OCD (obsessive compulsive disorder) is characterized by presence of obsessions (intrusive unwanted thoughts that get stuck in our mind) and compulsions (repetitive, often ritualized behaviours that we engage in in order to make ourselves feel better). OCD can present in a variety of forms. In pure “O” the affected individual is plagued with unwanted, often morally repulsive thoughts that make them doubt their ability to control their own actions. Others spend hours their lives adjusting minute details in order to reach an elusive sense of “just right feeling” and yet have very hard time explaining what they believe would have happened if the mugs in the cupboard faced in a different direction. It is as if persons with OCD do a lot of things “just in case” something bad happens and they want to be sure that they have done their due diligence. Of course, the more we take unnecessary protective actions, the more we believe such actions are necessary and the less we are able to persuade ourselves otherwise.  

 

International OCD Foundation offers detailed descriptions of many shapes that OCD can take. Here, let’s just spend some time discussing obsessions and compulsions. In everyday speech obsession means something that we are extremely preoccupied with, like someone who is “obsessed” with video games or someone who in their mind is uncapable of letting go of their former lover or past wrongs. The implication here is that obsessions take a deep root inside of us and become almost impossible to dislodge. That much is also true of obsessions as experienced in OCD. In OCD, obsessions produce fear. Imagine being bombarded with frightening images of your loved ones dying in a car crash, you losing control and assaulting the very people that you care about or being plagued with questions that rip apart your sense of morality as in “what if I am a pedophile?” Keep in mind that those questions and images represent the worse fears and not the desires of the person who is experiencing them. Criminals do not worry at night about a possibility of committing a crime or harming others, they do it and often develop elaborate plans on how to do it. A person with OCD starts developing elaborate plans on how to stop those things from happening. They might avoid using knifes at dinners, refuse to go out or pray way in excess to what is usual hoping not to be become people that they dread becoming.

 

An average person who has no OCD and no criminal tendencies might also experience unwanted thoughts, but such person is able to shrug them away as annoying vagaries of our minds. Research has shown that more than 75% persons without OCD experience unwanted intrusive thoughts as identified on Obsessive Compulsive Inventory (Purdon and Clark, 1999; Belloch, Morillo, Lucero, Cabedo, and Carrió, 2004). Persons with OCD believe that the very fact of having such thoughts is indicative of something dreadful.  

There three kinds of assumptions about intrusions that make the whole thing much more painful than it has to be. First, people who have unwanted intrusions related to losing control, committing acts of violence or suicide believe that such thoughts reflect who their deepest desires. Yet if that were true, should these thoughts be embraced instead of creating fear and self-disgust? Second, people believe that they have imagined something, it is likely to happen. As we go about our lives, we plan in our heads and our plans might acquire vivid details. You might have imagined going on a vacation to Italy, Singapore or hiding in your own backyard for well deserved rest and relaxation. Chances are that it is how you are going to spend your holidays. However, let’s be honest, no matter how vivid our imagination, that trip to Singapore or Italy might not happen. On the other hand, we might have spent time pacing the kitchen floor imagining the worse car pile up possible because our significant other is late only to have them show at the door, confused by how worked up we might have become. Thoughts are mental events. Just because something happens in our minds, it does not mean that the same thing is true of the physical world that we inhabit. Finally, some people get focussed on achieving “purity of thought”. Misguided by this idea, such individuals scan the recesses of their minds for thoughts and ideas that should be banished. Yet the more you search, the more you find. The more you try to erase a thought out of your mind, the more your mind points the flashlight on the painful thoughts because the very attempt at blocking a thought places it in the spotlight. Just try very hard not to think of a green apple…

 

Compulsions are behaviours that people engage in in order to ensure to reassure ourselves that our world is “just right”. One person might drive in circles to reassure herself that she has not killed a pedestrian without noticing it, another will engage in mental undoing or neutralizing like counting to a 100 and apologizing each time they notice an unwanted intrusion. Some people have a very strong urge to seek clarity and reassurance. I have seen many persons who would ask the same question several times in a row to ensure that they understood the answer and some who interrupt me mid-sentence in order to ask the question I am in the process of answering. Others cannot stop themselves from searching for a walled that they are holding in their hands because they have just imagined that the wallet has been left at a mall. Someone else might develop a belief that disturbing the sequence of tasks that they need to complete to clean the kitchen will bring disaster to their family and get stuck in an ever-repeating loop. There are at least three types of compulsions in OCD: (1) unnecessary safety behaviours that OCD sufferers engage in to protect self and others from perceived consequences of their intrusions; (2) repetitive behaviours that get associated with magical thinking (e.g., “If I fail wash the faucet at the public washroom 7 times, someone will get infected by my germs and I will be responsible for their death”) and (3) sequences behaviours that when interrupted create a profound sense of wrongness and/or urge for repetition until the “just right” feeling is achieved but are not associated with specific thoughts.

 

From CBT perspective we start by building an inventory of obsessions and compulsions that are being experienced. We work to understand and challenge unhelpful beliefs associated with obsessions and compulsions (cognitive interventions). We put our clients in situations that trigger the urge to engage in compulsions but have them refrain from engaging in these behaviours while learning that despite undeniable discomfort, nothing bad happens as a result of not engaging in their typical rituals (exposure-response prevention).

 

Some good self-help books to help you deal with OCD include:

 

The Mindfulness Workbook for OCD: A Guide to Overcoming Obsessions and Compulsions Using Mindfulness and Cognitive Behavioural Therapy by John Hershfield and Tom Corboy.

 

Overcoming Harm OCD: Mindfulness and CBT Tools for Coping with Unwanted Violent Thoughts by John Hershfield and Jonathan Grayson.

 

Break Free from OCD: Overcoming Obsessive Compulsive Disorder with CBT by Paul Salkovskis.

 

Overcoming Obsessive Compulsive Disorder: A self-help guide using cognitive behavioural techniques by David Veale and Rob Wilson. 

 

Overcoming Obsessive Thoughts: How to Gain Control of Your OCD by D. Clark and C. Purdon

 

​References:

Belloch, A., Morillo, C., Lucero, M., Cabedo, E., & Carrió, C. (2004). Intrusive thoughts in nonclinical subjects: The role of frequency and unpleasantness on appraisal ratings and control strategies. Clinical Psychology and Psychotherapy, 11, 100-110.

 

Purdon, C., & Clark, D.A. (1993). Obsessive intrusive thoughts in nonclinical subjects. Part I. Content and relation with depressive, anxious and obsessional symptoms. Behaviour Research and Therapy, 31, 713-72