Obsessive Compulsive Disorder, or OCD, is comprised of two distinct, problematic aspects – Obsessions & Compulsions. Obsessions are unwanted, repetitive & irrationally based thoughts, ideas, mental images & impulses that feel outside of the individual’s control & cause great anxiety, distress, shame & embarrassment. Their unrelenting nature severely impacts daily functioning, often disrupting an individual’s career or school performance, romantic, family & peer relationships, & their ability to engage in typical life activities.
While Obsessions can vary greatly, they tend to fall into one of these categories –
- Contamination OCD – Fears of contamination &/or feelings of extreme discomfort when exposed to a “contaminated” environment, thing or person.
- Doubt & Rumination OCD – The predominant feature of this type of OCD involves experiencing recurring doubt-based thoughts relating to the performance of a specific action or behavior. An individual suffering with this form of obsessive thinking can be plagued by a wide variety of worries that they feel unable to turn off or let go of such as the need to check door locks or that the stove was turned off. These thoughts can also be more intense, like the unrelenting feeling that the speed bump or noise they heard while driving was a person or animal, or even a fear that they have somehow given out secure personal information, like a bank or credit card number.
- Symmetry & Organizational OCD – An inability to not think about or focus on things in one’s environment that are either not symmetrical arranged, aligned, organized, or placed in just the right way.
- Sexual Orientation OCD – Obsessions that cause the individual to question his/her sexual identity.
- Scrupulosity –A n irrational preoccupation with thoughts & fears of committing sinful acts or sacrilege.
- Sexual & Harm Based OCD – These types of thoughts are typically seen in what is referred to as “Pure O”, when the individual has more severe obsessive thoughts without compulsions & the “urge to act”. Of all the types of OCD, these are considered the most distressing & shameful. These thoughts serve to upset the individual so severely, not only due to their content, but because they are completely out of line with the person’s true character & intentions.
By contrast, Compulsions are behaviors, acts or mental attempts to rid oneself of the anxiety & discomfort caused by the Obsession. Some Compulsions are straightforward, while others involve a series of nonsensical steps or acts that the individual feels compelled to engage in to prevent some negative thing from occurring. This includes behaviors such as:
- Washing & cleaning of one’s hands, body, clothing, or environment or performing some ritual to dispose of the contamination or being forced to avoid something that is associated with contamination, including family & friends
- Engaging in time consuming, irrational cleaning of the genitals, buttocks, or other body parts in response to using the toilet & belief that one is contaminated by urine or feces
- Engaging in repeatedly rechecking appliances, locks, or other behaviors in an attempt to rid self of fear & doubt
- Repeatedly reorganizing, rearranging, or moving items that are not symmetrically pleasing
- Need to perform nonsensical rituals involving specific rules or guidelines, i.e.- engaging in a behavior a determined number of times or until it just feels right, tapping, counting or carrying out a sequence of actions in a very specialized manner out of fear that not doing so could result in harm befalling loved one
- Performing mentally or physically repetitive acts
- Seeking frequent reassurance from a loved one or friend to lessen the discomfort caused by an obsession
- Mentally replaying statements, saying specific words or even being compelled to pray to ease discomfort & provide reassurance
OCD operates according to the Obsessive-Compulsive Cycle. Obsessions produce discomfort & anxiety; Wanting to relieve those emotions, the individual engages in a compulsion. Unfortunately, engaging in the compulsive act never fully dispels the anxiety. It is like scratching a mosquito bite – The urge to scratch is so great & is based on the hope that doing so will alleviate the itch. But anyone who has ever had OCD (or a bug bite) knows that the scratch only serves to make the itch even more intense. This is how the OCD Cycle plays out; the person continues to engage in compulsions more & more frequently in an ineffective attempt to alleviate the anxiety caused by the obsessions. Over time, OCD grows stronger or morphs into new obsessions & compulsions, invading more aspects of your life.
Most new clients contact my office feeling scared & embarrassed, believing that they alone are afflicted with these intrusive, & often unsettling, thoughts, feelings & behaviors . However, a conservative estimate is that in the U.S. alone, nearly 1 in 40 adults & 1 in 100 children have Obsessive-Compulsive Disorder. Many people first show symptoms in childhood or early adolescence, with 19 being the average age of diagnosis. It is among the top 20 causes of illness worldwide for people between the ages of 15-44. While OCD isn’t curable, with the correct treatment, obsessions & compulsions can be targeted so effectively, most individuals can live happy, healthy & productive lives with greatly reduced or virtually no symptoms at all.
Every organization that is knowledgeable about OCD [iv], conclusively agrees that the most effective form of treatment involves the use of Cognitive Behavioral Therapy with ERP, or Exposure & Response Prevention Therapy. ERP teaches the individual to face the anxiety & discomfort that occurs during an obsession & learn to avoid engaging in any of the compulsive acts that essentially keep the cycle going. During an exposure, we begin to see that an individual’s anxiety does lessen; over time, we are able to sequentially target more complex aspects, with the same positive impact. Yes, this treatment is challenging, however, as an experienced & knowledgeable therapist, Jenifer understands how to effectively structure this therapy, integrate other CBT modalities into use & offer the correct amount of empathy & distance to encourage you to become independent. It is also the undisputed gold standard for empowering individuals to learn to fight & eventually keep their OCD at bay. For clients that require the additional support of medication management to treat their OCD, Jenifer is happy to work with their physician or psychiatrist as a team in your treatment.
If you, or someone you care about, is struggling with any of the issues listed above, please feel free to call, email, or use the convenient “Contact Me” link located on every page to reach out to me. I speak with all potential clients on the telephone before the initial appointment, to ensure we are the right fit for one another. I look forward to the opportunity to help you begin to Live Your Life Fearlessly!
[i] http://beyondocd.org-facts Citing study conducted by World Health Organization
[ii] https://www.nimh.nih.org (National Institute of Mental Health/National Institute of Health
[iii] https://www.adaa.org (Anxiety & Depression Association of America
[iv] https://www.apa.org (American Psychological Association)
[v] https://www.iocdf.org (International OCD Foundation)