As the name suggests, Obsessive Compulsive Disorder is an anxiety disorder characterized by the presence of obsessions and compulsions. Obsessions are intrusive, often disturbing thoughts or images that are difficult to get rid of and cause a lot of anxiety. Compulsions are behaviors or rituals that a person performs to temporarily reduce the anxiety caused by the obsessions.
The exact content of obsessions and compulsions can vary by person, but there are some common clusters:
Contamination: Individuals with contamination fears have obsessive thoughts that germs or other contaminants may cause them to become sick or die. They perform compulsions like hand-washing, showering, sterilizing their environment, or cleaning their house to an excessive degree.
Checking: These individuals have obsessive thoughts that something important has not been done. For instance, they may worry that they did not turn off the stove, turn off a light, or lock the door. The compulsion is to check over and over that it has been done.
Symmetry/Order: These individuals feel anxiety if something is not in its right place, or not the same on both sides. For example, people with symmetry obsessions may tie and retie their shoes over and over until it “feels right” on both sides, or they may spend hours arranging things in their homes.
Hoarding: Individuals with hoarding obsessions feel a great deal of anxiety about throwing anything away because they worry that they will need it again some day. They may have homes that are overcrowded with papers or other items they collect and can not throw away.
Repeating/Counting: These individuals have obsessive thoughts that they need to repeat something a certain number of times to prevent something bad from happening. Repeating often includes mental rituals, such as repeating a word in one’s mind a certain number of times. A person may also have counting compulsions, such as counting tiles on the floor out loud or in one’s head.
Religious: Individuals with religious obsessions may have obsessive thoughts about or images of Satan, hell, or other religious figures and symbols. They may worry that they must pray or perform other compulsions to prevent something evil from happening.
Sexual/Aggressive: These individuals have intrusive thoughts or images of a sexual nature or about harming themselves or someone else. They may feel guilt and anxiety over the content of these thoughts and perform compulsions to alleviate the anxiety.
How is OCD treated?
A specific type of CBT called Exposure and Response Prevention (ERP) has been developed to treat OCD. This treatment targets both obsessions and compulsions. During exposure, the therapist helps the client to face feared situations head-on and to better tolerate and reduce the anxiety associated with obsessive thoughts. In response prevention, the therapist and client identify and eliminate compulsions that are done to reduce anxiety. The goal is to replace the compulsions with more effective ways of coping with stress and anxiety. Cognitive Therapy is also helpful in addressing beliefs that exacerbate OCD such as thought/action fusion (“I thought about doing something terrible, that means I am going to do it”) and over responsibility (“I have to make sure there are no dangers in the road otherwise people will die because of me”). Also beliefs that interfere with engaging in ERP (“it will make things worse”) can be addressed and evaluated.
Treatment involves confronting feared situations with the help of the therapist in session, and homework assignments in which clients develop and practice the skills needed to overcome OCD on their own. ERP is typically done gradually, starting with situations that the client considers less stressful and working up to the most feared situations. Research has shown that ERP is a highly effective treatment for OCD.