Understanding OCD

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Understanding Obsessions and Compulsions - Mark Ettensohn, Psy. Sacramento therapistYou may have heard people joke about “being OCD” because they like their desk to look a certain way or because they like to straighten crooked pictures on the wall. But for people who actually suffer from OCD and related disorders, the obsessions and compulsions that they struggle with on a daily basis are no laughing matter. According to the latest prevalence data, 1.2% of the US population suffers from OCD. That’s almost 4 million people – and those are only the ones who have sought treatment.

Obsessions and Compulsions

OCD is characterized by recurring thoughts (obsessions) and behaviors (compulsions) that cause significant distress in a person’s life.

Obsessions – Have you ever had a thought that you couldn’t get out of your head? Perhaps it was a song that played over and over and was driving you crazy, or maybe it was a word or an image that lingered a bit too long for your comfort. If so, then you have a small idea of what obsessions can be like in OCD.

The key feature of an obsession is that it is unwanted by the person having it. Obsessions are like uninvited guests at a party – they are insistent, unwelcome, and often inappropriate. Common obsessions include concerns about contamination (sickness, germs, or dirt), symmetry, forbidden or taboo thoughts (thoughts or images that have aggressive, sexual, or religious themes), and harm (thoughts or images of hurting oneself or others), but any unwanted repetitive thought or image could qualify as an obsession.

True obsessions come out of nowhere. They intrude on a person’s mind and often include really disturbing content. This is what makes them especially anxiety provoking. They can include thoughts like, “What if I lose control and stab everyone with a kitchen knife?”, “What if I’m a pedophile?”, or “What if I murder my family in my sleep?” They can also include violent images. It’s important to understand that obsessions don’t reflect the true wishes and desires of the person having them. In fact, it is often just the opposite. Obsessions cause distress because they involve thoughts and images that the person doesn’t want. This is why the person develops compulsive behaviors that are designed to get rid of them.

Compulsions – Do you feel you have to say “Bless you” after a person sneezes? This is an example of a compulsive behavior (albeit a very minor one). In OCD, compulsions follow on the heels of obsessions and are done in order to stop the obsession or prevent it from coming true. The key feature of a compulsion is that the person feels he or she MUST perform the behavior or something terrible will happen. Common compulsions include checking behaviors (checking to make sure the stove is off, the door is locked, etc.), cleaning behaviors (excessive hand washing, showering, etc.), counting and ordering behaviors (lining things up a certain way, counting the letters in words, etc.) repeating behaviors (saying a word or phrase over and over again in one’s mind, performing a certain action multiple times, etc.) and hoarding behaviors, although any activity that is done to counteract an obsession counts as a compulsion. Compulsions can be observable actions or thoughts in a person’s head. They can be obvious or secretive.

Treatment for OCD

OCD is a very treatable disorder. Common treatments include therapy designed to support a person in interrupting the cycle of obsessions and compulsions. One therapy approach that has shown much promise in the treatment of OCD and related disorders is Acceptance and Commitment Therapy (ACT). ACT helps people learn see their obsessions in a different light (a process called ‘defusion’) and to better tolerate the feelings of anxiety and distress that come up when they try to stop performing their compulsions. It also helps people to better define what is important in their lives and to take steps in the direction of achieving their goals.

Medication (typically antidepressant medications) can also be an effective treatment option for OCD when used in combination with therapy. It is seldom advisable to only use medication to treat OCD and related disorders.

If you or loved one is suffering from Obsessive-Compulsive Disorder (or a related disorder*), seeking a therapist trained in ACT can be a great first step toward recovery.

*The Diagnostic and Statistical Manual of Mental Disorders (DSM) used to group OCD with other anxiety disorders like Phobic Disorders, Panic Disorder, and Social Anxiety Disorder. But with the publication of DSM-5, Obsessive-Compulsive and Related Disorders is now its own diagnostic category. This is significant because it reflects a growing recognition that disorders like OCD, Body-Dysmorphic Disorder, Trichotillomania (hair-pulling), and Hoarding Disorder have common features that differentiate them from other anxiety disorders.

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