Obsessive Compulsive Disorder (OCD) is an anxiety disorder marked by repetitive unwanted thoughts (obsessions) coupled with external or internal efforts to relieve the anxiety and obtain a sense of certainty (compulsions).
Everything can be a source of fear with OCD. Furthermore, OCD obsessions can be triggered by anything. Some people are triggered to their obsessive fears by scenes on TV or experiences at school. Others are triggered by thoughts or images that momentarily pop into their mind. Still others are triggered by a physical sensation or normal biological function, such as breathing or sneezing.
Once triggered, obsessions often take the form of a “What if…” question, or “If ____, then _____” thought. A simple question that is usually answered with ease or disregarded by most can feel as important as life and death when OCD latches onto it. Some common obsessions include:
- What if I hurt someone today?
- What if I don’t fully know my sexuality?
- If I’m around my baby alone, then I might hurt her.
- What if that door knob isn’t really clean?
- What if my cough is actually lung cancer?
- If I’m not fully certain about my love for my partner, I’ll have a terrible life.
- If I have bad thoughts at church, I’ll be punished to Hell.
- What if I never stop focusing on my breathing?
Compulsions are a desperate attempt to regain a sense of certainty in a favorable outcome and to feel emotionally safe. For a time, these compulsions work, however their effectiveness starts to lose power. When this happens, the sufferer finds they must do a greater number of compulsions, perform them with increasing “perfection” or intensity, or add more rituals and routines. Unfortunately, compulsions eventually limit the sufferer’s freedom or negatively impact their work, school, relationships, or other aspects of their life. So, while compulsions may bring a temporary sense of relief, they only strengthen the thought/fear association.
Common compulsions include:
- Washing hands repetitively
- Opening doors with paper towels
- Visually checking that the stove is off more than once.
- Mentally replaying a conversation to see if you said something racist.
- Asking friends if you hurt their feelings, without any evidence harm was done.
- Excessive list making
- Re-reading the same page to make sure you fully understood it
- Re-driving your route looking for evidence you hit someone.
- Evaluating whether your emotions feel “right” or if you have “enough” of a feeling.
OCD’s impact on the sufferer can range from a mild obstacle in their day to leaving the sufferer homebound and entirely dependent on family and other caretakers for all aspects of their life.
Treatment for OCD
There is still hope! OCD can be effectively treated with Cognitive Behavioral Therapy (CBT), Exposure and Response Prevention (ERP), and mindfulness training, such as Acceptance and Commitment Therapy (ACT). This treatment combination helps the individual progressively face their fear and resist compulsive behaviors. By working to stand up to the fear, clients will learn that OCD over-estimates potential danger, that anxiety will reduce without the need for compulsions, and that the client is stronger than they think. Through repeated and increasingly difficult exposures, clients can develop a tolerance to their fears and have an overall reduced experience of anxiety called “habituation.”