OCD Online - Learn More About OCD

What is OCD?

Obsessive-Compulsive Disorder (OCD) is a disorder that affects approximately 2-3% of the population. It usually begins in late childhood or early adolescence. It involves recurrent obsessions and/or compulsions. These are usually highly distressing and can significantly impact on quality of life

Obsessions

Obsessions of OCD can be either thoughts, images or urges.

They are repetitive and unwanted and intrude into the mind without our control.

Obsessions often cause anxiety and distress, and an urge to act.

Compulsions

Compulsions are a response to help reduce the distress of an obsession.

Compulsions can be either mental or behavioural acts.

While they are intentional, they are difficult to control.

Some common obsessions include:

Fear of contamination, such as germs, viruses, or dirt
Obsessive doubt of whether you might cause harm or be a bad person
Fear of losing control & acting on impulses, such as stealing, swearing, or becoming violent
Preoccupation with order, symmetry, or patterns
Preoccupation with religious or moral issues
Unwanted sexual thoughts or images

Some common compulsions include:

Washing & cleaning to reduce fears of contamination
Physical or mental checking of things to alleviate doubts of causing harm or being bad
Ordering, counting, arranging to help with a need for symmetry and order
Praying, repeating “safe” words or phrases, thinking “good” thoughts to neutralise immoral fears
Asking for reassurance from others to help with self-doubt and uncertainty

This is not an exhaustive list! These are just some common themes.

Anything can become an obsession or compulsion

Can you be a little bit OCD?

No. The “D” in OCD stands for Disorder. This means that the obsessions and compulsions are not just annoying but highly distressing, and/or significantly impact on someone's quality of life.

Most people have had unwanted thoughts, and the urge to do something about them. For instance, many people can relate to the doubt of “did I lock the front door?” and the urge to go back and check. While some people might use the term “a little bit OCD” to refer to cleanliness, or a preference for order, this can undermine the disorder element of disabling OCD.

Click here to learn more about treatment for OCD

More About Obsessions

Obsessions are repetitive mental thoughts, images or impulses. While there are many different types of obsessions, the obsessions of OCD have some clear characteristics:

Obsessions are unwanted and intrusive.

OCD obsessions just “pop in” to our stream of thought, not because we have chosen to think about them.

Obsessions are distressing.
Obsessions are not about lovely or pleasant thoughts but are unacceptable or frightening, and so they are associated with distressing feelings.

Obsessions are resisted.

The unpleasantness of obsessions means that there are attempts to avoid triggers or suppress obsessions with compulsions.

Obsessions are ego-dystonic

They are inconsistent with the core values of the self

Obsessions go against who you are, in fact, they tend to say the very opposite of who you are!

Obsessions feel uncontrollable.

There is a lot of difficulty in trying to stop obsessions so they can feel overwhelming and uncontrollable.

Why are obsessions so upsetting?

OCD wants us to pay attention and to make sure that everything is ok!

Because our brain can easily ignore neutral, or even positive material, OCD gives us distressing material because we are more likely to notice it and want to do something about it.

There are some situations where this brain process serves us well, but in OCD, it is no longer helpful.

What about other types of obsessions?

The above characteristics are important because they help to distinguish the obsessions of OCD from other types of obsessions.

For instance, being “obsessed” or in love with something (philia) is different to an OCD obsession because it is in line with how the person feels (ego-syntonic), and there may even be pleasure associated with the thoughts.

More About Compulsions

The compulsions of OCD are purposeful behaviours or mental acts that are designed to reduce the distress of an obsession, or to prevent some feared event from occurring. While they are intentional acts, they don’t feel that way – they feel uncontrollable.

The link between obsessions & compulsions might not be obvious

Sometimes an obsessive and compulsive themes are easily linked. For instance, someone might wash their hands to prevent contamination, or check the door to prevent a break-in.

However, this is not always the case with OCD. The links might be less obvious. For example, someone may perform a washing ritual to make themselves feel more “pure” after having an unwanted sexual obsession, or count to a “safe” number to prevent harm coming to loved ones.

Anything can become a compulsion

Any behaviour can become a compulsion – even blinking or breathing or saying goodbye to others when you leave the house. These acts are a normal part of survival and everyday life which means that it is not the behaviour itself that is the problem, but the intention behind the behaviour.

If we do these behaviours with the purposeful aim to reduce distress and/or prevent something feared from happening, it can turn into an OCD compulsion

People with OCD know that their compulsions are irrational

One of the main features of OCD compulsions is that the person tends to understand that their behaviour is either unrealistic (e.g., repeating a “good” thought to prevent loved ones becoming ill), or excessive (e.g., checking a stove 30 times).

This means that people with OCD can feel overwhelmed with doubt and shame because on the one hand, they know the behaviour isn’t helpful, but on the other hand, they can’t be sure and feel compelled to do it.

What about other compulsive behaviours?

While OCD compulsions can involve a sense of relief, the compulsive behaviours in substance abuse, and sexual disorders, involve pleasure. The acts in these disorders are only resisted because of the possible harmful consequences.

In contrast to the compulsions of OCD, the compulsive movements in tic disorders are often involuntarily performed, or are not designed to reduce the impact of an obsession.

Treatment For OCD

Obsessive-Compulsive Disorder can be a disabling condition if untreated. Fortunately, there are a lot of treatment options that exist to help those with OCD to live a rich and fulfilling life.

Cognitive Behavioural Therapy (CBT)

Cognitive-Behavioural Therapy (CBT) is a psychotherapy treatment that involves examining how one’s thoughts, feelings and behaviours are all connected.

The “Cognitive” part of CBT looks at our mental processes and considering more helpful ways of thinking.

The “Behaviour” part of CBT involves Exposure and Response Prevention (ERP).

Acceptance and Commitment Therapy (ACT) is often incorporated into CBT for OCD.

Medication

The most commonly used medication for OCD are a type of antidepressant called selective serotonin reuptake inhibitors (SSRIs).

These are many different types of SSRIs and a psychiatrist or medical practitioner is required to help select the right medication and dosage.

Medications can help reduce the symptoms of OCD, as well as related symptoms of anxiety or depression.

Exposure and Response Prevention (ERP)

Exposure and Response Prevention (ERP), the individual with OCD learns how to approach their feared situations (exposure) without doing any of their compulsions (response prevention).

This is done in a graded and safe way, typically starting with less distressing obsessions and compulsions, and working up to tackling some of the more distressing situations.

Sometimes ERP therapy is done without the “cognitive” component of CBT.

Experimental

The above treatments have excellent scientific evidence for helping reduce OCD symptoms.

There are some other treatments that are being investigated, but there is not enough research yet to establish if they are safe or effective for OCD.

This includes medical treatments (e.g., deep brain stimulation. electroconvulsive therapy, transcranial magnetic stimulation) and psychotherapy approaches (e.g., hypnosis, EMDR).