- The Cohen Clinic
OCD - Get Out of My Head!
What is OCD? OCD is made up of obsessions, compulsions, or both. Obsessions are recurrent and persistent thoughts, urges or images that are intrusive and unwanted. Compulsions are repetitive behaviours or mental acts (i.e. praying, counting, repeating words silently) that one feels driven to perform in response to an obsession. These acts are intended to reduce anxiety and distress.
What are common types of intrusive thoughts or compulsive behaviours? There are so many unique variations of intrusive thoughts, but there are some common categories:
Organization, Order and Symmetry – i.e. organizing and labeling
Germs and Contamination – i.e. washing and rewashing hands or body, fear that your clothes, towels or sheets are contaminated, fear that things you buy are contaminated, or fear of raw meat
Sin, Religion or Morality – i.e. using prayer compulsively or asking for forgiveness repeatedly
Superstitious – Thinking if you do a behaviour or engage in a thought then an unrelated thing will happen. i.e. If I read this paragraph 3 times over no harm will come to my family.
Aggressive or Sexual – Fear that you would lash out or act inappropriately sexual with someone, despite not having a desire to do so.
Checking – Repeatedly worrying you have not done something. i.e. turned off stoves, locked doors, or closed garage doors.
How do people experience OCD? We all experience random disturbing thoughts. However, some people experience frequent unwanted thoughts that trigger intense anxiety or discomfort. It can be about anything, but one commonality is it triggers feelings of distress as the nature of the thought is inconsistent with one’s values. The person then tries to distract themselves to avoid the thought, tries to explore and analyze the thought, or does things to make the thought go away or at least quiet them down even if just for a moment. When most people think of OCD, they think of excessive handwashing or repeatedly checking the stove was turned off, but many people do not realize these behaviours are a result of an intense worry. Some examples: “What if I forgot to turn the stove off and I burn the house down?” or excessively washing their hands due to worry of contamination which would make others sick or cause them to die. It’s the intrusive unwanted thought that compels us to avoid situations or do certain things behaviourally or in our minds.
Why won’t the thoughts go away? Because we give them attention and explore their potential truth. People with OCD are often very rational and recognize their thoughts are irrational, but somehow in the moment they seem possible because “what if?” Every time we rationalize with or behave in a way that is congruent with the thought, it ultimately strengthens the anxiety and reinforces the unwanted thought. This creates a vicious cycle of first experiencing an unwanted thought, then feeling anxiety or discomfort, and then doing something to lower or eliminate the anxiety. This provides temporary relief until the thought pops again, and the never-ending cycle continues. Additionally, the things we do to alleviate the anxiety take up valuable time, and often also trigger feelings of shame, guilt and loneliness.
An example of the feedback loop: you worry about contamination, then rationalize how your hands may actually be contaminated, then engage in hand washing, then feel temporary relief until the contamination thought comes up again. This leads to excessive handwashing because you are continually managing your anxiety by engaging in this behaviour.
How is OCD treated? Intrusive thoughts can be quite debilitating and negatively impact one’s quality of life. It can also feel very isolating. The first thing to realize is that no matter what the content of the thought is, it’s just a thought and needs to be treated as such. It was a random thought that your brain took off with, and if you think back, you can most likely notice that over the years, the content of the intrusive thoughts may have changed. Therefore, if it’s just a thought then we need to acknowledge it but not engage with it, or do anything to alleviate the anxiety, which will pass eventually on its own. Easier said then done, right? Definitely. Overcoming intrusive thoughts is difficult work, but it can be done and it’s possible for the thoughts not to continue to take over your life. Exposure and Response Prevention (ERP) is a therapeutic approach utilized to treat OCD and works by gradually exposing one to the feared thoughts and situations and preventing the compulsion in response to the anxious thought. ERP works by helping you develop tolerance and sense of mastery over the intrusive thought and anxiety so that we begin to treat the unwanted thoughts as just thoughts. If unwanted thoughts are taking over your life, it might be time to reach out to a qualified therapist and begin the work on reclaiming your mind and life!