Obsessions & Compulsions / OCD
Overview of Obsessions & Compulsions: Persistent unwanted thoughts that lead to repeated, irrational behaviors are called obsessions and compulsions. For example, some people feel they must wash their hands hundreds of time each day, must count to ten every time they enter or leave a room, must check the locks on their doors repeatedly every night, or must 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.
The Medical Model and Obsessions & Compulsions: 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 be an incredible burden, causing shame and frustration, interfering with ordinary life activities, and sometimes causing depression. The behaviors can also interfere with relationships and lead friends and family members to feel very frustrated themselves.
OC behaviors seem to have some chemical component, and can also be triggered or worsened by environmental factors, especially anything that leads to anxiety, fear, or anger. Helping children to express their emotions and relax can be part of an effective treatment, as it canhelp adults if they can learn these skills.
Diagnostic and Statistical Manual of Mental Disorders (DSM): Obsessive Compulsive Anxiety disorder (OCD) (not be confused with Obsessive/Compulsive personality, an entirely different condition) is defined in the DSM as follows:
A. Either obsessions or compulsions:
Obsessions as defined by (1), (2), (3), and (4):
(1) Recurrent and persistent thoughts, impulses, or images that are experienced at some time during the disturbance, as intrusive and inappropriate and that cause marked anxiety or distress
(2) The thoughts, impulses, or images are not simply excessive worries about real-life problems
(3) The person attempts to ignore or suppress such thoughts, impulses, or images, or to neutralize them with some other thought or action
(4) The person recognizes that the obsessional thoughts, impulses, or images are a product of his or her own mind (not imposed from without as in thought insertion)
Compulsions as defined by (1) and (2):
(1) Repetitive behaviors (e.g., hand washing, ordering, checking) or mental acts (e.g., praying, counting, repeating words silently) that the person feels driven to perform in response to an obsession, or according to rules that must be applied rigidly
(2)The behaviors or mental acts are aimed at preventing or reducing distress or preventing some dreaded event or situation; however, these behaviors or mental acts either are not connected in a realistic way with what they are designed to neutralize or prevent or are clearly excessive
B. At some point during the course of the disorder, the person has recognized that the obsessions or compulsions are excessive or unreasonable. NOTE: This does not apply to children [Children can be diagnosed even if they do not meet criterion B].
C. The obsessions or compulsions cause marked distress, are time consuming (take more than 1 hour a day), or significantly interfere with the person’s normal routine, occupational (or academic) functioning, or usual social activities or relationships.
D. If another Axis I disorder is present, the content of the obsessions or compulsions is not restricted to it (e.g., preoccupation with food in the presence of an Eating Disorder; hair pulling in the presence of Trichotillomania; concern with appearance in the presence of Body Dysmorphic Disorder; preoccupation with drugs in the presence of a Substance Use Disorder; preoccupation with having a serious illness in the presence of Hypochondriasis; preoccupation with sexual urges or fantasies in the presence of a Paraphilia; or guilty ruminations in the presence of Major Depressive Disorder).
E. The disturbance is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition.
Case Examples of Obsessions & Compulsions:
Jason, 14, has begun being teased in school because he repeats himself constantly, and sits and stands over and over. When asked why he does this, he cannot explain, and hangs his head sadly. The therapist recognizes OC behaviors, and investigates Jason’s environment for stressors. It is discovered his father has an anger problem, and he is referred for treatment. This lessens but does not eliminate the OC 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, but also gains some relaxation skills, problem-solving skills, and some tools to delay the OC behaviors so that they are not embarrassing to him in public. A few years later, the behaviors diminish significantly, and slowly disappear as Jason reaches adulthood.
Ruth, 47, washed her hands every ten or fifteen minutes for as long as she can remember, until she was in her 30’s, at which time her first husband left her and she was forced to get a job outside the home. She learned to control her behaviors, which since then arise only in spurts. She has replaced the hand washing with counting and praying. Lately, the hand washing compulsion has returned and she seeks therapy. The therapist uncovers feelings of guilt and shame dating to childhood. Several months of therapy are needed for Ruth to work through those 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.
Therapy for Obsessions & Compulsions: There is a wide range of Psychotherapy Treatment Models or types of therapy used in the treatment of obsessions and compulsions. Most of these approaches fall into three historic camps of psychology: Psychoanalytic / Psychodynamic approaches; Behaviorism and; Humanism. Regardless of the type of therapy, there are some generally agreed upon elements of healthy therapy which are universal to all forms of psychotherapy. Before beginning therapy for obsessions and compulsions or any other issue, it is helpful to familiarize oneself with these elements.
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