What is OCD?

What is obsessive-compulsive disorder, and how do I know if I have it?

OCD is an anxiety disorder with two parts: intrusive thoughts (obsessions), and compulsive behaviors (rituals). It can be a difficult and highly disruptive disorder, and it impacts 2-3 million people in the US each year. In this post, we will explain what obsessions and compulsions are, and what type of help is available for this challenging disorder.

What is an obsession?

Obsessions are unwanted thoughts, images, feelings, ideas, or urges that cause distress. They are called ‘intrusive thoughts’ because they can occur at any time and are, by definition, unpleasant and unwanted. Because the thought is so distressing, people will actively worry and “obsess” about the potential consequences of this intrusive thought. For example, an intrusive thought could be, “Was that bump I just drove over actually a person? Did I just hit someone with my car? Am I a murderer? Will I be arrested? Did I just ruin my entire life?”

The thought process from above can continue anywhere from minutes to hours. Sometimes people can ruminate about these intrusive thoughts for days. OCD can be like a dog with a bone - once it starts chewing on an idea, it’s not going to let go until it’s ready. At this point, after an intrusive thought has occurred and caused significant distress, compulsive behaviors will begin.

What is a compulsion or ritual?

Compulsions/rituals are terms that can be used interchangeably to refer to the behaviors someone performs to reduce anxiety and prevent negative consequences from occurring.

In our driving example above (a common type of OCD called ‘hit-and-run OCD’), the idea that the driver accidentally ran a person over feels so upsetting that they will perform a compulsion/ritual to reduce their distress and ensure that no one was harmed. This could look like circling the block to check the road for bodies or examining the outside of the car for evidence (or the lack thereof) of a collision.

Sometimes compulsions have to be repeated numerous times before the person feels reassured and their anxiety decreases. This can lead to prolonged periods of compulsive behavior - sometimes lasting hours - in which a person feels “stuck” performing the ritual repeatedly until their OCD is satisfied.

Obsessions and compulsions do not always appear to make sense.

Sometimes intrusive thoughts and accompanying compulsions seem logical - like washing your hands after touching something ‘contaminated.’ But OCD is an irrational type of anxiety, and thus the obsessions and compulsions don’t always appear to make sense together. For instance, someone could have intrusive thoughts that, unless they tap the counter 3 times, their family member will die in a car crash. Obviously, tapping a counter has no impact on whether someone gets into a car wreck. But when you have OCD, the intrusive thoughts can feel urgent and overwhelming despite their apparent irrationality.

What are the most common types of OCD?

OCD thoughts and compulsions can technically be about anything, but there are some common subtypes or themes that frequently occur. Common themes for obsessions include:

• Harm or violence happening toward oneself or others.

• Committing acts of violence towards oneself or others.

• Contamination (people, places, or objects being unclean/dirty/toxic).

• Hitting people, animals, or objects with a car while driving.

• Debating one’s sexual orientation.

• Relationship issues (obsessing about one’s feelings in a relationship, their partner’s feelings toward them, or the concept of cheating).

• Sexually violent or disturbing ideas/thoughts/images.

Common themes for compulsions/rituals include:

• Checking behaviors, such as checking that a door is locked or a curling iron is turned off.

• Reassurance seeking by googling for information or asking people for reassurance.

• Repeating behaviors/tasks until they “feel right.”

• Cleaning, washing hands, or avoiding unclean objects.

• Counting certain objects or counting until reaching a specific number.

• Reciting certain phrases, words, or prayers.

What causes OCD?

The exact cause is unknown, but OCD is thought to be caused by a combination of genetic and environmental factors. We do know that OCD can run in families and that you are more likely to develop OCD if an immediate family member also has OCD. Environmental factors that can impact the development of OCD include stress, exposure to trauma, and even certain bacterial illnesses in childhood.

What is PANDAS?

PANDAS stands for pediatric autoimmune neuropsychiatric disorders. It is a phenomenon in which children develop tic or OCD behaviors after contracting certain bacterial illnesses, such as strep throat. Symptoms of this syndrome often have a rapid onset, with a child developing OCD behaviors seemingly overnight. Other symptoms can include:

• Bedwetting in previously potty-trained children.

• Anxiety and depression.

• Personality changes.

• Difficulty sleeping.

• Difficulty eating or sudden aversions to foods.

• Irritability or defiant behavior.

PANDAS is treated through a combination of therapy, psychiatric medications for mood management, and full treatment of the bacterial infection that precipitated the syndrome. PANDAS symptoms often improve significantly, and can even disappear entirely, with the proper treatment of the bacterial infection.

How is OCD treated?

The gold standard for OCD treatment is exposure and response prevention, or ERP. While this approach may seem intimidating, it is a highly effective and well-tolerated treatment when administered by an experienced OCD therapist. The goal of ERP is to experience OCD triggers and allow the anxiety to reduce on its own, rather than by engaging in a compulsive behavior. Someone with contamination OCD may touch a light switch and then allow themselves to adjust to the feeling of anxiety rather than wash their hands. This creates a new learning opportunity in which the brain can realize, “Maybe I don’t have to wash my hands to feel better.” After repeating this exposure several times, the brain will finally realize that lightswitches are safe to touch, and do not need to cause feelings of anxiety.

Do you want to learn more about getting therapy for OCD?

Check out our page about therapy for OCD here. Or you can message us to get a free consultation for therapy by following this link.