For a diagnosis of Obsessive-Compulsive Disorder, the person has to have both obsessions and compulsions, and these must cause a certain amount of distress in their daily lives. Obsessions are all the unwanted thoughts and images in your head, and compulsions are what you do to help ease the pain experienced by the thoughts.
What is OCD?
OCD stands for Obsessive-Compulsive Disorder and consists of having both obsessions and compulsions that affect your quality of life.
What are obsessions?
A key element of Obsessive-Compulsive Disorder is having obsessions. Obsessions are all the anxiety-provoking thoughts and images that pop into your head. In OCD, these obsessions often are contrary to who you are as a person and the values you live your life by.
Some examples of obsessions that occur within OCD are
- thinking you could harm someone or yourself
- you saying something unthinkable out loud in Church
- Fearing that you did not clean something correctly and may make yourself or the people you love ill.
A simple way to tell obsessive thoughts from other thoughts is that it is tough to dismiss them, as they frighten, disturb or disgust you so much.
What are compulsions?
Compulsions are the things you do to help you cope and can include;
- repeating or counting
- reassurance seeking
A compulsive behaviour within OCD differs from other behaviours you have, as you have to carry out these compulsions. They are hard to resist.
The following video taken from my online course for OCD explains some obsessions and compulsions.
Types of OCD
I find it easier to break this down into
- People who check
- People who hoard
- People who worry about contamination and germs
OCD and Checking
- Door, windows, locks
- Emails – were they sent properly or checking that they are perfect before you send them.
- Turning off cookers, curling tongs, electrical appliance
- Sending loads of texts to make sure someone is okay, that they got home okay, that they are alright with you
- The route (thoroughly) before you travel
Obsessions and Compulsions concerning doing something wrong – e.g. did I send that email to the right person?
If you don’t have this, you probably hit ‘send’ without doing a basic spell-check. If you always worried that you might do something wrong, emailing is a long and challenging thing.
The obsession might start with something simple like “have I got the email address right”, and behind this thought is a fear of not wanting to do something wrong or a fear of making mistakes.
The fear that you might get the email address wrong will lead you to carry out a compulsion – check the email address, but if only your compulsions were that short! You might also have to carry out the following if you have a fear of making a mistake;
- checking the email address many times
- proofreading the email many times
- not sending it after you have done the above, as you may have missed something
- Once you send the email, the anxiety can start, and you have to go into your ‘sent items’ and start checking again.
OCD and Hoarding
This is what it sounds like – you can’t get rid of anything. You keep everything just in case you need it, and it is too anxiety-provoking to consider getting rid of anything. The anxiety spike is so intense that it is just easier to keep everything, even though it is making your life difficult.
OCD and Contamination – OCD and Cleaning
If you have contamination OCD, somewhere in the back of your head (and it could be there and you don’t know it yet) is a fear of harming yourself or other people.
Because OCD and cleaning have been the subject of many television programs, it looks like the cleaning became the focal point instead of the actual fear and anxiety behind it.
If I had this, and somewhere in my mind, I thought I could inadvertently harm people I care about or myself through germs, yes, it is better to clean, just in case it is true.
The contamination fear can cause cleaning,
- Yourself – before you get in the shower, cleaning your products before and after you use them, cleaning the shower before you get out, and if you touch something or it doesn’t feel right, you start again.
- Objects or surfaces around you.
You may avoid many public places or crowds because of fear of contamination. It can be challenging to use the loo outside your own home, and many people don’t. You may not touch many things you have not made sure are clean and probably carry disinfectant gel with you.
The cleaning, especially of yourself, can be challenging, as your skin can hurt and burn.
Obsessions and compulsions concerning cleaning
If you have this, you might have come across contamination OCD, I am not big into labels, so I shall explain how this works.
Let’s say you were about to prepare dinner, and you had the thought, “is my kitchen counter clean?” This is the obsession.
More often than not, what is behind this obsession is a fear that you could cause harm to either yourself or others. You, not cleaning something correctly, could, for example, result in the spread of germs and make someone you care about ill, or worse.
This thought you could make someone ill will cause you to carry out your compulsion – the cleaning as you will not risk harming someone you care about.
Intrusive Thoughts – Pure O
Many people see this as only having obsessions without compulsions, but I often find that the compulsions are there if you look hard enough.
Typical intrusive thoughts are concerns relating to your sexuality, relationship, faith, and concerns that you could cause harm to yourself and other people.
The recommended treatment for OCD is Cognitive Behavioural Therapy – CBT, using Exposure Response Prevention – ERP. This page discusses all reputable models of therapy used to treat OCD to make an informed decision on what will work best for you.
Self-help and Treatment for OCD
Cognitive Behavioural Therapy for OCD
CBT is the traditional treatment for OCD as recommended by NICE guidance and comprises
Looking at your thoughts -and the meaning you place on your thoughts. For example, you probably take personal responsibility for having the thoughts first and think they must mean something about you as a person.
CBT will help you break this down and help to rational your thoughts.
It also has what we call a behavioural component. You are taught how to change your behaviours; with OCD, this would guide you to reduce and eventually eliminate your compulsions.
Acceptance and Commitment Therapy – ACT for OCD
At its most basic level, Acceptance and Commitment Therapy – ACT teaches you to accept your thought for what it is (just mental activity in your head) and commit to doing something else, i.e. not a compulsion.
This is such an essential part of recovering from OCD. As I have already stated, the compulsions you carry out only help short term, but long term, they keep your OCD going.
Exposure Response Prevention (ERP) for OCD
ERP should be carried out as part of Cognitive Behavioural Therapy, and sort of like acceptance and commitment therapy. The aim is to expose you to your thought without carrying out your compulsion.
Self Help for OCD
If you would like my help, I have an online course to help you with OCD that contains all my materials and information that you would get if you saw me in person.
See Also HSE