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What is Obsessive Compulsive Disorder?
Obsessive Compulsive Disorder (OCD) is made up of – just as the name suggests – two parts: obsessions and compulsions.
Obsessions are thoughts, images, or impulses to do something that repeat over and over again. They are generally unwanted, intrusive, and distressing or disturbing, and can get in the way of doing important things, such as fulfilling job responsibilities, schoolwork, parenting, engaging in relationships, and otherwise living our lives. Obsessions are often accompanied by intensely uncomfortable feelings, such as fear, anxiety, doubt, disgust, and persistent worry. Compulsions are the behaviors that we may do in order to neutralize, satisfy, or otherwise reduce their obsessions and the uncomfortable feelings that come along with them.
Compulsions include doing things over and over again or doing things in very specific ways, thinking certain thoughts to counteract the obsessions, asking repetitive questions to other people in order to obtain reassurance, and avoiding things or situations thought to be contaminated or likely to cause anxiety or worry.
How does OCD keep us stuck?
Like obsessions, compulsions typically take up a significant amount of time and can get in the way of doing important things. They can also be experienced as embarrassing if someone who didn’t understand the situation were to see them. Many people with OCD find that doing their compulsions do help at least to some degree in the short-run, keeping their obsessions and anxiety at bay or at least reducing them for a time. However, the obsessions are rarely gone for long, typically returning as strong as ever, reinforcing an escalating cycle of obsession, compulsion, obsession, compulsion, and so on.
Some people experience what is often described as “Pure O” OCD, in which the main difficulty is the frequent intrusive thoughts as well as the anxiety that comes along with them without many overt rituals or repetitive compulsive behaviors. However, significant time and energy is still spent wrestling with these obsessions, trying to ignore them, talk ourselves out of them, or otherwise reduce them.
Common Obsessions and Compulsions in OCD
When we think about OCD, many of us picture the most well-known symptoms, such as repeated hand-washing due to worry about germs or compulsively keeping things in order. However, there are many different ways that OCD can intrude on our lives. Common reasons why people with OCD seek treatment include:
● Fear of getting sick, contaminated, or catching a specific disease (such as HIV)
● Repeated washing, showering, “purell-ing,” avoidance of contaminated objects, or research into diseases and how they are contracted
● Fear of losing control and hurting oneself or others (e.g., attacking loved ones, pushing someone into the street, jumping off a train platform); Avoidance of and anxiety around knives, train platforms, heights, or any other objects or situations where one could do something dangerous
● Anxiety about having inappropriate sexual thoughts (violent images, incest, pedophilia, bestiality, etc.)
● Feeling contaminated, uncomfortable, or likely to change in some undesirable way due to being around or thinking about certain people or kinds of people (E.g., being around someone who has had bad luck will in turn make you “unlucky”)
● Worries about hitting a pedestrian while driving; Repeatedly checking mirrors, the road, the car, or news reports for evidence of it
● Need for things to feel “just right,” leading to repetitive cleaning, ordering, arranging, light switching, door or window-locking, re-reading, re-writing, walking up and down stairs or through doors, etc.
● Doubting one’s sexual orientation and fears about what those doubts will mean (In contrast with legitimately questioning one’s sexuality, in OCD there is not much actual attraction prompting the questioning, and much more focus on the “what if…”)
● Fears about offending God, thinking or doing things that are sins, going to hell, or not properly completing religious traditions or rituals (Strong adherence to religious practices is not OCD, but focusing more than others do on following the rules perfectly may be)
● Repeating things until reaching certain “good” numbers or and/or avoidance of “bad” numbers or “jinxed” dates.
● Distracting and frustrating philosophical thoughts or ideas
● Fear that one emits an unpleasant odor, possibly leading to repetitive checking and grooming (sometimes referred to as Olfactory Reference Syndrome or ORS)
Treatment for OCD
The most effective form of psychotherapeutic treatment for OCD is a particular type of Cognitive Behavioral Therapy called Exposure and Response Prevention (ERP).
During the exposure piece of ERP, the individual works together with the therapist to confront the thoughts, fears, people, things, and situations that are the focus of their obsessions and trigger their discomfort. The key element of this treatment is the response prevention aspect, in which the individual makes the choice – in the service of improving their lives in the long run – to refrain from doing the compulsions that they typically rely on, whether they be washing, performing a ritual, asking questions, repeating things, distracting themselves, or trying to push thoughts away or otherwise neutralize them.
How will this help my OCD?
By breaking this cycle of obsessions and compulsions, most individuals will find that their anxiety and discomfort will eventually decrease without engaging in the compulsion. By repeating these exercises over time, individuals can build up a level of comfort with situations that were previously thought to be unbearable. As this happens, individuals may begin to think differently about their obsessions, finding that these warnings of inescapable danger that the OCD insists upon are exaggerated, and that while the situations may be uncomfortable, they are also survivable and less threatening than initially feared. As this comfort level grows, individuals with OCD can begin to reclaim the hours of their lives that the OCD has been stealing away.
To some, this approach may sound counterintuitive at first. Many seek treatment to make these thoughts and feelings just go away rather than to confront them. However, it is often because of this desperate desire to feel better and think differently that many get stuck in that escalating cycle of obsessions, compulsions, and worse obsessions.
Successful treatment of Obsessive Compulsive Disorder is a choice to take a different approach from the one you are stuck in, one that may be quite challenging at first, but life-changing in the long-run! For help with your OCD, please contact us.
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