Obsessive Compulsive Disorder (OCD) is an anxiety disorder characterized by obsessions and compulsions which cause the person with the disorder great distress. The obsessions and compulsions can take up an hour or more of the person’s day.
Obsessions are unwanted, intrusive, recurring thoughts that feel outside of a person’s control. In most cases these thoughts are disturbing and don’t always make sense. They may bring up feelings of disgust, doubt, shame or fear. These obsessions interfere with everyday life making it difficult to get “out of your head”.
Compulsions are repetitive thoughts, behaviors or rituals a person uses in an attempt to get rid of the anxiety or stress caused by their obsessions. Even though a person may feel the rituals don’t make sense, they feel compelled to do them to relieve their anxiety and possibly prevent something bad from happening. In the long run, although compulsions seem to temporarily reduce anxiety, they are actually reinforcing the obsessive-compulsive cycle.
Common Types of OCD subtypes:
Contamination and Washing/Cleaning
Obsessions about Causing Harm and Checking
Symmetry, Ordering, and Arranging
Mental Ritualizing without Overt Compulsions
Common Obsessions in OCD
Fear of contamination from bodily fluids or germs/diseases
Fear of acting on an impulse to harm oneself or to harm others
Fear of being responsible for something terrible happening or hurting someone else because of not being careful enough
Concern about exactness
Difficulty with deciding whether or not keep or throw items away
Forbidden or perverse sexual thoughts
Obsessions about homosexuality
Concern with right/wrong thing or morality
Concern with offending God
Common Compulsions in OCD
Washing hands excessively or in a certain way
Excessive showering or grooming routines
Checking to make sure you did not harm self/others
Checking to make sure nothing bad happened
Repeating body movements (tapping, touching) or activities in multiples (doing something a certain number of times)
Repeating routine activities
Mental review of events to prevent harm
Praying to prevent harm
Avoiding situations that may trigger you
The most effective evidence based treatment for OCD is a type of Cognitive Behavior Therapy called Exposure Response/Ritual Prevention (EX/RP or ERP). The goal of treatment is to reduce the anxiety brought on by the obsessions to the point that the compulsions are no longer needed. EX/RP consists of psycho-education about OCD and doing exposures related to the person’s obsessions while NOT doing the compulsions. This is done in an attempt to break the obsessive-compulsive cycle to decrease the distressing, anxiety provoking feelings which in turn will reduce the urge to do compulsions.
Treatment is recommended for 17-20 sessions that are 90 minutes each occurring weekly or biweekly. Both in vivo and imaginal exposures can occur during the session, homework consisting of additional exposure exercises will be provided to be done at home.