Obsessive-Compulsive Disorder (OCD)

This section is  adapted from the Obsessive Compulsive Disorder Foundation website.

Obsessive Compulsive Disorder (OCD) is a mental health disorder that affects people of all ages and walks of life, and occurs when a person gets caught in a cycle of obsessions and compulsions. Obsessions are unwanted, intrusive thoughts, images or urges that trigger intensely distressing feelings. Compulsions are behaviors an individual engages in to attempt to get rid of the obsessions and/or decrease his or her distress.

What is OCD?

Most people have obsessive thoughts and/or compulsive behaviors at some point in their lives, but that does not mean that we all have “some OCD.” In order for a diagnosis of obsessive compulsive disorder to be made, this cycle of obsessions and compulsions becomes so extreme that it consumes a lot of time and gets in the way of important activities that the person values.
Here is one way to think about what having OCD is like:

Imagine that your mind got stuck
on a certain thought or image…
Then this thought or image got replayed in your mind
over and
over again
no matter what you did…
You don’t want these thoughts — it feels like an avalanche…
Along with the thoughts come intense feelings of anxiety…
Anxiety is your brain’s alarm system. When you feel anxious, it feels like you are in danger. Anxiety is an emotion that tells you to respond, react, protect yourself, DO SOMETHING!
On the one hand, you might recognize that the fear doesn’t make sense, doesn’t seem reasonable, yet it still feels very real, intense, and true…
Why would your brain lie?
Why would you have these feelings if they weren’t true? Feelings don’t lie… Do they?
Unfortunately, if you have OCD, they do lie. If you have OCD, the warning system in your brain is not working correctly. Your brain is telling you that you are in danger when you are not.
When scientists compare pictures of the brains of groups of people with OCD, they can see that some areas of the brain are different than the brains of people who don’t have OCD.
Those tortured with OCD are desperately trying to get away from paralyzing, unending anxiety…

What exactly are obsessions and compulsions?

Obsessions are thoughts, images or impulses that occur over and over again and feel outside of the person’s control. Individuals with OCD do not want to have these thoughts and find them disturbing. In most cases, people with OCD realize that these thoughts don’t make any sense. Obsessions are typically accompanied by intense and uncomfortable feelings such as fear, disgust, doubt, or a feeling that things have to be done in a way that is “just right.” In the context of OCD, obsessions are time consuming and get in the way of important activities the person values. This last part is extremely important to keep in mind as it, in part, determines whether someone has OCD — a psychological disorder — rather than an obsessive personality trait.

Unfortunately, “obsessing” or “being obsessed” are commonly used terms in every day language. These more casual uses of the word means that someone is preoccupied with a topic or an idea or even a person. “Obsessed” in this everyday sense doesn’t involve problems in day-to-day living and even has a pleasurable component to it. You can be “obsessed” with a new song you hear on the radio, but you can still meet your friend for dinner, get ready for bed in a timely way, get to work on time in the morning, etc., despite this obsession. In fact, individuals with OCD have a hard time hearing this usage of “obsession” as it feels as though it diminishes their struggle with OCD symptoms.

Even if the content of the “obsession” is more serious, for example, everyone might have had a thought from time to time about getting sick, or worrying about a loved one’s safety, or wondering if a mistake they made might be catastrophic in some way, that doesn’t mean these obsessions are necessarily symptoms of OCD. While these thoughts look the same as what you would see in OCD, someone without OCD may have these thoughts, be momentarily concerned, and then move on. In fact, research has shown that most people have unwanted “intrusive thoughts” from time to time, but in the context of OCD, these intrusive thoughts come frequently and trigger extreme anxiety that gets in the way of day-to-day functioning.

Common Obsessions in OCD
Contamination

▪       Body fluids (examples urine feces)

▪       Germs/disease (examples herpes HIV)

▪       Environmental contaminants (examples: asbestos radiation)

▪       Household chemicals (examples cleaners solvents)

▪       Dirt

Losing Control

▪       Fear of acting on an impulse to harm oneself

▪       Fear of acting on an impulse to harm others

▪       Fear of violent or horrific images in one’s mind

▪       Fear of blurting out obscenities or insults

▪       Fear of stealing things

Harm

▪       Fear of being responsible for something terrible happening (examples: fire burglary)

▪       Fear of harming others because of not being careful enough (example: dropping something on the ground that might cause someone to slip and hurt him/herself)

Obsessions Related to Perfectionism

▪       Concern about evenness or exactness

▪       Concern with a need to know or remember

▪       Fear of losing or forgetting important information when throwing something out

▪       Inability to decide whether to keep or to discard things

▪       Fear of losing things

Unwanted Sexual Thoughts

▪       Forbidden or perverse sexual thoughts or images

▪       Forbidden or perverse sexual impulses about others

▪       Obsessions about homosexuality

▪       Sexual obsessions that involve children or incest

▪       Obsessions about aggressive sexual behavior towards others

Religious Obsessions (Scrupulosity)

▪       Concern with offending God, or concern about blasphemy

▪       Excessive concern with right/wrong or morality

Other Obsessions

▪       Concern with getting a physical illness or disease (not by contamination, e.g. cancer)

▪       Superstitious ideas about lucky/unlucky numbers certain colors

Compulsions are the second part of obsessive compulsive disorder. These are repetitive behaviors or thoughts that a person uses with the intention of neutralizing, counteracting, or making their obsessions go away. People with OCD realize this is only a temporary solution but without a better way to cope they rely on the compulsion as a temporary escape. Compulsions can also include avoiding situations that trigger obsessions. Compulsions are time consuming and get in the way of important activities the person values.
Similar to obsessions, not all repetitive behaviors or “rituals” are compulsions. You have to look at the function and the context of the behavior. For example, bedtime routines, religious practices, and learning a new skill all involve some level of repeating an activity over and over again, but are usually a positive and functional part of daily life. Behaviors depend on the context. Arranging and ordering books for eight hours a day isn’t a compulsion if the person works in a library. Similarly, you may have “compulsive” behaviors that wouldn’t fall under OCD, if you are just a stickler for details or like to have things neatly arranged. In this case, “compulsive” refers to a personality trait or something about yourself that you actually prefer or like. In most cases, individuals with OCD feel driven to engage in compulsive behavior and would rather not have to do these time consuming and many times torturous acts. In OCD, compulsive behavior is done with the intention of trying to escape or reduce anxiety or the presence of obsessions.

Common Compulsions in OCD

Washing and Cleaning

▪       Washing hands excessively or in a certain way

▪       Excessive showering, bathing, tooth-brushing, grooming ,or toilet routines

▪       Cleaning household items or other objects excessively

▪       Doing other things to prevent or remove contact with contaminants

Checking

▪       Checking that you did not/will not harm others

▪       Checking that you did not/will not harm yourself

▪       Checking that nothing terrible happened

▪       Checking that you did not make a mistake

▪       Checking some parts of your physical condition or body

Repeating

▪       Rereading or rewriting

▪       Repeating routine activities (examples: going in or out doors, getting up or down from chairs)

▪       Repeating body movements (example: tapping, touching, blinking)

▪       Repeating activities in “multiples” (examples: doing a task three times because three is a “good,” “right,” “safe” number)

Mental Compulsions

▪       Mental review of events to prevent harm (to oneself others, to prevent terrible consequences)

▪       Praying to prevent harm (to oneself others, to prevent terrible consequences)

▪       Counting while performing a task to end on a “good,” “right,” or “safe” number

▪       “Cancelling” or “Undoing” (example: replacing a “bad” word with a “good” word to cancel it out)

Other Compulsions

▪       Putting things in order or arranging things until it “feels right”

▪       Telling asking or confessing to get reassurance

▪       Avoiding situations that might trigger your obsessions