Obsessive Compulsive Disorder

Obsessive Compulsive Disorder (OCD) is a very misunderstood disorder. Unfortunately, there are still a lot of misconceptions about it.

Written by: Anna Zajaczkowska; 11-09-2024

What is OCD?

Obsessive Compulsive Disorder (OCD) consists of two parts - obsessions and compulsions.

Obsessions are repeated intrusive thoughts, mental images and urges. These are ego-dystonic in nature meaning that they go against a person’s values and are unwanted. Everyone gets intrusive thoughts (and the like) from time to time; people with OCD are more likely to become preoccupied with these. Someone with OCD may worry about these thoughts and their meaning, which causes them to develop an obsession. Sometimes these obsessive thoughts come up randomly, but sometimes they may be triggered by some external event or situation (e.g. seeing or talking about something).

Compulsions are actions or rituals that an individual feels compelled to carry out in order to prevent something bad happening or to reduce anxiety. It is important to note that most people with OCD understand that this is irrational and doesn’t make sense. Unfortunately, the urge to carry out a compulsion is very strong and they would still feel that they need to do something ‘just in case’. Resisting a compulsion for someone with OCD is very hard and can result in extreme anxiety or panic.

People without OCD may also experience obsessions and/or compulsions. The disorder part of OCD comes when these obsessions and compulsions start to interfere in daily life. OCD sufferers may have all areas of their life impacted including social, work and personal. Obsessions bring a large amount of distress into their lives and compulsions can take hours and hours worth of time out of their day.

How do I know if I have OCD?

As mentioned above, you must have both obsessions and compulsions that interfere with daily life for you to have OCD. Despite the common stereotype, OCD is not just about cleaning - obsessions and compulsions can concern virtually anything. There are different subtypes of OCD, however the mechanism behind all is the same - it actually does not matter what the content of the obsessions is (and one person can have more than one obsession). What actually matters is the mechanism behind obsessions and compulsions. This is the main way you can identify an obsession or a compulsion.

Subtypes of OCD and possible obsessions:

(TW: mentions uncomfortable topics including suicide, self-harm, harm, sex)

Contamination OCD - worries about: catching an illness; spreading germs

Emotional Contamination OCD - worries about: becoming contaminated by a thought/emotion/other person; other people or objects or places being in some way contaminated

Relationship/Friendship OCD - worries about: being loyal to partner; whether friend has good intentions

False Memory OCD - worries about: having done bad something that they don’t remember; having said something inappropriate

Religious OCD - worries about: blasphemy; being a good person

Existentialism OCD - worries about: the meaning of life; purpose

Scrupulosity/Moral OCD - worries about: whether they are a good person; whether they will be a good person

Symmetry/Just Right OCD - needing to keep things exactly right - this is a little different from the others because it may not have a clear worry but rather an extreme feeling of uncomfortableness or that something is not right as the driver to the compulsion

Suicidal/Self-harm OCD - worries about: committing suicide; inflicting self-harm (note: this is NOT having the intention to do this/ideation; the thoughts are intrusive)

Harm OCD - worries about: causing harm to other or oneself; worries about harm coming to oneself or others

Pure O - ‘purely obsessional’ OCD - this term is slightly misleading because Pure O does involve compulsions but these are hidden/internal so less noticeable - see ‘Hidden Compulsions’ below.

Checking OCD - worries about: the door being left open; losing something (things you need to check on)

Counting OCD - needing to count things e.g. actions or items in order to feel ‘just right’ (see ‘just right’) or because some numbers are ‘bad’ or ‘good’

Magical Thinking OCD - worries about different things but compulsions surrounding the worry that these thoughts will directly influence reality and cause something bad to happen/make it more probable

Pedophilia OCD - worries about: being a pedophile; causing harm to children

Real Events OCD - worries about: a past event having gone wrong - OCD will shift the event to make it seem more harmful; unpleasant than it actually was

Sexual Orientation OCD - can affect anyone of any sexual orientation - worries about: being in denial about your sexual orientation; hyperawareness about being perceived as a different orientation than they are

Sexual OCD - unwanted intrusive thoughts about sex

Perinatal or Postpartum OCD - worries about: your child being in danger; causing harm to your child

Sensorimotor OCD - hyper awareness of physical sensations such as breathing, blinking, etc, worries about how one is breathing/blinking/heart rate/etc

Some common misconceptions about OCD are:

It is about cleaning and germs only

It is about symmetry and wanting everything neat and perfect

People with OCD enjoy their compulsions

OCD is a character quirk

Hidden Compulsions

Some compulsions are more visible, while others are less. This does not make any difference to their nature. The important thing is the role they serve in the mechanism of OCD, which is the same regardless of obsession and compulsion (see below). Some compulsions that are more difficult to notice are listed below:

Rumination - excessive overthinking about something: this is a compulsion because it brings short term anxiety relief.

Blinking

Internal counting

Neutralisation - thinking a ‘good’ thought after having a ‘bad’ thought

Googling things - similar to rumination

Reassurance including self-reassurance or arguing with the OCD

Reviewing memories

The mechanism

Disclaimer: Writer is not a medical professional or scientist but the explanation below has been checked by a person with lived experience.

A more scientific decription will be added later

It is important to note that compulsions only give short term relief which is why they are not helpful. Essentially, they drive the OCD cycle. This is because engaging in compulsions reinforces the connection between obsession and compulsion. Compulsions reinforce the thought that the obsessive thoughts are a threat (a misidentification). This makes the cycle stronger and harder to break. Compulsions become stronger and develop - for example more are needed or different ‘stronger’ ones are made. Any external triggers for the obsessions (e.g. seeing something) may also develop and increase in number. The outcome is an increase in severity of the OCD.

Treatment

Disclaimer: Writer is not a medical professional and therefore cannot recommend the following.

The following is simply a collection of common forms of treatment for OCDs

Usually, OCD is treated with therapy - CBT with ERP. ERP is a therapy that deals in Exposure Response Prevention and has so far proved to be the most effective form of therapy for treating OCD. During recovery, an individual with OCD may still have some obsessions and compulsions occasionally but may no longer qualify the criteria for having OCD.

Some people may also find medication (SSRIs) to be helpful. However, it is important to note that this is not a cure and does not make OCD go away. It may reduce the intensity of the obsessions and compulsions.

Comorbidities

OCD is often comorbid with anxiety, depression, ADHD, Autism, BFRBs, BDD and Hoarding disorder.

Support

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