Obsessive-Compulsive Disorder (OCD) is stereotypically associated with cleaning, ordering and being overly concerned with hygiene and neatness. People often describe themselves or others as ‘a bit OCD’ in response to being particular about things, but there’s much more to it than this. OCD isn’t something you have a ‘bit of’ – it’s a clinically diagnosable anxiety disorder that can be incredibly debilitating.
OCD involves obsessive thoughts that cause anxiety and compulsive actions that are taken in an attempt to get rid of the anxiety. Purdon and Clark, the authors of Overcoming Obsessive Thoughts, highlight that, “The CBT model of OCD begins with the assertion that everyone has unwanted intrusive thoughts. It is likely that the thoughts, images, or impulses that are relevant to your most important goals and sense of identity are the ones most likely to grab your attention.” In OCD, it is these very thoughts that cause the distress.
Obsessions in Obsessive-Compulsive Disorder
An obsession may be a thought, image or urge that is unwanted. They are often described as intrusive which means that they occur unintentionally, rather being thoughts that we actively think of. Obsessions can cause you to feel distressing emotions such as anxiety, shame and disgust, depending on their nature.
Intrusive thoughts are those that pop up into our mind. We all have them but with OCD, these thoughts go against the individual’s core values, are interpreted as important and meaningful and so cause extreme distress. For example, a person who values being kind and considerate may experience an intrusive thought about pushing a cyclist off their bike and interpret this to mean that they must want to do this are therefore a bad and dangerous individual. This would then trigger distress and a compulsive reaction to get rid of the distress.
Compulsions in Obsessive-Compulsive Disorder
A compulsion is an action taken to get rid of anxiety. This may be a visible behaviour such as washing in response to thoughts about contamination, checking sockets in response to images of a house fire, or avoiding parks in response to concern about impulsively pushing over a cyclist. Often there is a rational understanding that these actions aren’t truly necessary but the fear of not doing them ‘just in case’ they are necessary makes it incredibly difficult to not act on the urges.
OCD can be very distressing due to the lack of control felt about the intrusive nature of obsessions and the strong and often seemingly unbreakable urges to act on the compulsions. Some people may feel too embarrassed, afraid or ashamed to talk about their obsessions. However, OCD usually requires treatment in order for improvements to be made.
Treatment for OCD
The recommended and most effective treatment for OCD is Cognitive Behavioural Therapy (CBT) with the use of Exposure Response Prevention (ERP). Medication can also be used alongside this. Treatment in therapy focuses first on building an understanding of your experience of OCD, your current coping strategies and the factors maintaining your symptoms. The focus then moves on to systematic exposure to the intrusions and obsessions and preventing the compulsive response to these. The aim is to break the connection between obsessions and compulsions and help you build your tolerance to the distress caused by the obsessions to point where it is either manageable, or no longer a source of distress. This is done in a graded and supportive way to ensure you are outside of your comfort zone but still within your window of tolerance. An experienced therapist will work at your pace and regular review progress with you.
If you relate to the information in this blog and would like support with OCD, get in touch to find out more about starting CBT.