Understanding Obsessive Compulsive Disorder (OCD)

People with OCD experience-anxiety provoking thoughts that are intrusive, distressing and unwanted that they can’t get rid of (obsessions). In an attempt to manage obsessive thoughts, and reduce their anxiety about their thoughts, people often engage in repetitive rituals (compulsions) which they acknowledge are excessive and unreasonable. An example may be someone washing their hands repeatedly and excessively to manage fears of contamination or illness. However, often the ritualised behaviours can begin to take over people’s lives.

The reason why people persist in engaging in compulsions is because they have not learned to respond to their anxious thoughts in ways that are workable. Like all other anxiety disorders, people are simply being pushed around by their mind’s thoughts, and this activates their brain’s threat system. In addition, for people with OCD, they have also incorrectly ‘linked’ up in their minds that certain behaviours are functioning to keep them safe, because performing them causes a temporary relief in their anxious thoughts and feelings.

This is actually a seductive trap. It results in a self-reinforcing feedback-loop between the anxious obsession and the behavioural compulsion, because people mistakenly deduce through a process of ’emotional reasoning’ that the behaviours they are engaging in are actually doing something to keep them safe – because they ‘feel’ less anxious after performing the compulsion. This becomes a very powerful reinforcer, and the OCD continues. 

What is needed is a combination of skills that draw upon Mindfulness, self-regulation, and reality-testing, combined with a thorough understanding of the brain’s emotion regulation systems. With such an understanding, these skills will facilitate engaging in Exposure therapy, which is an individually tailored way to perform reality-testing and to learn through experience that the compulsions do not actually serve their assumed function. This new learning can upgrade and replace old unquestioned habitual ways of responding to what your mind is doing and can set you free again.

Understanding Obsessions (vs Compulsions)

Obsessions are intrusive, unwanted thoughts, images, or urges usually about negative or catastrophic events or outcomes. Obsessions are typically accompanied by intense and uncomfortable feelings such as anxiety, fear, shame, disgust, doubt, or a feeling that things have to be done in a way that is ‘just right’, or something ‘bad’ might happen… 

Compulsions are repetitive behaviors or mental acts performed to reduce the distress caused by obsessions or to prevent a feared outcome. In short, obsessions create anxiety, and compulsions are attempts to relieve it.

Common obsessions:

 Contamination

• Environmental contaminants (e.g., chemicals, asbestos, radiation)
• Body fluids (examples: urine / faeces)
• Germs/disease, or Dirt

Obsessions Related to Perfectionism

• Concern about evenness / exactness
• Concern with a ‘need to know’ or remember
• Inability to decide whether to keep / discard things
• Fear of losing / forgetting important information when throwing something out
• Fear of losing things
• Obsessions about sexuality
• Forbidden / perverse sexual thoughts / images / impulses
• Religious Obsessions (Scrupulosity)
• Concern with offending God (blasphemy)
• Excessive concern with right/wrong or morality

Losing Control

• Fear of acting on an impulse (e.g., to harm oneself / others)
• Fear of violent or horrific images in one’s mind
• Fear of stealing things
• Fear of blurting out obscenities or insults

Harm

• Fear of being responsible for something terrible happening
• Fear of harming others because of not being careful enough

Moral Scrupulosity

• Obsessive concern about being immoral, unethical, or having committed a wrongdoing—even when there’s little or no evidence—often leading to excessive confessing, seeking reassurance, or avoiding situations where one might act “improperly.”

Other Obsessions

• Preoccupation with getting a specific disease (e.g. cancer)
• Superstitious ideas (e.g., lucky/unlucky numbers; certain colours)

Understanding Compulsions

Compulsions are performed to relieve the anxiety and worry that accompanies obsessions, or to prevent a feared outcome, such as illness. Compulsions are distressing and time consuming, and can interfere with day to day routines and living.

Washing & Cleaning

• Washing hands / body in a certain way
• Doing things to prevent contact with germs / contaminants

Checking

• That you did something in a certain way / did not make a mistake
• That you did not harm others / yourself

Mental Compulsions

• Reviewing events to prevent negative consequences / harm
• Praying to prevent harm
• Counting to end on a ‘good’ or ‘right’ number

Repeating

• Activities (in / out of doors a certain number of times)
• Sequences of body movements (e.g., touching, tapping or blinking)
• Words (e.g., rereading, rewriting, or avoiding certain words / combinations of letters)
• ‘Multiples’ (e.g., doing something ‘3 times’ because it is ‘safe’)

Others

• Hoarding, saving or collecting compulsions
• Avoiding situations that might trigger your obsessions
• Ordering or rearranging things until it ‘feels right’
• Confessing, to receive reassurance

Compulsive Behaviors Similar to OCD

Trichotillomania is a body-focused repetitive behavior characterized by recurrent, irresistible urges to pull out hair from the scalp, eyebrows, eyelashes, or other areas, leading to noticeable hair loss. While distinct from OCD, it shares features such as difficulty resisting urges and is often triggered by stress or negative emotions. Individuals may experience shame, low self-esteem, and social withdrawal.