Obsessive compulsive disorder, or OCD, is primarily characterized by the presence of obsessions and compulsions. Obsessions are defined as repetitive, persistent thoughts (e.g., thoughts of germ contamination), images (e.g., mental images of violent deaths of loved ones), or urges (e.g., an impulse to stab someone). Of note, these thoughts are not enjoyable or voluntary and do not represent a person’s actual desires (e.g., wanting loved ones to die, wanting to harm someone). On the contrary, the thoughts are intrusive, upsetting, and worrisome. Repeated attempts are made to ignore or avoid these unwanted thoughts or to counteract the thoughts with a different thought or action, such as performing a compulsion.
Compulsions are repetitive, ritualistic behaviors (e.g., hand washing) or mental acts (e.g., repeating words silently) that are performed in response to obsessive thoughts (e.g., thoughts of germ contamination leading to washing) or rigidly followed rules (e.g., every time a hearse is seen, a certain phrase must be repeated mentally). The aim of compulsions is to decrease the distress caused by the obsessions or to prevent a feared outcome from occurring. However, these behaviors are either not connected in a realistic sense to the feared outcome (e.g., repeating a phrase to prevent harm from coming to a love one) or are very excessive in nature (e.g., washing for hours a day). While compulsions are not completed for pleasure, an individual can experience temporary relief from intrusive thoughts and related anxiety and distress. However, this relief is only short-term and, over time, engaging in the compulsive behaviors to minimize intrusive thoughts conversely reinforces these very thoughts, creating a viscous cycle of obsessions and compulsions.
The frequency and severity of obsessions and compulsions vary. Some people with OCD may have mild symptoms, spending 1 or 2 hours per day obsessing or carrying out compulsions, while others may have nearly constant intrusive thoughts or compulsions that are incapacitating. Additionally, individuals with OCD experience a range of responses when confronted with situations that result in obsessions and compulsions. For instance, an individual could experience significant anxiety leading to panic attacks. Others report strong feelings of disgust. It is very common for individuals with OCD to avoid thoughts or situations that trigger obsessions and compulsions (e.g., individuals fearing contamination may avoid public restrooms entirely). While performing compulsions, some individuals report an upsetting feeling of “incompleteness” or unease until things seems “just right.” Additionally, individuals with OCD can have varying levels of insight, or awareness, related to their beliefs, ranging from recognition that their beliefs are probably not true to being completely convinced that the beliefs are true. Age and developmental factors are important to consider when assessing the level of insight an individual has about their beliefs.
Of note, obsessions and compulsions must be time consuming (e.g., take more than 1 hour per day) or cause significant distress or impairment in an individual’s life. Most people experience occasional intrusive thoughts or repetitive, ritualistic behaviors. Someone without diagnosable symptoms can even experience similar thoughts and behaviors to someone with OCD. For instance, a person may remember the old childhood adage “step on a crack, break your mother’s back” and step over the lines on a sidewalk. The person does not believe that these actions are realistically connected to a potential negative consequence that needs to be prevented. For this individual, the thoughts and behavior do not lead to emotional distress or functional impairment. Specifically, if stepping on a crack cannot be avoided, the person would not experience significant emotional turmoil or related behavior changes. The person does not rigidly follow these rules daily or experience the thoughts as intrusive. In this case, a diagnosis of OCD is not necessarily warranted. However, someone with obsessive-compulsive features may think of this childhood adage repetitively and persistently, despite rigorous mental efforts to avoid the thought. The person may fear that harm could come to a loved one if the rules of the phrase are not followed precisely. Certain sidewalks may be avoided due to these fears, causing the individual to be unable to complete daily tasks and avoid certain places. If stepping on a sidewalk crack cannot be avoided in a circumstance, the person could decide to forgo their plans entirely to return the way they came or proceed with substantial worry and fear that may lead to additional ritualistic behaviors. Given the time-consuming nature, as well as the level of distress and impairment, a diagnosis of OCD may be warranted in this case.
The Obsessive-Compulsive Cognitions Working Group, an international group of OCD researchers, identified six faulty beliefs associated with OCD. These belief categories provide helpful context when considering the symptoms of OCD.
Exposure and Response Prevention (ERP), a form of cognitive behavioral therapy (CBT), is considered the “gold standard” for treating OCD. Studies estimate that more than 85% of patients experience significant symptom reduction after a course of this type of treatment. ERP involves gradual exposure to anxiety provoking situations accompanied by prevention of associated compulsions. Learn more about effective treatment for OCD and how to find an effective OCD therapist.
For more information about OCD or to schedule an appointment with an OCD treatment specialist at Austin Anxiety and Behavioral Health Services please call (512) 246-7225 or email us at firstname.lastname@example.org. We are currently accepting new patients at our Round Rock and Austin therapy offices.