What is OCD? A Definitive Guide
Obsessive compulsive disorder, commonly abbreviated to OCD is a mental health condition where the sufferer is plagued by a cycle of obsessions and compulsions.
These obsessions usually take the form of unwanted intrusive thoughts, images, or triggers which disturb the sufferer so much that it causes a bout of anxiety. As our bodies natural fight or flight mechanism kicks in, the sufferer will look for ways to squash this anxiety, usually in the form of compulsions.
In an effort to disprove the initial obsession, to ensure that what they have thought, seen or heard is not true, or does not come to be true, an OCD sufferer will perform a compulsion to disprove these obsessions. They’ll usually take the form of ruminating on the idea, performing a check, or some other act to ensure safety from these unwanted obsessions.
This is where the cycle of OCD begins.
The initial compulsions are used to dispel the obsession, but then it appears again, and again, and again, and again, until the sufferer is in a perpetual loop of obsessions and compulsions.
These recurring and ritualistic behaviours disrupt the entire lives of the person afflicted, and can significantly affect daily activities and interactions. If these routine behaviours are not performed it will cause the sufferer a great amount of stress and anxiety.
OCD is a very personal condition so the content of the obsessions and compulsions can take many forms. For example, for someone who is particularly health conscious may become continuously worried about becoming sick and will start to compulsively wash their hands to avoid this fear coming to fruition.
However, the portrayal of OCD in modern pop culture and media, has caused a mass misunderstanding of the disorder. Which has forced the question, what isn’t OCD?
What isn’t OCD?
In the television, movies, the media and nearly everywhere else in the misinformed world, OCD is known as a quirky trait where someone has to keep their pencils in order, or wash their hands regularly or keep their drinks facing outwards in the fridge. What is hardly ever illustrated are the countless hours of anxiety every single day, the unrelenting urge to perform compulsions, the loss of relationships with loved ones and all the other pain that surrounds this awful disorder.
This has forced the question, what isn’t OCD?
It’s a fairly simple question with a somewhat simple answer. Do you feel an intense, all-consuming, life-threatening anxiety if a specific thing in your life doesn’t feel right? No? Then you likely do not have OCD. Of course, this is trivialization, but the point still stands. Being a neat-freak, or a perfectionist, is not OCD. Liking something in a specific order, is not OCD. Liking things to be clean, is not OCD. While these traits may exist in someone who is suffering from OCD, they are not symptoms or afflictions of the condition.
To have choice is the main differentiator between someone suffering from OCD and someone who isn’t. When an urge or obsession arises for someone with OCD, it doesn’t feel like a choice, it feels as though their life is on the line, that this needs to be acted on or something truly terrible will happen. It becomes an intrinsic need to ensure their safety. This is what OCD is.
Who OCD can affect?
Sadly, OCD is a fairly common condition which affects millions of people worldwide. According to OCDUK, 1.2% of the population in the UK is suffering from OCD, with more than half falling into the severe category. Higher figures are seen in the US, with NIMH reporting more than 2.3% of the population currently suffering with OCD.
OCD is a very indiscriminate condition, it affects people of all ages, of all genders, in all walks of life.
Research from OCDUK has shown that the condition usually becomes problematic for males in their adolescence and in their early twenties for females. However, children are also prone to developing the disorder, with some cases beginning at the age of six, and 25% of all cases beginning at fourteen. Usually the symptoms of the disorder are gradual, but there are cases where an acute onset of symptoms occur.
The above research has also shown that OCD is slightly more prevalent in females and that they are also much more likely to seek out treatment than men, with OCDUK showing a 75% contact ratio from women as opposed to men.
Common questions asked by sufferers are “what caused my OCD?”, “why have I developed this condition and others haven’t?”. Despite the longing for answers to these questions, there is unfortunately nothing conclusive. It would be impossible to give a definitive cause to the development of this condition. This is most likely because there isn’t one. According to leading specialists, it’s more likely a combination of several factors as opposed to one event or variable. In no particular order, here are the most researched factors:
Stress and Trauma
Environmental factors such as parenting and childhood experiences can contribute to the development of OCD later in life. If growing up you had many abusive or troubled experiences, these repressed thoughts can manifest into OCD and other mental health conditions later in life.
While stress itself is unlikely to be the cause of OCD, ongoing stress in your daily life can trigger OCD-like symptoms or worsen already existing symptoms. The same can be said about traumatic experiences, this is seen in the development of OCD in sexual abuse victims, war veterans and others. Studies have shown that up to 50% of those suffering with OCD had one or more major life event prior to the onset of their symptoms.
Professor David Veale reports that genetics can contribute to a vulnerability to OCD. He shows that 5 percent of those suffering with OCD also have a close family member with the same ailment. Also, 10-15 percent of OCD sufferers are seen to have close family members with compulsive symptoms but not OCD. As these figures are so low, you are only slightly more likely to “inherit” OCD than it occurring naturally, meaning this should not influence your decision on starting a family in fear of your child suffering from OCD.
As OCD is a problem of the mind, it’s fairly common to assume that there must be some sort of neurological issue. Put simply, there are claims that a lack of serotonin in the brain of OCD sufferers is a contributing factor to their development of OCD. Though scientists have agreed that evidence is inconclusive and could easily be a case of OCD causing the lack of serotonin as opposed to a lack of serotonin causing OCD.
OCD sufferers follow very similar personality traits, these include: perfectionism, worrisome temperaments, meticulous behaviours, cleanliness, inflated responsibility and more. Though these are commonly seen in OCD patients, it isn’t a hard and fast rule, there is simply a correlation between those with these traits and those suffering with OCD. By no means does it insinuate that people with these traits will develop OCD, it has just been observed that there is a slight increase in likelihood.
In the treatment of OCD there is a common method known as ERP, where you expose yourself to the fears of your obsessions which retrains your mind to understand that they do not offer any threat.
There is also a similar theory around the development of OCD. It hypothesised that OCD sufferers can teach themselves to attach worry and fear to certain aspects of their lives. For example, each and every one of us has had violent thoughts pop into their heads, the most outrageous and disgusting things that we can imagine, however, most of the time these offer no bearing on our lives. We’re able to continue our day without giving this a second of our time, but, what if we did? What would happen if we did question these thoughts for a few moments? Why am I having them? What do they mean? Am I going crazy? Then this passes and we consider it ridiculous that this was even given a second of our time. Then it pops up again. And we question them again, just for a moment.
By continuing to question and ruminate on these thoughts, your brain gradually begins to attach danger to them, to consider them a threat to your well begin. Eventually, this could become severe OCD if left unmanaged.
Scientists have observed that in some severe bouts of streptococcal infections (commonly seen as strep throat), children have gone on to exhibit OCD symptoms.
It is suggested that the antibodies created to fight the infection, when directed to the brain, may in some way be linked to Paediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infection (PANDAS). If a child is afflicted, they are likely to show OCD symptoms one to two weeks after developing the infection.
It’s also important to note that there are no known cases of this occurring in adults and it is rare to see this in children after the age of 12.
The psychodynamic or psychoanalytic theory was once commonly accepted in the past as being a major factor in the development of OCD. However, in recent years it has become more and more disregarded.
The perspective attempts to understand the content of the sufferers obsessions. It suggests that previously taught behaviours, emotionally charged events, traumatic experiences and so on, create an internal conflict, something that has been repressed or forgotten but suddenly manifests in the specific obsessions of OCD.
This theory takes on a more symbolic meaning of obsessions and compulsions, it analyses the content of these areas in an attempt to trace this to a root cause somewhere else in your life. Ideally in the hope to rectify this underlying problem, which will ease OCD-like symptoms.
The cycle of OCD follows formulae that is almost identical in all patients. An intrusive thought or image appears, this will cause the sufferer distress and anxiety, they’ll then think, ruminate or ponder on this initial trigger looking for the most beneficial response, this is more than likely their compulsions. This initiates an endless paradox of ensuring safety and never feeling quite sure that they are safe.
The symptoms of OCD stay true to almost all patients, here’s how they usually look.
Intrusive thoughts, images, impulses & triggers
All OCD sufferers are plagued with mental intrusions, mostly in the form of thoughts and images, but can sometimes take the form of impulses (the feeling of wanting to do something) or a physical trigger which onsets anxiety.
The content or context of the initial intrusion is completely dependent on the specific case of OCD. For example, a patient worried that they may become contaminated or sick, may be triggered by the idea of using a public bathroom. The subject of the intrusion is irrelevant, what is however (and consistent among all sufferers), is that it’s unwanted.
One of the reasons that these thoughts cause so much distress is that they are unwelcomed. The intrusions pose physical or emotional danger to the afflicted, so much so that they have to find a way to alleviate some of this threat. These come to be known as the obsessions in OCD.
A common symptom of many mental health conditions and with OCD in particular is anxiety.
Anxiety can bear it’s evil teeth in many forms and causes a multitude of symptoms, from nausea, to sweating, to shortness of breath, to tightness in the chest and a whole host of other ailments.
The funny thing about anxiety is that though it causes a host of physiological symptoms, it’s completely due to your psychological state and in the case of OCD, a bodily response from encountering an obsession.
The anxiety we feel is a trait from our primal “fight or flight response”, if we stumble across a tiger our body needs to know that we are in danger, so our brain sends signals to our body warning us that we are in danger, in the form of anxiety. In the case of a tiger, we know to get the hell out of there, but, the same sensations being caused by an intrusive thought is what really makes OCD threatening.
Every human alive is guilty of ruminating. Spending too much time thinking about something with very little importance, playing out would-be or could-be scenarios, pondering how things may affect our lives and then we get back to our day. For an OCD sufferer, this period of rumination is what keeps the cycle alive.
After an obsession appears they’ll likely ruminate on the idea, consider the what if’s, the could-be’s and every single outcome that you could possibly imagine. And at the end of it, they would have found no solution, no answer that could absolutely guarantee their safety. Because of this they’ll be forced to perform a compulsion, as this is the only act that can offer some salvation from the feeling of worry and dread that comes with the obsession.
In some cases of OCD ruminating is not only something they sufferer will do alongside their primary compulsions, but the compulsion itself. In a type of the condition (known as rumination OCD), the entire disorder lives in their mind, there is no physical compulsion, making the rumination even more detrimental.
Compulsions are widely portrayed as organising items or washing hands fairly regularly, and while these acts can be compulsions they are not even the half of it.
A compulsion in the case of OCD is a repetitive act that the individual feels compelled to perform in an effort to relieve anxiety based symptoms caused by obsessions.
The nature of the compulsion differs from case to case depending on the type of OCD, for example, someone with a fear of contamination may compulsively wash their hands. It’s important to take note of the word “compulsively” as this is very different from normal hand-washing. A person who does not suffer from OCD will wash their hands when they are visibly dirty or logically unclean (i.e after using the bathroom), an OCD sufferer however, will wash their hands when they “feel” unclean, despite any evidence that they are actually unclean and will do so until they “feeling” has dissipated.
This same ritual occurs in all cases of OCD, the sufferer will feel compelled to perform a physical or mental act to alleviate the feeling of anxiety and will do so until they feel “just right” (this usually being when the anxiety has subsided).
It’s very simple, a diagnosis for OCD must be made by a health professional. While you may be able to make a very accurate self-diagnosis, you must seek out a health professional; this is not something you can do yourself.
That being said, it’s beneficial to see what the diagnosis process may look like and what kind of things you should be looking out for if you suspect you’re suffering from OCD.
The first step would be to check your symptoms against the symptoms that we listed above. Though OCD takes several different forms, the format of the disorder does stay very similar throughout all cases. If you do notice that you are suffering from these symptoms and they are directly impacting your daily life and well-being, it’s time to seek out a health professional. If however, you notice “some” of these symptoms and they are not causing any distress to your life, it is unlikely that you are suffering from OCD, though it may still be beneficial to receive a formal diagnosis.
During an official diagnosis your healthcare professional will likely follow NICE Guidelines, and ask the following questions:
- Do you wash or clean a lot?
- Do you check things a lot?
- Is there any thought that keeps bothering you that you’d like to get rid of but can’t?
- Do your activities take a long time to finish?
- Are you concerned about putting things in a special order or are you very upset by mess?
- Do these problems trouble you?
They’ll then go on to decide to assess your risk, the purpose of this is to ensure that you’re not at a high risk of self-harm or suicide. It is imperative that you’re wholly and completely honest during the assessment, these professionals have your best interests at heart and will not judge you on any of your answers. This is especially important for anyone suffering with particularly personal subsets of OCD which may include sexual behaviours or violence. Again, they will not judge you or believe you to be crazy, they’ll simply tell you what they think and offer you the best approaches for your treatment.
Some professionals may also perform a physical exam, this is just to ensure that there is nothing physically wrong that may be causing or exacerbating the issues.
There are several sites that offer OCD tests, some as an unknowingly offensive quiz to test how much of a “neat-freak” you are and others which offer a “diagnosis” on a serious condition. We’re not here to lambast each of the tests that exist on the internet, as some will genuinely offer insight to your condition, that being said, these tests should never be a replacement to a diagnosis from a healthcare professional, nor should their results be taken as gospel.
Types of OCD
As we’ve mentioned previously, the cycle of OCD is very similar amongst all cases. However, there are certain types and categories that can be grouped together. Most OCD sufferers will be able to categorise their condition into one of the following types:
Despite what many conceive to be making sure that a door is locked after leaving the house, checking OCD is much more complex.
Known as “checking OCD” because it usually requires the sufferer to perform physical checks as compulsions, this type of disorder can take many forms. For example, the commonly seen checking doors to ensure they’re locked is a compulsion seen many times, however, it goes far beyond a quick turn of a door knob.
The OCD sufferer will be constantly plagued with intrusive thoughts of the consequences of leaving their home unlocked, “what if a burglar breaks in and steals my stuff?”, “what if they wait for me to get back and murder me?”, “what if they hurt my children?”. These types of thoughts and scenarios will play over and over in their minds, again and again, causing unbearable anxiety. Then they may see a door in public which will trigger more thoughts and more anxiety. Eventually, the only option is to check that the door is locked.
For someone without OCD it would seem logical that after this check you’d be able to go on with the reassurance that the door is locked and it’s more than likely that no one will break in. OCD isn’t so trusting. More thoughts will appear, “is it definitely locked?”, “should I check one more time?”, “did I hear it lock? I’m not sure I heard it lock?”. This leaves the sufferer in a perpetual loop of intrusive thoughts and checking on these thoughts, the obsessions and compulsions of OCD.
The example above is just one obsession seen in checking in OCD, it can really appear in anything and everything. If your compulsion requires you to make a physical check, it’s known as checking OCD.
We all to some extent worry about contamination, we wash our hands regularly, maintain a hygiene routine, but, it’s to the extent that we perform these behaviours which separates someone who is suffering from OCD and someone who isn’t.
Contamination OCD is generally the fear and worry of becoming contaminated which will cause illness or even death. Though, other worries still exist within contamination OCD, such as spreading some sort of contamination to friends or family, or even contracting something as detrimental as HIV, the primary fear is becoming contaminated and what consequences that may have on them and their loved ones.
To ensure that this does not happen, certain compulsive measures need to be in place. Those suffering from contamination OCD will likely excessively wash or clean themselves, usually until the anxiety has subsided enough for them to continue their day. They’ll also ritually avoid certain places and situations, such; public toilets, shaking hands, large groups of people and much, much more.
These compulsively behaviours are usually a response to certain intrusive thoughts and triggers, things like: touching the rail on a bus, noticing someone coughing, or shaking hands with a colleague. These instances will provoke thoughts such as “I wonder who else has held this rail? Do I need to wash my hands? I should probably wash my hands” or “Am I too close to that man coughing? I wonder what he has? What if it’s TB? Is that contagious? I need to get away from him now”
Now washing your hands after using public transport may not seem too bad of an idea, as it is a breeding ground for bacteria, but, the extent and frequency of washing for someone suffering from OCD far outweighs the initial could-be contamination. Contamination OCD sufferers will wash and clean themselves for large amounts of their day, all in the quest to relieve the worry that comes with the thoughts of not doing so. Some severe cases have seen sufferers not able to leave their house in fear of becoming contaminated.
Generally it’s thought obsessions are thought based and compulsions are an external act that is performed. Though some compulsions are mental checks, in most other forms of OCD, compulsions are physically performed. This is where rumination OCD differs.
In rumination OCD the sufferer will face both their obsessions and compulsions internally, though some compulsions will be performed externally, most of the turmoil will exist inside their mind. Intrusive thoughts and triggers will appear causing an onset of anxiety, with the only escape to ruminate on these ideas, to conjure evidence and memories that disprove them. Essentially, to find an answer that will temporarily dispel the anxiety.
The compulsion in rumination OCD is the thinking process, the rumination that goes along with intrusive thoughts and triggers. Within rumination OCD a common obsession are relationships. This is where the sufferer tormented with ideas about their relationship; do I love my partner? Am I attracted to them? Do I want to see other people? These intrusions will play over in their mind causing great amounts of anxiety, compelling them to compulsively ruminate on these ideas, searching for answers that they will never find. The issue in all cases of OCD is the search for absolute certainty, to find a solution that will create a permanent solution. As we know, nothing in life is certain and we won’t be able to guarantee absolute certainty on anything, and it’s this uncertainty that is troublesome.
In the case of someone obsessed with their relationship, when an intrusive thought arrives they’ll quickly look for evidence to refute these ideas. For example, if they begin to worry about whether or not they love their partner, they’ll quickly find lots of evidence which proves they do love their partner i.e the happy times they’ve spent together, which will provide temporary relief from the anxiety, until another intrusive thought appears.
Religious OCD, also known as scrupulosity, causes the sufferer to worry and fixate over obsessions that are based on religion, God and beliefs around morality. As with the other types of OCD that we have discussed, religious sufferers are constantly afflicted with intrusions around doing the right thing and ensuring that they are acting within their faith. They’ll likely analyse each and every decision they make to ensure that it aligns with their beliefs, and replay events from the past in their minds to check that they acted correctly.
The afflicted will likely be bombarded with blasphemous, unholy and unfaithful thoughts and images, so much so that it makes them doubt their own belief. They’ll worry that these thoughts are appearing because they are something that they want, or maybe subconsciously believe. In most cases these thoughts will be recurring and likely centred around a specific idea which is particularly important to them. For example, some cases have seen such obsessions as: fears about sins that they have committed, prayers being said incorrectly or sexual thoughts. It’s these obsessions which will create an intense anxiety and can only be temporarily placated by performing compulsions.
OCD is personal, so the exact obsessions and compulsions that may appear will be different. However, some common compulsions seen in religious OCD include: compulsive prayer, reassurance from others within the same faith that you are acting correctly, reading or studying religious text or compulsively repenting for sins.
The act of placing items in symmetry or organising things based on colour is satisfying to say the least, however, for most of us it isn’t an all-consuming urge that feels imperative to our well-being.
Pop culture portrayals of symmetry or exactness OCD, shows the stricken comically putting their pencils in a specific order, facing the right way, usually in a quirky manner. However, for someone actually suffering from this disorder, it’s far from a quirk.
Symmetry OCD causes the sufferer to believe that something terrible may happen if a specific order, exactness or balance isn’t maintained. This can occur in literally any aspect of their lives, from pillows on a couch, to books on a shelf, to words on the page of a book. Whatever their trigger/s may be, once they have been seen or even just discussed, they have to be made “just right” before something terrible may happen.
In the regards to the “something terrible” that these persons worry about, it will differ from case to case. Anything from a friend dying, to causing a natural disaster. Most sufferers will be completely aware that the act of ordering and perfecting will most likely have no bearing on the “something terrible” that they are trying to avoid, however, because it is impossible to make such guarantees, the afflicted will continue doing so just in case. The classic trait of OCD – “rather being safe than sorry”
Symmetry OCD differs from the other types as obsessions are usually not thought based, yes, the patients may will experience intrusive thoughts and images, but these cases are usually trigger based. The sufferer will more than likely have to see the disorderliness, before feeling the anxiety and urge to perform a compulsion, in this case making whatever item it may be, “just right”.
Magical thinking OCD follows a similar cycle to symmetry. The sufferer will usually believe that something catastrophic may happen, unless XYZ is performed. Magical thinking patients, along with most other forms of OCD, have an inflated sense of responsibility for themselves and their loved ones. They want to ensure that only good happens and avoid bad events at all costs, for them, the only way to ensure this is to perform specific ritualistic behaviours.
Again, the exact behaviours that are performed will differ from case to case, but here are few examples that have been seen: fear that failing to think or say certain words, phrase, sounds, or numbers a specific number of times will cause harm to oneself or others, a fear that failing to do something a certain way will cause harm or a fear that if a specific thing is not avoided harm will come to themselves or loved ones. These fears are the obsessions in their case of OCD, these thoughts will pop up over and over again, causing anxiety and a need to perform a compulsion. Similar to symmetry, many of these fears are trigger based, most intrusions will appear from an external stimuli as opposed to thoughts appearing organically.
In the case of someone who worries that if they do not count their steps something catastrophic will happen, the sufferer will usually need to be walking for the urge to perform a compulsions to take place. That being said, they may also ruminate on counting their steps as and when they decide to start walking again.
What are ‘obsessions’?
As we’ve discussed some of the different types of OCD, we’ve seen some of the obsessions that occur in different cases. We’ve also seen obsessions take the form of intrusive thoughts, fears, images, impulses and more. But, what exactly constitutes something being an obsession in OCD? Put simply, it’s dependent on the frequency, duration and impact that these thoughts have on the sufferer. We all have intrusive thoughts and worries, but most of the time they’ll wizz on by without a second look, the transition to obsessions is our response to the intrusions. If we begin to notice that similar worrisome thoughts are popping up more often and we’re ruminating on them for longer periods of time and to top it all off it’s causing us great amounts of anxiety, it would be logical to assume this has now become an obsession.
However, this does not necessarily mean you’re suffering from OCD. It’s very possible to deal with obsessive thoughts and worries without any compulsions. It’s also important to notice the nature of the thoughts, if you’re worrying about something within your control that is an everyday problem, it’s unlikely that this will be considered an obsession. Obsessions in OCD generally have great meaning to the sufferer, and are so unwanted because they pose a potential threat to the sufferer or their loved ones, as opposed to everyday concerns which will generally have a fairly simple solution.
We touched briefly on the many forms that obsessions can take, and how these unwanted fears can appear in an OCD sufferers life. Here’s a deeper look into this.
Types of obsessions
Intrusive thoughts and images
This is the little voice in your head that tells you what and what not to do, it’s there when you need to mull things over, to remind you of things, and so much more. However, these thoughts are completely out of our control. We do not choose the thoughts that appear in our minds, which is what makes unwanted intrusive thoughts so terrifying.
In regard to obsessions, these thoughts will usually appear as “what if’s” – “what if this?” “what if that?”, asking the most absurd questions or making the most outlandish statements. The message can then be reinforced by images and scenarios, which can feel even more tangible as you see it playing out before you. Similar – and a lot of the times the same exact thoughts – will appear over and over again, unwanted and causing a whole lot of distress.
An impulse is described as a sudden strong and unreflective urge or desire to act. This can come in handy in a lot of different situations e.g when faced with danger or knowing you should seize an opportunity. However, impulse can sometimes appear where we don’t want them to, urging us to do things that we don’t want to do, things that terrify us. A common example of this is when standing at a height, people commonly feel the urge to jump, this is not because they want to die or because they actually want to jump at all, it’s just a feeling that they get.
Similar feelings are seen in OCD obsessions, where the sufferer feels urges to do things or want things, that they truly know are wrong and are not in fact what they want. But, the simple fact that this impulse has appeared causes great amounts of anxiety. The sufferer will wonder “why would I have this feeling if I didn’t want it?”, and this becomes cyclical, the urge appears, they become anxious and they perform a compulsion to rid themselves of anxiety.
Triggers appear in several mental health conditions and remain consistent throughout. This is an external stimulus which triggers anxiety or an onset of negative thoughts for the sufferer. In OCD, triggers will sometimes not only cause anxiety, but also bring about intrusive thoughts or fears of the afflicted.
Triggers appear in a multitude of forms within OCD, a common example is in contamination OCD where the patient will see or notice something unsanitary, this will cause them to become anxious and also begin to think about their own hygiene; “Am I clean?”, “Do I need to wash my hands?”, “Did I touch that?”. Of course, the next step for the sufferer is to wash or clean themselves, in an effort to tame the anxiety and intrusive thoughts.
What are compulsions?
Compulsions are the behaviours, rituals, and actions OCD sufferers will perform to rid themselves of anxiety and the obsessions that they are faced with. The afflicted will feel that it’s absolutely necessary to perform their compulsion, or something very terrible will happen, and though they may know subconsciously that performing this ritual is not a solution to their worries, they have to perform it anyway.
Discussing the different types of conditions within OCD, we’ve seen some of the compulsions which can occur. But as we asked with obsessions, how do we know if something is a compulsive behaviour or an appropriate reaction to a worry?
When faced with a worry, we usually look to find a solution to the problem, a fix or change we can make in our lives that will put this worry to rest, and a lot of the time this is possible. However, there are some instances where the worry cannot be solved, where there is no perfect answer, and though this is difficult, it is something that we have learned to live with.
For someone suffering from OCD, these worries must be responded to. It’s far too distressing to just live with the worry and move on, something must be done and that something is to perform a compulsion.
We’ve briefly touched on the compulsions that appear in a few of the different types of OCD, and while compulsions can take any form with millions of variations, let’s take a look into the more common types that appear in cases of OCD.
Types of compulsions
The different types of compulsions are usually broken down into two sub groups, mental and physical compulsions.
Checking: This is the physical act of checking on the obsession that appears in your mind, for example, checking that the door is locked if you begin to worry that a burglar may break in or checking that the stoves are turned off in fear of burning your house down.
Decontaminating: This is usually only seen in contamination OCD, however, it can become a compulsion in other forms of OCD. This is the act of cleaning, washing or decontaminating oneself in response to the fear of being contaminated in some way, shape or form.
Counting: This is commonly seen in magical thinking OCD where the sufferer will be compelled to count certain things in their life, it could be steps, objects, all in an effort to avoid something catastrophic happening. Counting also appears as a compulsion in symmetry OCD, where the sufferer will count objects to ensure that there is an even number.
Ordering and Arranging: Those suffering with symmetry OCD will ritually order and arrange their items until they are “just right”. However, those suffering with other forms of OCD may also order things in an effort to remain decontaminated or safe from some other catastrophe.
Avoidance: As certain places, things, events and even people can be very triggering to OCD persons, it’s only logical for them to avoid these situations altogether. In an effort to avoid anxiety and being plagued with obsession, OCD sufferers will steer clear of certain things that they know will trigger them. For example, someone is worried about becoming contaminated will forgo any situations which they feel are overly unhygienic.
Safety-seeking: This is the act of asking someone for reassurance, be it through words or actions, safety-seeking is getting validation for your obsessions, to verify that you are acting so that your feared outcome will not happen. For example, for someone who worries that they may not love their partner, they may ask their friends “do you guys ever worry about not loving your partner?”. This is to temporarily reduce anxiety and to gain reassurance that they do not need to be worrying about this.
Rehearsal: When ruminating on obsessions, some sufferers will plan and consider what future events will look like. They’ll test how they feel towards future events, how anxious they are, how much they need to perform compulsion. This is in an effort to mentally prepare themselves for whatever may come in the future, however, it doesn’t do that at all, it simply perpetuates the worry and creates more uncertainty.
Reviews: This is where the person will take their past experience as evidence towards their OCD. They’ll check that there is no event in the past which could contribute to validating their fears. For example, someone who is worried that they may burn their house down due to leaving appliances on, will meticulously check the events of their day and past day to ensure that they have turned the appliances off.
Checking: Similar to physical checks, some sufferers will also perform mental checks. This is usually a checklist to ensure that all compulsions and safety behaviours have been performed, which ironically, is a compulsion itself.
There are several treatments that are used for OCD, though they are mostly used in conjunction with one another, it’s most important that you find a treatment method that works for you.
To begin, we’ll take a look through some of the talking therapies that are used in treatment for OCD, though they can be performed alone using apps like ours, it’s also very beneficial to discuss with a health professional.
Cognitive behavioural therapy focuses on your thoughts and emotions. It uses a gradual retraining of the attachment that we give specific thoughts and emotions, to remove the overwhelming meaning we have given them.
As OCD creates a perpetual cycle of negative thoughts and anxiety, CBT aims to understand that these thoughts that appear have no physical bearing on our lives, they are just thoughts and should be treated as such.
Unlike other talking therapies, CBT does not consider your past experiences or look for root causes. It simply looks to alter your future thinking patterns and bring a greater awareness of the bad habits that you already have in place.
The application of CBT with OCD aims to do a few different things. The initial action is to tackle the intrusive thoughts of the obsessions, to understand them as non-impactful events of the mind, to allow them to float on by without a second look. The goal not being to remove intrusive thoughts, but to accept them.
The ultimate goal is to understand your cycle of OCD, to notice the routine and start making attempts to catch the intrusion before the cycle can even begin, to be aware of triggers and your response to them.
Exposure response prevention is one of the most effective treatments for OCD. It uses the simple premise of facing your fears by exposing yourself to them. This is also commonly seen as treatment for those who suffer from severe phobias, for example for those afraid of heights, they’d gradually start visiting places with heights, increasing the intensity as when they start to feel more comfortable.
This works similarly with OCD, the sufferer will confront their triggers, their fears and their compulsions, then, let the anxiety rise and subside without performing any compulsive behaviours. With continued practice of this, you’ll begin to realise these obsessions, these fears, these worries are not of any threat to you.
For example, a sufferer who is fearful of becoming contaminated and compulsively washes their hands, will start to expose themselves to more and more unhygienic or dirty things, each time resisting the urge to wash their hands and allowing the anxiety to rise and fall on it’s own.
The aim is to expose yourself so often to these threats, that your mind begins to understand that there is nothing to worry about at all.
Acceptance and commitment therapy is a CBT practice which focuses on accepting the thoughts and feelings in your body, to understand that they are out of your control and not meaningful in any way. ACT aims that the feelings and thoughts that appear do not have any meaning, unless we attach one to them.
In the treatment of OCD, the sufferer will aim to allow intrusive thoughts to appear without any reaction, to allow them to disperse like the hundreds of other intrusive thoughts that we see on a daily basis.
The same logic is applied to anxiety. Usually anxiety is a sign of danger, in OCD however, the sufferer has attached this anxiety to specific intrusions and as they appear the sufferer will begin to feel the symptoms of anxiety as an automated response. Using ACT, the afflicted will notice and understand their anxiety, but not react to it, allowing their mind to comprehend that though they are currently feeling anxious there is no threat here, that these symptoms are a bodily response to an intrusive thought.
Though there is a stigma around medication for mental health conditions, there is irrefutable evidence that specific medications can ease the symptoms of OCD.
Generally medication is not the quintessential treatment, it is usually used alongside CBT and acts as the “water wings” for treatment, to ease the symptoms enough that other treatments become easier.
The most common medication used for the treatment of OCD are SSRIs. SSRIs increase the amount of Serotonin in the brain by blocking the elimination of Serotonin (which is called Reuptake). Because the removal of this neurotransmitter is inhibited, its level is increased.
Often OCD sufferers will ask the question, “do I need medication?” and the answer can only come from you and your doctor. If you feel you’re really struggling with your OCD, we recommend making an appointment with your doctor and discussing medication with them, they are the only people qualified to advise you on this area. Do not listen to the advice of friends and family on this.
A practice first introduced in Buddhism, mindfulness has become all the rage in the western world. With countless meditation apps and programmes, mindfulness simply teaches us to live in the present.
Using a number of different techniques, mindfulness shows us to look at our present moment, without judgement and with an openness to stay with this moment. The most common method of doing this is a mindfulness meditation, where you’ll usually be guided to place your attention on your breath, as opposed to the thoughts in your head, and to bring attention back to the breath whenever it wanders.
Mindful meditations are a great tool to practice mindfulness, it strengthens your ability to bring your attention back to the present. When applying the practice of mindfulness to OCD, we use an ACT approach, when intrusive thoughts arise, we do not attempt question or ruminate on them, we watch them, present in the moment, noticing the thought, our surroundings, our breath, our body, without judgement and without a need to move away.
Self management approaches
It is always advised that you seek the support of a medical professional if you find yourself struggling with OCD, however, there are things you can do by yourself to help treat, ease and manage your condition.
Impulse – OCD Treatment and Therapy
We’ve created an audio based course of therapy, where users are taken through sessions and given advice, techniques and information that can help treat their exact case of OCD. Using the treatments we have shown above, we’ve collated the research and methods of the leading OCD specialists from around the globe and put it all into one place.
We understand that not everyone has access to therapy, we want to act as an alternative for those who are unable to get the treatment they deserve. This is not a sales pitch, nor is it a claim that we will cure OCD, we just think that we’ve put together something pretty useful and it might be worth your time checking out.
Books & Blogs
Understanding your OCD is half the battle. You should know everything about your exact case of OCD, what your obsessions and compulsions are, what treatment looks like, how others have dealt with it and anything in between. You should know your enemy inside and out.
We suggest doing as much research and reading as you can on the topic, of course, not to the extent where it becomes a compulsive behaviour. There’s a wealth of content online, aside from our blog:
There are also a number of books that we think all OCD sufferers should read:
Brain Lock, Jeffrey M. Schwartz
Break Free From OCD, Dr. Fiona Challacombe, Dr. Victoria Bream Oldfield and Professor Paul M Salkovskis
Overcoming Obsessive Compulsive Disorder, Dr David Veale and Rob Willson
The Happiness Trap, Dr. Russ Harris
Meditation, mindful or otherwise is something that can be greatly beneficial. Aside from the mindfulness benefits of being more present, there is also the relaxation side. Studies have shown those who regularly practice meditation are calmer and are able to manage negative emotions more easily.
But the question that most people ask “is where do I start?”. There are a number of different meditation methods, we’d suggest finding the one which you find most appealing and set aside ten minutes a day to practice. Try and commit to doing this each and every day, at first it’ll be very frustrating and your mind will constantly wander, but gradually it will become easier and more fulfilling.
Sometimes those suffering with OCD can feel alone, they can feel as though no one understands them, that their obsessions are too embarrassing for anyone to find out about. This fear and isolation only causes even more distress. As cliche as it sounds, talking about your condition can feel like a weight off your shoulders.
It’s advisable to open up to someone about your OCD, someone you trust, someone who won’t be judgemental. You should explain that you’re not looking for advice or a solution, but an ear to listen, someone who can listen and empathise with what you have been dealing with.
Though speaking with a health professional is essential for treatment, they won’t always be there, which is why it’s ideal to have a loved one who you can turn to. Failing that, there are several free online counseling platforms, where you’re connected with someone who you can talk to, honestly and openly, about anything.
Here are a few:
Journaling and Tracking
We’ve previously discussed the benefit of understanding your condition, and there is no better way to further your understanding than recording your progress. Tracking when and how often you had to perform compulsions or the level of anxiety you experienced during the day, or even the amount of time you spent ruminating on intrusive thoughts can be useful to understanding your cycle of OCD. You’ll be able to notice the patterns and trends in obsessions, where you’re most likely to perform compulsions and what triggers make you most anxious. Having this information at hand will be very useful when it comes to stopping the cycle in its tracks.
At a later date this information can also be used for treatment, for example, recording compulsions could be used as an ERP exercise, where the sufferer will use the compulsions that they are performing on a daily basis as an exposure hierarchy. This is the process of gradually facing triggers without performing compulsions, starting with the least anxiety inducing and working your way up to the most, eventually getting to the stage where you’re able to confront your most threatening trigger without performing a compulsion.
Journaling or expressive writing has been found to have a host of therapeutic benefits, it has been reported to reduce symptoms of anxiety and even boost moods. It’s thought that by confronting our emotions through the medium of writing, we expose ourselves to these negative emotions and create a comprehensive narrative.
Journaling is often associated with teenage girls, starting each entry with “Dear diary,” something that is definitely not for adults. This couldn’t be further from the truth. Purposefully writing about our feelings and thoughts, in an unbiased and non-judgemental approach has many benefits.
However, to ensure that the writing is constructive and not just a dump of words that may reinforce negative ideas, there are a few guidelines to follow. Baikie and Wilhelm, authors of Emotional and Physical Health Benefits of Expressive Writing offer the following advice:
- Write in a distraction free zone.
- Write at least once a day
- Allow yourself time to reflect after writing
- Structure the writing however you feel is right to you
- Keep your journal private: it should be for your eyes only.
Due to the isolation and personal nature of OCD, many sufferers begin to feel alone, to feel as though no one understands them and that no one has experienced what they’re feeling now.
Finding, talking and understanding people out there who are also suffering from OCD can really put your condition into perspective, it can help you see that you aren’t alone, there are others out there that are suffering, managing and living their lives with OCD, just like you are.
Having an environment where you can talk openly about your condition, with people who can empathise and understand is greatly beneficial. However, what is important is to avoid enabling one anothers symptoms, to offer advice which suggests performing compulsions or agreeing that their fears are something worth worrying about. The point of a support group is to create an open and honest space where individuals can share their experiences and feelings, not somewhere to be judged or given treatment.
In you’re interested in finding a support group, here are some great resources:
Physical and mental health go hand in hand, they generally work in conjunction with each other and when one is lacking, the other is sure to suffer.
It’s common for OCD sufferers to see their physical health go to the wayside as the condition becomes their priority. Ironically, ensuring that your physical health stays in order can have a great impact on easing OCD symptoms.
Exercise is a well-known anti-anxiety treatment. The release of endorphins through exercise relieves tension, stress and some of the other symptoms of anxiety. It can also result in better sleep and a boost in energy. We can go on and on about the benefits of exercise, it’s constantly being shouted from the rooftops – exercise is good for you. It’s also important to note, even if you don’t feel like exercising at all, doing something is always better than doing nothing at all.
Another integral factor in your physical health is diet. Studies have shown that a poor diet (with high levels of saturated fat, refined carbohydrates and processed sugars) is linked to poor mental health. Though these studies are inconclusive, the fact is simple, a bad diet = poor physical health, which = poor mental health and exacerbation of existing issues and this case, OCD-like symptoms. A good diet is essential for overall quality of life.
Friends & Family with OCD
Living with or being surrounded by someone with OCD can be a stressful experience. You may not quite understand why they do the things they do, or you may want to help but not sure you can. There are many worries that come with being a loved one of someone suffering with OCD and while you won’t be able to cure them, you can definitely help in many ways.
Understand OCD: Research, don’t judge and be patient
Usually those suffering with OCD don’t have people they can confide in, people who they can share their worries with, usually due to a fear of judgement or simply the person not understanding what they’re going through. If you want to be that person they can turn to, you need to understand OCD.
You should strive to understand OCD as well as you can, read books and articles, case studies, research as much as you can about the condition until you have a deep understanding of what it is and how it works. It’s from here that you can knowingly listen to them about their condition, understand their obsessions and compulsions, with an intelligent stance on the subject.
Your job in this position is just to listen. Do not question or try and make them see reason, you listen, understand and appreciate what they’re going through. Generally, OCD sufferers are aware that their behaviours and worries are irrational, the last thing that they need is to be told that by you. Yes, they may want to hear what you think and they may ask what you think they should do, and it’s here that you should explain that they should potentially seek the advice of a medical professional as you’re not trained, that it would be better to get the guidance from someone who is.
Help Access Treatment
One of the biggest things you could do to help your loved one suffering from OCD is to aid and encourage them to seek out treatment.
Many afflicted with OCD tend to avoid treatment in fear of judgement or worst case scenario, the treatment not working. You should reassure them that following the correct steps of treatment and sticking to it, will help. You can do this by finding them a health professional to talk about their condition, or if they’re not ready to take that step, suggesting the appropriate reading materials for their condition.
You need to encourage all the possibilities of accessing treatment – an ease in symptoms, recovering aspects in their life that have been lost to OCD, having more time to spend on the things that they enjoy. Explain that you’ll be there every step of the way, supporting them.
Once they have started treatment, you’ll want to continue offering them encouragement if you see their motivation start to wane. Remind them of all the progress that they have made, of all the progress they’re going to make, you’d be surprised how powerful the encouragement and support of a loved one can be.
One of the most common mistakes loved ones make is reassurance. A compulsion of OCD is to look for reassurance wherever possible, be it the confirmation that their fears are something they should be worrying about or even something they don’t need to worry about. The safety-seeking can come in many forms and is highly dependent on the type of OCD, it’s important to be aware of when they are looking for reassurance.
Instead of offering the reassurance that they are looking for, try making aware of what they are doing, that they are performing a compulsion, a safety-seeking behaviour.
OCD Related Disorders
Unfortunately, OCD can work in conjunction and even onset other mental conditions. These are known as comorbid conditions. We’ll be going through some of the most common comorbid OCD conditions, for your awareness.
Body dysmorphic disorder is a condition where the sufferer becomes obsessed with a certain part of their body, considering it ugly or disfigured in some way, though to onlookers these flaws are only slightly visible if at all. This disorder causes excessive ritual and compulsive behaviours, such as; checking in the mirror, grooming and styling.
Bipolar disorder is a condition which causes drastic changes in mood, activity and energy levels. Studies have shown that up to 20% of people with Bipolar disorder also suffer from OCD. As they share some very similar symptoms in; mood changes, anxiety and social phobia, it’s fairly logical that OCD can be seen in many of the afflicted.
It’s commonly asked which is better to treat first, and thought cases and conditions will vary, treat the bipolar first and the OCD symptoms may submit. Those suffering with bipolar disorder may have episodes or periods of OCD-like symptoms, which is why it’s often suggested to treat bipolar first.
The word depression is thrown around so often that it wouldn’t be hard to believe that it’s just the feeling of sadness. But it’s so much more than that.
Major depressive disorder is a debilitating condition where sufferers go into a state of sadness where nothing is enjoyable and interest is lost in all things. It’s also normal to see symptoms such as; eating too much or too little, sleeping too much or too little and recurring suicidal thoughts.
Depression is known to appear at the onset of OCD, as the symptoms of OCD can sometimes cause so much distress that depression ensues. Usually there’s an overlap in intrusive thoughts i.e the obsessions. Depression generally causes sufferers to be plagued with negative thoughts of worthlessness and hopelessness, something that is seen in many OCD patients.
Hoarding disorder was once actually considered a form of OCD, though hoarding could still be a compulsion in other forms of OCD, it has become a disorder in of itself. Hoarding is the collecting of various items, usually unnecessary, and storing them in a chaotic manner creating a huge mess. This clutter will get in the way of everyday living, obstructing essential areas of the home such as the kitchen and the bathroom. The sufferer will gain an attachment to all of the items, that they’ll refuse to get rid of them and in even refuse to let someone else borrow them.
There are clear similarities between hoarding disorder and the symptoms of OCD, which is why it’s still widely considered a subtype of OCD. In each the afflicted feels compelled to perform irrational behaviours in fear of what might happen if they don’t. Fortunately, due to the crossover, hoarding is treated very similarly to OCD.
The two most common disorders, anorexia and bulimia, share several similarities with OCD. Anorexia is a mental disorder where the sufferer will severely restrict the amount of food that they are eating and also exercise very often to ensure that they remain under a specific caloric intake. This is usually due to a deep fear of gaining weight or maintaining a specific weight, which is usually far below healthy.
Bulimia ultimately shares the same goal, of losing weight or maintaining a specific weight, it’s the methods of doing so which differ. For those suffering with bulimia, they will eat large amounts of food, known as bingeing, and then try and purge themselves through vomiting, taking laxatives or diuretics, fasting or exercising excessively.
The appearance of OCD in both disorders starts with their thoughts, those afflicted will have constant intrusive thoughts about their image, their weight, how they look, how much they’ve eaten and so on and so forth. It’s from this that compulsive behaviours can start, which can turn into full blown OCD.
Excoriation (skin picking)
Excoriation is a skin picking disorder where the sufferer will constantly and compulsively pick at their skin causing bruises, cuts and bleeding. A lot of the time the sufferer will be picking at their skin without even knowing they are doing so, usually on their face and arms.
Unlike OCD skin picking is more of an impulse control issue as opposed to a compulsive behaviour. OCD is fueled by intrusive thoughts which cause the need to perform compulsive behaviour, however, skin picking is performed to relieve tension and stress.
Trichotillmania is a hair pulling disorder where sufferers feel an intense urge to pull their own hair out. This could be in response to a stressful situation or simply to relieve tension. Most will pull the hair from their head, however, some will even pull their hair from eyebrows, bears and genital region.
Similar skin picking, this is more of an impulse control issue, as it is not a compulsive behaviour to relieve anxiety from intrusive thoughts.