Of all of the anxiety disorders, Obsessive Compulsive Disorder, or OCD, can be the most complicated. Today we’ll be breaking down exactly what OCD is, how it works, and how it can be overcome with the help of a therapist.
What Is OCD?
There are two crucial components to OCD; obsessions, and compulsions. According to psychologists Martin Seif and Sally Winston:
Obsessions…are repetitive thoughts, or images that feel uncontrollable, threatening, repulsive or shocking, that arrive with a “whoosh”, and contain a strong urge to avoid or get rid of the thoughts or images. Obsessions increase anxious distress. The other component is compulsions, which are actions or thoughts whose function is to lower anxiety.
Perhaps the most commonly misunderstood component of OCD are compulsions, which may be, in part, due to tv shows and movies depicting people with OCD. Many people think that compulsions are always actions, such as turning a light switch on and off, or washing one’s hands. However, they are not always necessarily actions. The defining characteristic of compulsions is that they are oriented towards lowering anxiety. As Seif and Winston highlight, “obsessions and compulsions are defined not by their content but by their relationship to each other”.
Types of OCD
OCD can manifest in many different ways and in varying levels of severity. Three of the most common types of OCD include cleaners/avoiders, checkers, and “just right” OCD.
Cleaners and avoiders are those who are concerned about contamination, and may have obsessions and compulsions related to cleanliness, germs and infection or getting sick.
Checkers, on the other hand, are concerned with potentially overlooking something that may result in someone being harmed, or their own embarrassment. An example might be obsessions about leaving the stove on, which they fear could result in a gas leak and explosion, resulting in compulsions to constantly check that the stove is indeed off.
Finally, “just right” OCD involves compulsions related to a need for symmetry, order and evenness. For example, if a person touches one arm, they might need to touch the othen to obtain a sense of “evening it out”. They often feel a sense of discomfort that comes from something being unfinished, uneven or incomplete.
There are, of course, other types of OCD. It’s worth mentioning that OCD can also be confused for other conditions, such as kleptomania (impulsive stealing), compulsive gambling, tic disorders, addictions, and eating disorders. Seeing a therapist can help you to identify whether or not the obsessions and compulsions you experience are classified as OCD or one of these other disorders.
What OCD Feels Like
OCD has a range of accompanying feelings and symptoms which can make it a very complicated condition to deal with. Obsessions and compulsions can often feel intrusive, disrupting day to day life. In some cases, a person’s life can be completely overtaken by the condition as they strive towards a sense of certainty that is never achieved, thereby stuck in an endless loop of feeling anxious and trying to relieve the anxiety.
Checkers are often characterized by a strong sense of responsibility and accompanying guilt, because they are worried about other people and how their actions, or inaction, might harm or kill others.
Cleaners and avoiders can carry a great deal of disgust, which is less about getting sick and more about experiences they consider to be gross or disgusting.
People with OCD can often feel stuck or trapped as they attempt to make a decision based on their compulsions, which at the core is really about asking “which choice will help to lower my anxiety?”
Can OCD Be Cured?
While all anxiety disorders are treatable, working through OCD can be incredibly difficult and requires a great deal of patience and determination. This is partly due to the sometimes complicated and overwhelming rituals that people with OCD have.
The key to managing, and eventually overcoming OCD, is to remember the distinction between obsessions and compulsions. You may recall that obsessions increase anxiety, whereas compulsions are oriented towards decreasing anxiety.
However, the compulsions do not get rid of the anxiety; they are only a temporary balm. Eventually, the anxiety comes back, and left unchecked, it can worsen or transform into other obsessions, and consequently, new compulsions. In this sense, compulsions are a form of avoidance, meaning they only lead to the anxiety being maintained and reinforced.
The ultimate goal of treating OCD is to increase the tolerance for anxiety, while not resorting to the usual compulsions to reduce the anxiety. This is easier said than done. The natural impulse for people with OCD is to do something to relieve themselves when they are feeling anxious. So the work in therapy is to slowly expose someone to more and more anxiety, and then encourage them to sit with the anxiety, rather than doing something about it.
Are OCD Thoughts True?
People with OCD can struggle to discern if their thoughts are real or not. It can be hard to tell the difference between a thought, a feeling, an impulse, and reality itself. This is a common feature for all anxiety disorders; thoughts about something threatening or stressful can seem true, despite only being thoughts.
Part of working through OCD in therapy is being able to recognize that the thoughts someone is having are just thoughts. They aren’t real, and just having those thoughts doesn’t mean they will come true.
In practice, this means being able to be aware of the thoughts that are coming up, and being able to accurately label them as OCD thoughts, despite how real or threatening they might be.
Getting Help For OCD
OCD can be an incredibly debilitating condition, and it’s very important to seek help if you’re struggling with it. Seeing a psychotherapist can help you to work through and overcome your OCD.
Shaun McMahon is a Melbourne based psychotherapist who works with clients struggling with anxiety. He conducts sessions both in person and online, and is currently accepting new clients. If you are interested in seeking support, you can arrange a FREE 15 minute consultation by clicking here.
Source: Seif, M. N., Winston, S. (2014) What Every Therapist Needs To Know About Anxiety Disorders: Key Concepts, Insights and Interventions. Routledge: London.