OCD / Obsessions and Compulsions

Hand washing

Obsessions, or persistent, unwanted thoughts, can often lead to repeated, irrational behaviors, known as compulsions. For example, some people with diagnosable obsessive compulsive disorder (OCD) feel they must wash their hands hundreds of time each day, or count to ten every time they enter or leave a room, check the locks on their doors a certain number of times every night, or engage in any number of behaviors that have no real purpose other than to manage the anxiety felt when the person does not give in to these impulses.

When obsessions and compulsions interfere with functioning, the support of a therapist or mental health professional may be helpful in the management of symptoms.

Examples of Obsessive-Compulsive Behaviors

Obsessive-compulsive behaviors are repetitive and ritualistic actions that are motivated by intrusive and compelling thoughts. Some of the behaviors that are characteristic of OCD can include:

  • Hand washing or sanitizing
  • Tapping
  • Checking and rechecking door locks
  • Feet wiping
  • Counting before performing actions, such as opening or knocking on a door
  • Collecting
  • Hoarding
  • Organizing and arranging things

OCD is a way of coping with extreme anxiety, and people who struggle with OCD feel their behaviors help them maintain a sense of control. These behaviors can be so extreme that they interfere with daily life. The rituals of OCD can damage careers, impair daily functioning, and put immense stress on interpersonal relationships.

Sensorimotor Obsessions

Sensorimotor obsessions, also known as body-focused obsessions, are often symptoms of OCD. People who experience these behaviors find themselves unable to shift their attention away from the obsessive or compulsive thought or action. They feel as if they are stuck on a particular act, such as focusing on their blinking, breathing, or swallowing. The acute level of awareness of these otherwise involuntary bodily functions can create a cycle that is often debilitating and overwhelming. Not only do people with sensorimotor obsessions become fixated on these actions, but they tend to overanalyze them as well, concentrating on every minute detail of their speech, breath, or eye contact between blinks.

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These obsessions can cause people to become consumed with the details of their every movement, and many times, mental and verbal rituals accompany the cognitive process. People who experience sensorimotor obsessions may count the number of times they blink or over-emphasize positive thoughts while they are obsessing about their heart rate in an attempt to control their pulse. These behaviors can cause frustration and often lead to increased stress, anxiety, and a decreased ability to function, causing the person to feel even more out of control and unable to shift their awareness away from their obsessions.

Sensorimotor obsession is a form of OCD and can be effectively treated with exposure and response prevention (ERP). This technique addresses the obsession and the ritual so that the person in treatment reduces their anxiety and their behavior simultaneously. The process of ERP involves setting a realistic goal, identifying the triggers that cause the anxiety, and confronting the triggers one at a time until they can be managed without rituals or obsessive behaviors.

Pure Obsessional OCD

Pure O, as pure obsessional OCD is also known as, is a form of OCD in which compulsions typically consist of mental rituals that go unnoticed by others. Because the compulsions are not always noticeable, some believe that pure O differs from traditional obsessive-compulsive behavior, but this is not the case. Those with pure O often experience intrusive and inappropriate thoughts, impulses, and mental images that may be violent or sexual in nature. These thoughts are frequently disturbing and affecting because they tend to deviate significantly from an individual's ethics and nature. For example, some common obsessions seen in pure O are the recurring fears of molesting a child, killing one's spouse or child, or accidentally bringing harm to others.

Individuals experiencing pure O may exhibit such compulsive reactions as avoiding situations that bring about these thoughts, performing ritualistic or superstitious acts to prevent bad things from happening, or praying or chanting phrases in order to counteract or avoid unwanted thoughts.

Pure O has been shown to respond, in many cases, to ERP. The condition can also be treated with a newer variation of ERP, called imaginal exposure. In this form of therapy, a therapist or other mental health professional uses audio tapes of short stories based on the obsessions of the person in treatment to expose that individual to situations that cannot otherwise be experienced. For example, this form of therapy may be helpful to an individual who is obsessed with the thought of poisoning his entire family, a situation that he can not actually expose himself to.

Mindfulness-based cognitive therapy has also been shown to be effective at treating pure O. This form of therapy helps individuals become better able to accept uncomfortable thoughts and urges, so it can often help an individual with pure O become more able to experience and accept obsessive and unwanted thoughts and respond to them without engaging in compulsive behavior.

Treatment for OCD

The treatment of obsessions and compulsions has been researched and written about extensively. Obsessions are present in people of all ages, economic classes, and ethnic groups. Their presence can often be an incredible burden that may cause shame and frustration, interfere with ordinary life activities, or cause depression. The behaviors can also interfere with relationships and lead friends and family members to also experience frustration or anxiety. OCD behaviors seem to have some chemical component, and they can be triggered or worsened by environmental factors, especially factors that leads to anxiety, fear, or anger. Helping children and adults to express their emotions and relax can be part of an effective treatment protocol.

How Therapy Can Help with OCD

People with OCD can receive help through various therapeutic approaches. Psychotherapy for OCD usually includes both cognitive therapy and exposure therapy. In exposure therapy, the person in treatment is exposed to an obsession but attempts to refrain from acting on an accompanying compulsion. This is initially done in small increments of time, and gradually, the length of time increases. At each interval, the therapist asks the individual to gauge anxiety and uses cognitive techniques to help put the anxiety into perspective. Over time, a person in treatment typically learns that the obsessive thoughts are unrealistic and distorted and can often then develop the tools necessary to cope with anxiety without resorting to obsessive and compulsive behaviors.

Case Examples

  • Adolescent boy teased for displaying obsessive-compulsive behaviors in school: Jason, 14, has been teased in school because he repeats himself constantly and sits down and stands up over and over. When asked why he does this, he cannot explain his reasoning, only that he feels as if he has to do so. The therapist recognizes obsessive-compulsive behaviors and investigates Jason’s environment for stressors. It is discovered that Jason's father has an anger problem, and his father is referred for anger management therapy. This lessens, but does not eliminate, Jason's obsessive-compulsive behaviors. A psychiatric evaluation is completed, but the family chooses not to place Jason on medication due to the potential for some troublesome side effects. In therapy, Jason learns to accept his condition, and he also gains some relaxation skills, develops problem-solving skills, and learns methods to delay the unwanted behaviors so that others are less likely to notice them. As Jason continues in therapy as he approaches adulthood, the behaviors diminish and eventually all but disappear.
  • Chronic hand washing caused by anxiety: Rivka, 47, enters therapy, seeking help for compulsive hand washing. From as far back as she can remember until her 30s, she washed her hands every ten or fifteen minutes. When her first husband left her and she was forced to get a job outside the home, she learned to control her behaviors, and since then they arose only in spurts. Rivka was able to replace the hand-washing compulsion with counting and praying, but recently, the compulsion to wash her hands returned. In therapy, she uncovers feelings of guilt and shame dating back to childhood. Several months of therapy are needed for Rivka to work through those difficult feelings, and she also accepts an anti-anxiety medication to take when her compulsions are at their worst. Therapy enables her to function reasonably well and to relax more often, and before long, the compulsion begins to subside and she is able to stop the medication. Though she continues in therapy, she is able to reduce the frequency of her sessions.

References:

  1. Bretécher, R. (2013, August 31). Pure OCD: A rude awakening. Retrieved, from http://www.theguardian.com/society/2013/aug/31/pure-ocd-the-naked-truth
  2. Diagnostic and statistical manual of mental disorders: DSM-5. (5th ed.). (2013). Washington, D.C.: American Psychiatric Association.
  3. OCD | Symptoms and Treatment. (n.d.). Retrieved from http://ocdla.com/whatisocd
  4. Pure Obsessional OCD | Pure O Treatment. (n.d.). Retrieved from http://ocdla.com/obsessionalocd
  5. When Unwanted Thoughts Take Over: Obsessive-Compulsive Disorder. (n.d.). Retrieved from http://www.nimh.nih.gov/health/publications/when-unwanted-thoughts-take-over-obsessive-compulsive-disorder/index.shtml

 

Last updated: 08-02-2016

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