What is Obsessive Compulsive Disorder?
When people think of Obsessive Compulsive Disorder or OCD they often think of someone who washes their hands until they are red raw and of houses so clean and tidy they don’t look lived in. However, while contamination obsessions and cleaning compulsions are one subtype of OCD, there are a wide variety of different forms a person’s OCD can take. The form an individual’s OCD takes can centre on their values and what is most important to them but can also shift over time depending on the phase of life and particular concerns they are facing at the time.
At the core of this condition there is a preoccupation with the need to get rid of the sense of doubt and uncertainty related to an intrusive thought (an obsession). This is why it is also known as the ‘doubting disease’. What’s common across the different subtypes is the experience of obsessions, which are intrusive upsetting thoughts, and compulsions, which are the strategies that people use to try to cope with the obsessions.
Obsessive-compulsive disorder (OCD) is a mental health condition characterized by intrusive what-if type thoughts (or images or movies) and repetitive behaviours that individuals feel compelled to perform. To meet diagnostic criteria for OCD (according to the DSM-5) the symptoms also have to be causing significant distress or impairment in functioning.
More specifically…
Obsessions are the repetitive intrusive thoughts, images or urges people experience popping into their heads randomly or in response to a trigger. While everyone tends to experience random intrusive thoughts at times for the person with OCD their obsessive thoughts are more frequent, stickier and distressing. Intrusive thoughts can trigger feelings including anxiety, discomfort, disgust or guilt. Common examples include worries about harm coming to oneself or a loved one (eg. What if I have an urge to jump off the cliff), having doubts about a relationship, doubts about not having done something correctly, or not having switched something off.
Compulsions are the repetitive behaviours, strategies and rituals which people engage in order to get rid of the obsessive thoughts and reduce their sense of uncertainty and the uncomfortable feelings that go along with this. Compulsions can be external or internal and mental . Examples of external compulsions include checking and re-checking doors are locked, washing hands, asking others for reassurance, or repeatedly doing an action over and over until it feels right.
The OCD Cycle
Compulsions are the problem in OCD, but of course its not that easy to just stop them or you would likely have done that already. Engaging in compulsions can provide a (temporary) sense of relief. At other times there may be no sense of relief but people still feel compelled to do the compulsion as not doing it feels even worse and too big of a risk.
Over the long term engaging in compulsions keeps the problem going and keeps sufferers stuck in the vicious cycle of OCD. The more people struggle with and try to get rid of their obsessive thoughts the stickier these thoughts tend to become. This is because the more we react to a thought, treat it as threatening and struggle with it the more powerful it tends to get and the more likely it will reoccur. Over time people often find the urges to perform compulsions increases over time with compulsions often becoming longer and more elaborate.
Avoidance behaviours can also play a role in contributing to the OCD cycle. These are the ways people may try to avoid potential triggers for intrusive thoughts such as avoiding situations, places or stimuli that could trigger them such as certain tv shows or taking on extra responsibilities. While providing some relief in the short-term, over the long-term avoidance further reinforces the sense of threat associated with the intrusive thoughts.
Mental Compulsions
Mental compulsions are the things people do in their heads in an attempt to reduce their anxiety and distress about the obsessive thought/image. These type of compulsions can be overlooked in treatment as they go unseen. They are often habitual thinking patterns that people engage in sometimes without even realising it.
Rumination-focused ERP is a variant of ERP which focuses on helping clients to identify, catch and stop these mental compulsions along with any type of engagement with the obsessive thought
Examples of mental compulsions:
Trying to figure something out or solve a problem
Mentally reviewing/checking past events
Counting, praying, or other mental rituals to suppress intrusive thoughts
Pushing thoughts away
Monitoring body sensations or anxiety level
Directing attention towards particular parts of the body (which then creates sensations there, such as the groinal response sensation)
