Skip to main content

Obsessive-Compulsive Disorder

Book a Session for OCD

OCD or obsessive-compulsive disorder may be one of the more recognizable mental health conditions, yet it is still severely misunderstood by the general public. The typical view of someone with OCD is someone who is overly concerned with cleanliness and order, which from the outside, can make them seem rigid and particular. But the reality is that Obsessive-compulsive disorder is a severe mental health condition that can cause a tremendous amount of pain and anxiety in the person experiencing it. OCD can also have many different subtypes, which I will explore later on, but first let’s take a look at the symptoms of OCD:

These symptoms come directly from the DSM-V:

A. Presence of obsessions, compulsions, or both:

Obsessions are defined by:

  1. Recurrent and persistent thoughts, urges, or images that are intrusive and unwanted, and that typically cause marked anxiety or distress.
  2. The individual attempts to ignore, suppress, or neutralize these thoughts, urges, or images (e.g., by performing a compulsion).

Compulsions are defined by:

  1. Repetitive behaviors (e.g., handwashing, checking) or mental acts (e.g., praying, counting, repeating words silently) that the individual feels driven to perform in response to an obsession or according to rules that must be applied rigidly.
  2. The behaviors or mental acts are aimed at preventing or reducing anxiety or distress, or preventing some dreaded event or situation. However, these behaviors or mental acts are not connected in a realistic way to what they are designed to prevent, or they are clearly excessive.

B. Time-consuming or impairing:

The obsessions or compulsions are time-consuming (e.g., take more than 1 hour per day) or cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

As you can see, there is no specific reference to orderliness or cleanliness, that is because there is a wide variety of forms of OCD. Understanding these different forms may offer some relief to you, as many people who suffer with OCD don’t realize they are actually suffering with it and instead believe the thoughts they are struggling with are the cause of some sort of moral failing. Let’s take a look at some of these subtypes.

1. Contamination and Cleaning

  • Obsessions: Fear of germs, dirt, or contamination (Ex: bodily fluids, dirty countertops, or someone coughing near you). This can be a feeling of disgust or a fear that you will get sick (or cause someone else to get sick).
  • Compulsions: Excessive washing, cleaning, or avoiding situations perceived as "dirty" (e.g., public restrooms, shaking hands).
  • Common triggers: Public spaces, bathrooms, subways, other people, etc.

2. Checking

  • Obsessions: Fear of causing harm to oneself or others due forget fulness (Ex: leaving doors unlocked or stove on).
  • Compulsions: Repeatedly checking locks, appliances, or other items to ensure safety.
  • Examples: Checking the front door lock dozens of times before leaving the house.

3. Harm

  • Obsessions: Fear of unintentionally harming self or others (Ex: what if I pick up this knife and stab someone? What if I jump in front of this train?) – Keep in mind these intrusive thoughts are different from suicidal or homicidal thoughts. With harm OCD, you DON’T WANT to act on it, you are just afraid your body might impulsively act. This causes tremendous stress and anxiety.
  • Compulsions: Avoiding subways or driving, locking away utensils, keeping distance from others.
  • Common triggers: Utensils, cars, subways, or anything that can potentially be dangerous.

4. Relationship OCD

  • Obsessions: Doubts and fears about the quality or authenticity of one's relationship (Ex: Do I really love my partner?, "Is my partner right for me?)
  • Compulsions: Seeking reassurance from the partner, comparing the relationship to others, or analyzing feelings excessively.
  • Common triggers: Romantic conflicts, reminders of past partners, imagining ideal partners.

5. Perfectionism

  • Obsessions: Fear of making mistakes, not meeting specific standards, or disappointing oneself or others.
  • Compulsions: Rechecking work, rewriting emails or texts, seeking reassurance on performance, delying decision making
  • Triggers: Receiving criticism at work, someone expressing disappointment in you.

6. Religious/Moral OCD

  • Obsessions: Fear of sinning, fear of hell, fear of punishment (or for non-religious – fear of doing the right thing, fear of harming others, fear of disappointing others).
  • Compulsions: Obsessive praying, seeking forgiveness, seeking reassurance from others.
  • Triggers: Church, religious symbols, disappointing someone

7. Sexual OCD

  • Obsession: Fear of intrusive sexual thoughts that don’t align with your sexual identity
  • Compulsions: Checking your body for signs of arousal, avoiding people, avoiding dating, avoiding images that remind you of the fear
  • Triggers: People, bodily sensation, images

8. “Just Right” OCD

  • Obsession: Feeling that behaviors or processes are not “right.” (Ex: Feeling the way you pushed a button felt wrong, feeling your clothes do not fit “just right”). This form is less specific as there is often not an identifiable fear, but instead a “feeling” that something is off.
  • Compulsions: Redoing tasks until they feel correct
  • Triggers: Triggers for this OCD tend to be internal and are based on a feeling.

As you can see, there is a wide range of different forms of OCD, and this list certainly does not encapsulate all of them. You may struggle with something not on this list or struggle with multiple forms. The thread that connects all of them however are intrusive obsessive thoughts, that are followed by compulsive actions or thoughts, that are intended to relieve the stress of the though. The problem is that the more we act out our compulsions, the more frequent and intense our obsessions become. This forms an obsessive-avoidant loop that is very difficult to escape. So, how do we treat OCD?

Treating OCD

The first line of defense against OCD is simply acknowledging that OCD operates outside of yourself. By this I mean that you do not choose your thoughts. As the saying goes, you cannot think a thought before you think it. Intrusive thoughts are simply neurons that are firing off in your brain without your permission. Therefore, rather than over-identifying with them and taking them too seriously, we can see our thoughts as merely words on a projection screen. We are merely witnessing our thoughts scroll across the screen. In this sense, we can take the power away from them. The thoughts you see in your mind need to have no more power than the words you see on a sign or in a book. They are just words. They do not need to carry any more meaning than that.

This is a nice start, but will probably not rid you of the terrifying fear accompanied with it. So how do we tackle the fear? This is where Exposure and Response Prevention (or ERP) comes in.

What is ERP?

ERP is a method of identifying and neutralizing obsessions by exposing ourselves to the fears behind the thoughts and preventing ourselves from engaging in our compulsions. In a sense, you will be doing the exact opposite of everything your mind and body want to do when you are confronted with these terrifying thoughts and situations. Let me give you an example:

Let’s say you have a form of contamination OCD. You may get intrusive thoughts about getting sick when around filth. These thoughts cause you to engage in compulsions which may include excessively washing your hands, avoiding touching dirty things, wearing gloves, etc. With our use of ERP, we will begin to identify when we resist these thoughts and engage in these behaviors and try to flip them on their head. When faced with a thought, “if I touch this I could get sick, so I better not touch it,” we will learn to embrace the thought and respond with “that’s true, I could get sick, but that is a risk I am willing to take.” Instead of resisting the thought and trying to make it “untrue,” we will accept it and lean into the fear. This may seem scary at first, but with practice it becomes easier. Our next step will be to slowly begin to engage in some anxiety inducing behaviors. Instead of washing your hands for 2 minutes, we will reduce it to 20 seconds. When you begin to get more comfortable with that, we will reduce it to 5 seconds with no soap. Eventually we will begin to start intentionally touching dirty things and not washing your hands for hours.

I realize the idea of doing this sounds very scary, but we will do it at your pace. We take our time and gradually expose you to more and more uncomfortable things. This may seem counter-intuitive, and in a sense, it is. But the reality is that the more we run from our fears, the bigger the fear inevitably becomes. As we begin to step into uncertainty and resist our compulsive behaviors, we slowly become less and less reliant on them. We learn to face uncertainty and fear head on, and eventually find freedom through acceptance of what is out of our control.

As I have mentioned in other areas of this website, I am not a psychiatrist, and so I cannot provide medication treatment for Obsessive-Compulsive Disorder. That being said, there are effective medication options for OCD. I can work alongside your provider to assist in your current treatment plan, or help you find a psychiatrist who specializes in treating OCD.