Obsessive Compulsive Disorder (OCD)

What is Obsessive Compulsive Disorder (OCD)?

Obsessive Compulsive Disorder (OCD) is a mental health condition characterized by persistent, unwanted thoughts, urges, or images (obsessions) that cause significant distress and anxiety. People with OCD often try to reduce their distress through repetitive behaviors, mental acts, and avoidance (compulsions).

While most people experience intrusive thoughts occasionally, those with OCD can't easily dismiss or control these thoughts. The obsessions and compulsions disrupt daily life and can become extremely time-consuming.

Common Obsessions in OCD:

Fear of contamination from dirt, germs, or harmful substances

Disturbing thoughts about violence, harm, or blasphemy

Excessive need for order, symmetry, or exactness

Intrusive thoughts about sex, relationships or being unfaithful

Common Compulsions in OCD:

Excessive hand washing, bathing, or cleaning

Ordering or arranging things in a specific way

Mentally reviewing facts

Counting, tapping, twitching repeatedly, repeating words silently, or seeking reassurance

Counting, tapping, twitching repeatedly, repeating words silently, or seeking reassurance

Who Is Affected By OCD?

Millions of people are affected by OCD. Current estimates are that approximately 1 in 40 adults in the U.S. (about 2.3% of the population) and 1 in 100 children have this condition.

Types of OCD

Contamination OCD is one of the most widely recognized forms of OCD and is often what people think of when they hear about OCD. This subtype involves intense, irrational fears of being contaminated by dirt, germs, viruses, or other harmful substances. These fears can extend to various sources of contamination, including physical objects, bodily fluids, and even abstract concepts like moral or spiritual contamination.

Obsessions:

  • Fear of Dirt and Germs
  • Fear of Sticky Residues, Grease, or Oil
  • Fear of contracting a disease or illness
  • Fear of Wearing Clothes that May Have Contaminants
  • Fears of Spreading Contaminants
  • Fears that Certain People are Contaminated

Common Compulsions:

  • Bleaching surfaces multiple times daily
  • Engaging in extreme hygiene behaviors following bowel movements
  • Showering and handwashing excessively
  • Throwing away anything thought to be contaminated
  • Smelling and frequently checking foods
  • Not allowing loved ones to go places that are associated with being “unclean”

These intrusive doubts and compulsive behaviors around relationships can cause significant distress for those with OCD. The doubts feel very real, while the compulsions are an attempt to ease the doubts, albeit temporarily. Breaking this cyclical pattern is part of OCD treatment.

Relationship OCD (rOCD) is a subtype of Obsessive-Compulsive Disorder characterized by intrusive thoughts, fears, and doubts specifically focused on one's intimate or romantic relationships. People with rOCD often experience intense anxiety about their relationship and their feelings toward their partner. These doubts and fears can be distressing and disruptive, affecting both the individual and their relationship.

Harm OCD involves persistent, intrusive thoughts of intentionally causing violence or injury to oneself or others. While having the occasional intrusive violent thought is not uncommon, those with Harm OCD become extremely distressed and preoccupied by these thoughts. They have an intense fear that they may act on the violent urges, despite having no desire or intent to do so.

Obsessions:

    • Obsessively seeking reassurance that they won't act on violent thoughts
      Avoiding anything that could potentially cause harm like knives, guns, or cars
    • Repeatedly reviewing past actions and interactions to ensure no one was harmed
    • Excessive rumination, checking, and mental review to prevent potential violent acts

Common Compulsions:

    • Providing themselves with reassurance
    • Asking others for reassurance
    • Mental reviewing the past to ensure they haven't acted in a harmful way
    • Avoiding situations, objects or people
    • Avoiding media that contains themes of harm or suicide
    • Isolation or constant companions to avoid being alone

Sexual Orientation OCD causes a person to doubt their own sexual orientation. These doubts can be particularly unsettling for individuals who have always identified with a specific sexual orientation, such as heterosexuality. The uncertainty and anxiety stemming from these intrusive thoughts can lead to significant emotional turmoil.

Obsessions:

  • Constant doubts about whether you are denying or mistaken about your authentic sexual orientation
  • Excessive fears that your sexual identity will spontaneously shift, disrupting relationships
  • Obsessive worries that others will make incorrect assumptions about your sexuality based on mannerisms or behaviors

Common Compulsions: 

  • Repeatedly seeking reassurance about your sexual orientation from partners, friends or online
  • Compulsively reviewing fantasies, attractions or porn to scrutinize your sexual arousal patterns
  • Intentionally avoiding situations, people or environments that could trigger obsessive doubts

Pedophilia OCD involves persistent, intrusive thoughts and fears of being sexually attracted to children, despite having no actual pedophilic desires. It is distinctly different from pedophilic disorder, which is a condition characterized by an actual sexual interest in prepubescent children.

With pedophilia OCD, the obsessive, ego-dystonic thoughts create intense anxiety and an individual engages in compulsive behaviors in an attempt to neutralize the fears, reassure themselves, or prevent potential harm - despite having no intention to act on the thoughts.

Obsessions:

  • Constant doubts and fears of unconsciously harboring pedophilic urges
  • Disturbing, unwanted mental images or thoughts about sexualizing children
  • Obsessive worries of potentially acting on these thoughts without remembering

Common Compulsions: 

  • Compulsively reviewing past interactions with children for any ill intent
  • Avoidance of children or situations that could trigger the obsessive thoughts
  • Seeking excessive reassurance from others about not being a pedophile
  • Mental rituals or excessive reviewing to counteract the unwanted thoughts

Postpartum OCD occurs directly after childbirth while Perinatal OCD occurs while the individual is pregnant. This form of OCD is unwanted thoughts or mental images about potential harm coming to their child.

Obsessions:

  • Obsessions involving the fear of harm coming to the unborn or newborn infant.
  • Not wanting to tell others about obsessions for fear of being diagnosed with psychosis or being hospitalized.
  • Needing to have a partner or helper nearby because of obsessional fear
  • Trouble sleeping because of obsessions and compulsive urges.
  • Interference with taking care of the child or other child because of obsessions.

Common Compulsions:

  • Fear that you might harm the baby even when you don’t really want to.
  • Compulsions are meant to control or stop the obsessional thoughts, or to prevent fears from coming true (e.g., checking on the baby, excessive washing, repeating prayers, or requests for assurances).
  • Avoiding certain activities with the baby (e.g., bathing, using stairs, holding, diaper changing).

Scrupulosity, this form of OCD, centers on religious, moral, or ethical concerns. Individuals experience excessive worry and guilt about violating a religion or ethical code. It can cause doubt that what they thought or did might be a sin or go against their spiritual faith.

Obsessions

  • Fears about sinful and dishonest
  • Fears of inadequacy in their faith or not adhering to religious standards
  • Fear of committing blasphemy or offending God
  • Doubting your salvation, if it happened
  • Excessive fear that loved ones about going to hell

Common Compulsions:

  • Writing prayers to check they're done “correctly”
  • Excessive confession.
  • Repeatedly seeking reassurance from religious leaders and loved ones.
  • Repeated cleansing and purifying rituals.
  • Ruminating about past mistakes, errors, or possible sinful behavior

Treatment Approaches For OCD

OCD is a treatable condition, and even severe cases can be effectively managed with the right professional care. Mental health experts utilize a combination of psychotherapy and medication to help individuals gain control over their obsessive thoughts and compulsive behaviors.

Psychotherapy

Specific forms of psychotherapy have proven highly effective for OCD. The most widely used approaches include: Cognitive Behavioral Therapy (CBT), Exposure & Response Prevention (ERP), & Inference-based Cognitive Behavioral Therapy (I-CBT).

Cognitive Behavioral Therapy (CBT)

Engaging in Cognitive Behavioral Therapy stands out as an highly effective approach for gaining control over the persistent and intrusive symptoms. CBT equips individuals with powerful coping strategies to keep anxiety in check throughout their lives. A core component is an emphasis on mindfulness-based techniques.

Through CBT, one learns to identify and challenge the irrational, catastrophic thinking patterns that fuels excessive anxiety. Distorted thoughts are systematically restructured into more balanced, reasonable perspectives grounded in reality. CBT also cultivates mindfulness skills to tolerate uncomfortable anxiety sensations without fueling them through avoidance or distress.

Exposure Therapy

Exposure Therapy is a form of behavioral therapy that focuses on altering one's response to anxiety-provoking situations by gradually confronting them instead of avoiding them. For example, someone with a fear of public speaking might start by imagining themselves giving a speech, and then gradually progress to delivering speeches in real life. Initially, they might believe that they would be unable to handle the experience or that they would embarrass themselves. However, through the process of exposure therapy, they are likely to develop the belief that embarrassment is less likely or that they can manage it even if it occurs. Exposure Therapy is effective in treating various anxiety disorders.

Inference-based Cognitive Behavior Therapy (I-CBT)

Inference-Based Cognitive Behavioral Therapy (I-CBT) is an evidence-based treatment, demonstrating its effectiveness in treating OCD on par with Exposure and Response Prevention (ERP). I-CBT aims to resolve obsessional doubts by helping clients understand that these doubts differ fundamentally from normal doubts.
I-CBT empowers clients to trust themselves and their perceptions, steering them away from the OCD narrative. This approach does not rely on exposure techniques.