Obsessive Compulsive Disorder (OCD)

What is OCD?

Obsessive Compulsive Disorder is a relatively common, but often misunderstood set of symptoms. As a society, when we think of OCD, we imagine people washing their hands too much or having things clean and organized in a particular way. While those things may be true for some people, this isn’t a very good picture of what it is all about.

Obsessions are thoughts, images, urges or sensations that make attending to other life obligations challenging (or sometimes impossible). These thoughts are sticky, loud, and can feel scary or uncomfortable. People having obsessions tend to get stuck on:

• Harming yourself or others

• Being contaminated or dirty

• Practicing religion 

• Being a good or moral person

• Sexual orientation

• Gender identity or expression 

• Relationships

• The meaning of life or existential thoughts 

• Emotional contamination

• Feeling hyper-aware of your body

• Getting stuck on past events 

• Losing control

• “Seeing” gruesome images

• Having uncomfortable thoughts around sex

• Perfectionism 

• Anything… OCD only cares about the things you care about. Everyone’s OCD is unique

Compulsions (also known as rituals) are strategies that people use to minimize, avoid and neutralize the obsessions that are upsetting. The problem with compulsions is that they snowball. One compulsion quickly isn’t enough to relieve the anxiety and fear of the obsession. Compulsions can be behavioral and/or specific ways of thinking. Common compulsions include:

• Checking 

• Washing and cleaning

• Repeating and counting 

• Asking for reassurance

• Avoidance

• Comparing

• Counting 

• Hoarding or saving items

• Symmetry and exactness

• Planning out what to do next

• Ruminating 

• Reciting phrases

• Anything can become a compulsion

Signs of OCD

Here are some of the most common signs of OCD:

• You have frequent thoughts that pop up in your head that make you very uncomfortable. It feels like there is no way to “shake it off” or move on.

• You feel like you MUST do something to make yourself feel better. Maybe you think about it for hours or do something to try and make yourself feel comfortable again. You may know the things you are doing don’t make sense, but you just have to do them. Other times you may think you are doing things “normally,” but other people disagree.

• You have been in therapy to deal with anxiety, but you just don’t feel better.

• You feel like you are always on edge

• You avoid things that make you uncomfortable or anxious

How I Treat OCD

Once a person discovers they have OCD there are treatment options that are quite effective at helping take back control in their lives. I have been treating OCD, anxiety and related disorders exclusively for many years and stay up to date on treatment research to assist clients in finding relief and returning to their full lives.

Cognitive Behavioral Therapies have been shown to be the most effective treatments for treating OCD. I teach my clients about two specific CBT treatments so they can decide which direction to take their therapy:

Exposure and Response Prevention 

During ERP people focus on making the obsessions less upsetting. They do this by facing the thing that causes anxiety in small, manageable steps. 

Response (or ritual) prevention is all about cutting out the compulsions. When we behave in a new way it changes the way we think and feel.

Someone who has OCD around making a mistake may go back and check their work 12 times. With ERP that person would do exposures around making a mistake while cutting out the checking compulsions.

Inference Based Cognitive Behavioral Therapy

I-CBT addresses the doubt (the “what if”) that happens before the obsession even takes off. When you can identify what is a here-and-now problem and what is a problem OCD has used the imagination to create, you then get to leave behind the things that don’t need to be attended to in reality

Someone who has OCD around harming others would start learning to trust what they see in front of them and trusting their senses. When you know that keeping others safe is important to you and you don’t see anyone else hurt there is no reason to even go down the “what if” path.

Oftentimes I will pull in skills from Acceptance and Commitment Therapy to help you rebuild what OCD has taken away. ACT helps people learn to accept that life is full of pain, but making a commitment to live your life according to your values makes the hard times worth it. 

Sources:

Aardema, F. (2024, April 27). What is I-CBT? Inference-based Cognitive-Behavorial Therapy. https://icbt.online/what-is-icbt/

ACT for the Public | Association for Contextual Behavioral Science. (n.d.). https://contextualscience.org/act_for_the_public

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596

International OCD Foundation. (2023, December 27). International OCD Foundation | Exposure and Response Prevention (ERP). https://iocdf.org/about-ocd/treatment/erp/

Obsessive-Compulsive Disorder (OCD). (n.d.). National Institute of Mental Health (NIMH). https://www.nimh.nih.gov/health/statistics/obsessive-compulsive-disorder-ocd

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Senter, M. S., Patel, S. R., Dixon, L. B., Myers, R. W., & Simpson, H. B. (2021). Defining and addressing gaps in care for Obsessive-Compulsive Disorder in the United States. Psychiatric Services, 72(7), 784–793. https://doi.org/10.1176/appi.ps.202000296

Storch, E. A., Rasmussen, S. A., Price, L. H., Larson, M. J., Murphy, T. K., & Goodman, W. K. (2010). Yale-Brown Obsessive-Compulsive Scale–Second Edition [Dataset]. In PsycTESTS Dataset. https://doi.org/10.1037/t01431-000

Ziegler, S., Bednasch, K., Baldofski, S., & Rummel-Kluge, C. (2021). Long durations from symptom onset to diagnosis and from diagnosis to treatment in obsessive-compulsive disorder: A retrospective self-report study. PloS One, 16(12), e0261169. https://doi.org/10.1371/journal.pone.0261169