCD
Common obsessions – Obsessions involving the fear of harm coming to the unborn or newborn infant, fear of harming the baby even when one doesn’t really want to
Common compulsions – Repetitive checking on the baby, excessive washing, repeating prayers, reassurance seeking, avoidance of certain activities with the baby such as bathing, holding, diaper changing
Just Right OCD
Common obsessions – Fear of the “not right” feeling
Common compulsions – Repetition of ordinary tasks, repeatedly checking writing and reading, repetitive touching, tapping, counting, ordering and arranging
Common obsessions – Fear of not being able to stop noticing common bodily functions such as breathing, swallowing, blinking, thinking, and sensations
Common compulsions – Mental checking for awareness of trigger, avoidance of situations that could trigger the obsession, asking for reassurance about whether awareness will go ever go away, using distraction to avoid awareness of trigger
Common obsessions – Fear of having acted counter to one’s personal morals, values or ethics, overly-focused on moral or ethical perfection, fear of being accused of an immoral or disloyal act
Common compulsions – Mentally reviewing past acts and thoughts to ensure one has not acted immorally or unethically, asking for reassurance about whether one has acted or thought in an unethical or immoral way, excessive self-sacrifice, avoidance of objects or situations that one associates with immorality
Religious Scrupulosity OCD
Common obsessions – Fear of having committed a sin, blasphemy, or excessive worry about religious issues
Common compulsions – Excessive praying, repeatedly asking for reassurance from religious leaders and family members, avoiding situations that could trigger obsessions, making pacts with God, repeated cleansing or purifying rituals
Common obsessions – Fear of being in the wrong relationship, intrusive thoughts about whether one truly loves their partner
Common compulsions – Monitoring and checking one’s feelings for “proof” of love, comparing one’s relationships with others, avoidance of triggering situations, mental review of a partner’s behaviors
Common obsessions – Fear of being sexually attracted to a child, fear of having sexual thoughts about a child, fear one has sexually assaulted a child in the past
Common compulsions – Mental rumination about thoughts and why one is having them, reassurance seeking on internet, checking for arousal around adults and children to compare and test whether they are attracted to children, avoidance of children and triggering environments
Common obsessions – Fear of not knowing the meaning, purpose or reality of life or one’s own existence, repetitive thinking about questions that cannot be answered
Common compulsions – Mental rumination about existential/philosophical questions, reading books and/or taking classes to find the truth, trying to mentally figure out answers to one’s obsessions, asking for reassurance
Treatment for OCD
Studies show that Cognitive Behavioral Therapy (CBT) with Exposure and Response Prevention (ERP) is the most effective treatment for OCD. Using a combination of CBT therapies, clients learn the tools needed to significantly reduce the frequency and severity of OCD, as well as the impact OCD has had on their lives.
In therapy, clients learn how the OCD cycle is maintained by compulsions and how to challenge their distorted thinking. Mindfulness training teaches clients how to skillfully respond to OCD and learn to tolerate discomfort while not doing compulsions. Acceptance and Commitment Therapy helps clients learn to change their relationship to their thoughts, feelings and sensations while focusing their attention on valued activities.
Once clients learn and practice these tools they are ready to gradually face their fears using Exposure and Response Prevention. Scientific studies have repeatedly shown that ERP is 65% to 80% effective for children, adolescents and adults.
ERP is a collaborative and compassionate process. The first step of ERP is identifying the mental and physical compulsions clients are currently doing to reduce anxiety from OCD triggers. Together the therapist and client create a hierarchy of the compulsions to eliminate, from easiest to hardest. In treatment clients will learn tools to help with this process. They continue to work on gradually facing fears and responding to OCD thoughts, feelings, sensations and urges in a new way that does not feed the OCD cycle. Clients are in charge of the exposures that they choose to do and the pace they do them.
The remainder of therapy is doing ERP, applying what clients have learned to help them respond skillfully, not react to OCD. Through exposure therapy clients gradually take their lives back, engaging in the world without OCD taking up so much space, focus or attention. Clients are much freer to pursue those things in life that bring them meaning and joy.
Medications for OCD
Studies show 7 out of 10 people with OCD will benefit from medications. Click here to learn about the most effective medications for OCD.