Almost everyone has at some time repeatedly hummed a song that was stuck in his or her head or experienced doubt about having locked the front door. Perhaps you have been suddenly struck by the potential number of germs on an escalator handrail or avoided walking where someone just sneezed. However, you simply go on with your day, forgetting about these obsession-like thoughts.
However, someone with OCD experiences obsessions throughout the day and continues to experience anxiety concerning unwanted thoughts, images, or impulses regardless of reassurance.
Obsessions are recurrent, intrusive, unwanted thoughts, images, or impulses. Obsessions can cause considerable anxiety, even to the point of experiencing a Panic Attack.
Some of the more common obsessions are:
• Doubting (e.g., locks, turning off appliances, accuracy of a task),
• Nonsensical thoughts/images (e.g., repeating numbers, letters, phrases),
• Nonsensical impulses (e.g., shouting profanities, undressing in public),
• Aggressive (e.g., dropping a baby, running over a pedestrian, causing an accident, harming or killing someone),
• Accidental harm (e.g., poisoning the family meal),
• Sexual (e.g., obscene thoughts, images, or impulses),
• Horrific images (e.g., mangled or dead bodies),
• Religious or moral (doubting salvation, blasphemous thoughts, fear of shouting blasphemies, excessive guilt),
• Contamination (e.g., germs, bacteria, illness).
The person continues to experience obsessions despite attempts to ignore, suppress, or neutralize them with another thought or action. For example, someone may continue to fear having left a door unlocked or appliance on even after checking it numerous times. Many people with OCD experience excessive guilt regarding thoughts, images, and impulses that they experience, especially sexual or violent obsessions. However, people with these types of obsessions are usually the least likely to actually carry out such actions. Yet, this type of reassurance does very little to decrease anxiety long term.
Obsessions do not represent excessive worries about real-life concerns which is more representative of Generalized Anxiety Disorder. If the recurrent thoughts and images consist of previously experienced traumatic events a diagnosis of Post Traumatic Stress Disorder may be more appropriate. Obsessions are not delusions because the person is able to recognize that the obsessional thoughts, impulses, or images are a product of the own mind as opposed to believing that they are reasonable.
Compulsions are repetitive behaviors or mental acts that are believed to neutralize an obsession or alleviate anxiety. Some compulsions are merely actions performed according to a set of rigidly applied rules.
Some of the more common compulsions are:
• Checking (e.g., locks, appliances, driving routes, papers),
• Counting (e.g., certain letters or numbers, words, objects, bars in a song),
• Internal repetition (e.g., phrases, words, prayers),
• Hoarding (e.g., newspapers, garbage, trivial non-sentimental items),
• Washing (e.g., excessive hand washing or showering, over-using antibacterial soap),
• Rules or sequences (e.g., symmetry, behavioral rituals or routines).
Although clearly performed to an excessive degree, some compulsions are directly connected to obsessions, such as repeated hand washing in response to fear of contamination or repeatedly checking a lock in response to doubts about having locked the door.
Other compulsions, though seemingly not logically connected to the obsession, serve the same neutralizing function of preventing or reducing distress or preventing some dreaded event or situation. The classic example from childhood is avoiding stepping on cracks in the sidewalk in order to save our poor mothers’ backs.
Occasionally, compulsions are not connected to obsessions, but are simply performed according to a set of rules because the person finds them psychologically soothing in some way. Also, some people experience a Pure Obsessional form of OCD in which they do not perform compulsions in response to obsessions. However, sometimes a connection between the obsession and compulsion only comes to light during the course of treatment.
Obsessions and compulsions often take up a considerable amount of mental energy and time, especially when compulsions take the form of a complex routine of behaviors or when the person has to repeatedly redo their compulsion if it is not performed "correctly" the first time.
Except among children, the person recognizes that the obsessions and compulsions are excessive or unreasonable. OCD usually causes the person a great deal of distress and is time consuming. Performing compulsions can take up more than an hour a day or significantly interfere with the person's life in some other way, such as his or her occupation, schooling, usual social activities, or relationships. People with OCD appear to be at increased risk for experiencing depression, partially due to the debilitating nature of OCD resulting in isolation and hopelessness.
The most effective treatment for OCD appears to be a form of Cognitive Behavior Therapy (CBT) that teaches the person to experience obsessions without carrying out compulsions. This technique is called Exposure Response Prevention (ERP). There are also CBT techniques that are helpful for people who experience obsessions without compulsions or compulsions without obsessions. Some people with more severe OCD have been shown to fair better with a combination of medication and CBT. Newer techniques of mindfulness and acceptance are also often included.