Obsessive Compulsive Disorder

Obsessive-compulsive disorder (OCD) is a common mental health disorder where a person experiences uninvited and unwanted recurring thoughts or images (“obsessions”) and behaviors (“compulsions”). Obsessive thoughts trigger distressing feelings and compulsions are behaviors an individual engages in repeatedly to get rid of an obsession and/or decrease distress. 

Many people experience obsessive thoughts or compulsive behaviors at some point. For someone to be diagnosed with OCD, the cycle of obsessions and compulsions has to consume a lot of time, cause significant distress, or get in the way of important activities. Obsessive thoughts can lead to feelings such as anxiety, doubt, disgust, or the feeling that things must be done in a particular way to prevent a catastrophe. When someone does not have OCD, they may experience a distressing thought, feel momentarily upset, and then move on. With OCD, obsessive thoughts come frequently and trigger high levels of anxiety that get in the way of day-to-day functioning. 

Similarly, people with OCD feel compelled to engage in compulsive behaviors as a way to neutralize or get rid of the obsessive thought and would rather not have to do these behaviors. These behaviors are not done for pleasure or based on general preference. Rather, a person with OCD feels they are necessary to prevent some type of negative consequence or decrease anxiety or the presence of obsessions. 

Common obsessions include:

• Fear of germs or contamination

• Unwanted thoughts that feel forbidden such as thoughts related to sex, harm, or religion

• Thoughts related to difficulty tolerating uncertainty

• Aggressive-type thoughts related to oneself or others

• Thoughts related to things needing to be symmetrical or in perfect order

Common compulsions include:

• Excessive cleaning and/or hand-washing

• Ordering/arranging things in a particular and precise way

• Repeatedly checking on things such as checking that the door is locked or the stove is turned off

• Compulsive counting

• Requesting constant reassurance from others

This brief video from the American Psychiatric Association provides general information on OCD. 

Two common beliefs in those with OCD are:

• Exaggerated sense of responsibility: Belief that you are responsible for preventing harm to yourself, loved ones, and others

• Overestimation of threat: Belief that things are riskier than they are

People with OCD believe what they are worried about, their obsessive thought, is very likely to happen and their sense of responsibility means they must act to prevent it. So, these two beliefs can create an unhelpful cycle of obsessions and compulsions. 

Cognitive behavior therapy (CBT) is very effective at treating OCD. More specifically, a type of CBT called Exposure and Response Prevention (ERP) is one of the most effective treatments for OCD. ERP involves exposure to or confronting, the thoughts, images, or situations that cause anxiety and provoke obsessive thoughts, and response prevention, or choosing to not engage in a compulsive behavior once anxiety is triggered. 

In general, a person with OCD feels anxiety because they view the obsessive thought, image, or situation as a threat, and by exposing yourself to this anxiety, and not engaging in compulsions, you teach your brain that a threat does not actually exist. In other words, by being in a fearful situation without anything bad happening, you learn that your anxiety alarm is misfiring, a threat is not actually present, and your thoughts are just thoughts. You also learn that you can cope with anxiety and distress without relying on compulsive behaviors and anxiety decreases over time. 

If you are interested in learning more about therapy for OCD, please contact us at CBTDenver.