Obsessions & Compulsions / OCD

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 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.

• Examples of Obsessive Compulsive Behaviors
• Sensorimotor Obsessions
• How Therapy Can Help with Obsessions & Compulsion
• DSM Definition of Obsessive-Compulsive Anxiety Disorder (OCD)
• Adolescent Boy Struggling with Obsessive Compulsive Behaviors - Case Example
• Chronic Handwashing Caused by Anxiety - Case Example

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 are hand-washing, tapping, checking-rechecking door locks, feet wiping, counting before performing actions (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 feeling 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 obsessive compulsive disorder (OCD). People who suffer with these disturbing behaviors find themselves unable to shift their attention away from the obsessive or compulsive action. They feel as if they are stuck on a particular act, such as focusing on their blinking, breathing or swallowing. This acute level of awareness of these otherwise involuntary bodily functions can create a debilitating and overwhelming cycle of frustrating for people who struggle with this. Not only do people with sensorimotor obsessions get stuck on these actions, but they tend to over analyze them as well, concentrating on every minute detail of their speech, breath or eye contact between blinks. 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 suffer with sensorimotor obsessions may count the number of times they blink or may over emphasize positive thoughts while they are obsessing about their heart rate in an attempt to control their pulse. These behaviors 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 client 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. 

How Therapy Can Help with Obsessions & Compulsion

People with OCD can receive help through various therapeutic approaches. Psychotherapy for OCD usually includes both cognitive therapy and exposure therapy. Exposure is as its name implies and involves exposing the client to the obsession while refraining from acting on their compulsion. This is done in small increments of time initially, and is gradually increased. At each interval, the therapist asks the client to gauge their anxiety and using cognitive techniques, helps the client put their anxiety into perspective. Over time, the client learns that their thoughts are unrealistic and distorted. They develop the tools necessary to cope with their anxiety without resorting to obsessive and compulsive behaviors. 

DSM Definition of Obsessive-Compulsive Anxiety Disorder (OCD)

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.

Adolescent Boy Struggling with Obsessive Compulsive Behaviors - Case Example

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.

Chronic Handwashing Caused by Anxiety - Case Example

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.

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