September 25th, 2024
As a therapist who has treated obsessive-compulsive disorder (OCD) in its many forms, I’ve found myself doing some pretty unexpected things alongside my patients. I’ve stuck my fingers in public toilets, I've rolled around on the floor, I’ve spilled an entire box of pens in front of a crowded classroom, and even made retching noises to sound like I was about to vomit.
If you’re wondering how these activities are related to OCD treatment, keep reading—you’ll be surprised. And if any of those activities sounds absolutely unbearable to you, you might be asking yourself, “Do I have OCD?”
Obsessive-Compulsive Disorder (OCD) is a complex and often misunderstood condition that can manifest in many different ways. The most common stereotypes of OCD, often portrayed in TV shows and movies, involve someone who obsessively washes their hands out of fear of germs or someone who needs everything to be perfectly organized, becoming highly irritated if it isn’t.
However, OCD extends far beyond these portrayals, taking on many forms that are less recognized but just as challenging. Through my firsthand experience working with clients who have OCD, I can tell you that there are many more varieties of OCD symptoms than most people realize.
While it’s true that some people with OCD are concerned with germs, and some people with OCD like to keep things organized, these are just a few examples of the many ways OCD can manifest.
In fact, these common traits barely scratch the surface of the variety of OCD symptoms and types of OCD that exist. It's also important to note that simply being organized or worried about getting sick doesn’t necessarily mean someone meets the diagnostic criteria for OCD.
The “O” in OCD stands for “obsessions.” The definition of “obsession” is an unwanted idea, image or impulse that intrudes on a person’s thinking. An obsession will invade your mind again and again, even when you do not want to think about it.
Ironically, the more someone tries to resist an obsession, the stronger it becomes, which increases the feelings of distress. In some cases, obsessions can involve themes of harm, risk, and danger to self or others.
The “C” in OCD stands for “compulsions.” A “compulsion” is something that a person does to cancel out the obsession and relieve distress.
This could be an observable behavior (e.g., ‘I have to tap my foot four times’) or it could be a thought pattern (‘I have to think good thoughts to neutralize the bad thought.’) A compulsion could also be the avoidance of something (e.g., ‘I can’t touch the bathroom door handle with my bare hand.’)
It is very important to note that compulsions are not enjoyable, but they can provide temporary relief from distress. Compulsions are often time-consuming and inconvenient, but for a person with OCD, they seem necessary for preventing negative consequences.
It is also possible for someone to experience “Pure O”, which means they have obsessions but do not perform compulsions.
An intrusive thought is an unwanted word, phrase, or image that invades a person’s mind and causes distress. For example, I worked with a teenage patient who experienced intrusive thoughts about her parents being injured or dying.
As a result, she struggled with separation anxiety, and she felt very worried when she was away from her parents—especially if she could not contact them to check if they were all right.
These thoughts occurred with no factual evidence to support them. Her parents were alive and well with no severe health conditions. However, the intrusive thoughts felt so real that she believed they could be true.
People with OCD can have intrusive thoughts about inflicting harm on themselves or others. Some people with OCD may also experience intrusive thoughts of a sexual nature. It is important to clarify that these intrusive thoughts do not reflect any real desires.
The person who experiences them does not want to think about these things, and they have no intentions of acting on their intrusive thoughts.
I will provide an example of one of my more memorable cases. I worked with a patient who had obsessions about being a pedophile. Not only would she experience thoughts like “What if I’m a pedophile?”.
But she would also have thoughts such as: “There's a spot on the floor in my room, which is where the soccer ball used to be. What if the soccer ball touched little girls’ butts during the game? If I touch the spot, does that mean that I’m a pedophile?” Of course, she was not, but her intrusive thoughts made her believe otherwise and caused her severe distress.
In spite of her best efforts to silence these obsessions, they became increasingly disruptive, and she would perform compulsions in an attempt to make them go away.
Intrusive thoughts can be extremely detrimental to a person’s well-being, and many people suffer quietly for a long time due to fear, shame, and embarrassment instead of heading to therapy to treat OCD.
While the main symptoms of OCD involve obsessions and compulsions, the specific content of those obsessions can look drastically different from person to person (different OCD types). One subtype is contamination, in which a person may have obsessions about becoming sick or making other people sick.
This could also include mental contamination, in which a thought, memory, or feeling makes the person feel ‘dirty’; or emotional contamination, when someone believes that a person or object exudes a contagious negative energy.
Another OCD type or subtype is perfectionism, which can encompass several different categories. This could refer to concerns about failure or social rejection, a fear of asymmetry, or a need for things to be “just right” (e.g., avoiding the “wrong” color, having concerns about walking or speaking the ‘right’ way).
A lesser-known subtype is religious OCD or scrupulosity, in which someone is overly worried that their thoughts or actions may violate a religious belief, or that they will say something that could be considered blasphemous.
They may have obsessions about going to hell or being punished, as well as the fear that they are a bad person. It is important to note that being a devout person with firmly held religious beliefs is different from having religious OCD.
Some other lesser-known subtypes are:
The most likely explanation for the root cause of OCD would be a combination of biological factors and personal experiences.
Biological factors may include:
Personal factors may include
It is important to note that no single experience can be identified as the definite cause of OCD. However, if someone has more of the biological factors and personal experiences listed above, then they would be more likely to develop OCD.
Obsessive Compulsive Personality Disorder (OCPD) is different from OCD. A person with OCPD tends to be preoccupied with perfection and control. They display rigid thinking and have a hard time making exceptions to their rules.
This may make it more difficult for them to complete tasks in a timely manner, because they must do things ‘just right’ or else they are not satisfied. A person with OCPD is also more likely to be diagnosed with depression, anxiety, or (unsurprisingly) OCD.
The motivations and behaviors behind these disorders are different. OCPD is more about control and achieving perfection, whereas OCD centers on relieving anxiety through compulsive actions.
SSRIs (selective serotonin reuptake inhibitors) are the most commonly prescribed medications for OCD. Some examples include:
These medications are also prescribed for other conditions, including anxiety and depression, so they may be especially helpful for someone who has been diagnosed with OCD and another disorder.
Other medications that can be used to treat OCD are clomipramine, a type of antidepressant, and aripiprazole (also known as Abilify) which is an atypical antipsychotic. (Note, Abilify is still considered “off-label” for OCD in the United States.)
While there is no one “perfect medication”, or one pill that can completely relieve the symptoms, medications can be very helpful when combined with effective OCD therapy.
Exposure and Response Prevention (ERP) is the most effective form of therapy to treat OCD. In ERP, the therapist will encourage the patient to say or do things that relate to their obsessions or fears. This is effective because it teaches the patient to tolerate the uncertainty and distress that they experience.
That outcome can be accomplished if the ERP therapist also helps the patient resist the urge to do compulsions to ‘cancel out’ the obsessions or relieve their distress. Over time, the patient learns that their uncomfortable feelings will eventually go away, so they experience less distress each time they encounter something that provokes fear or anxiety.
This can be accomplished through “in vivo” exposures (e.g., a person who has contamination OCD can eventually put their hand in the toilet). It can also be accomplished through imaginal exposures, such as thinking about the worst case scenario (e.g., “Because I laid on the floor, I will get infected with a terrible disease, and I’ll have to go to the hospital.”)
Patients may also write a list of “what if statements” (e.g.,“What if I drop a box of pencils in front of everyone, and then they all think that I’m stupid? What if they laugh at me?”).
Finally, another form of exposure is an interoceptive exposure (in which the patient does something that makes them feel uncomfortable physical sensations such as holding their breath, coughing, sitting in front of a heater, or spinning in a chair.) Interoceptive exposures are commonly used to simulate physical feelings of panic, like someone would experience during a panic attack.
ERP may seem counterintuitive at first. After all, people may wonder “Why would I voluntarily do something that makes me uncomfortable, anxious, or disgusted? Wouldn’t that make me feel worse?” In order to ease the patient into treatment, the therapist will help them make a hierarchy, which means they will make a list of exposures that starts with the least intimidating activity.
This allows the patient to customize their treatment so they can work at their own pace, and they make decisions about what kind of exposure they will do. While ERP is uncomfortable to some degree, it is highly effective, as 80 percent of people with OCD experience positive results from ERP.
If you think you may be experiencing obsessions, having intrusive thoughts, or doing compulsions, it is recommended that you discuss this with a mental health professional.
During an assessment, your therapist will most likely ask you how often you experience obsessions or intrusive thoughts, if you do anything to make them go away, or if you spend a lot of time trying to manage your thoughts.
They may have you complete a brief OCD test (Yale Brown Obsessive Compulsive Scale, or YBOCS) to find out more about the type of obsessions you may have. Most importantly, a therapist will not interrogate you about your thoughts or judge you in any way. We are always here to help.
If you’re struggling with OCD or think you are experiencing OCD symptoms, Clarity Clinic can help. Our healthcare providers can offer personalized and compassionate OCD therapy to help you recover.
Whether you are searching for the best OCD therapist near you or prefer the convenience of online therapy, our mental health clinic provides both options so you can choose what works best for you.
With clinics located throughout Illinois, you can find affordable therapy near Evanston, Winneka, Northbrook, Arlington Heights, Schaumburg, Elk Grove, Oakbrook, Chicago, Naperville, Aurora, and more.
If you are in Chicago, make sure to check out our conveniently placed clinics in the Loop, River North, Lakeview Broadway, and Lakeview Belmont.
What are you waiting for? Schedule an appointment with one of our therapists near you! Reach out today to find relief with the best in-person therapy or online therapy that takes insurance with a trusted therapist in Chicago.
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Related Readings:
- Living With Someone Who Has OCD: A Family Guide
- Staying Motivated in OCD Treatment
- Anxious Habits
What does OCD mean?
OCD stands for Obsessive-Compulsive Disorder, a mental health condition characterized by intrusive, unwanted thoughts (obsessions) and repetitive behaviors or rituals (compulsions) performed to relieve anxiety.
Is OCD an anxiety disorder?
Yes, OCD is considered an anxiety-related disorder because obsessions often cause significant anxiety or distress, and compulsions are performed to alleviate that anxiety.
Am I OCD?
If you are experiencing persistent, unwanted thoughts that cause anxiety and feel compelled to perform certain actions to reduce that anxiety, you may have OCD. However, only a mental health professional can provide an official diagnosis. Taking an OCD test or seeking an OCD therapist at Clarity Clinic is a good first step.
Is obsessive-compulsive disorder genetic?
Studies show that genetics can play a part in OCD. If you have a family history of OCD, you may be at a higher risk of developing the disorder, but genetics are just one of several factors involved.
Is there medication for obsessive-compulsive disorder?
Yes, there are medications available for OCD. Common treatments include SSRIs (Selective Serotonin Reuptake Inhibitors), which help reduce the symptoms of OCD. Medication is often used alongside therapy, such as Cognitive Behavioral Therapy (CBT).
What does an OCD episode look like?
An OCD episode typically involves intrusive, distressing thoughts (obsessions), followed by compulsive behaviors or rituals aimed at reducing the anxiety caused by the obsessions. For example, someone may repeatedly check if the door is locked or wash their hands excessively.
Are people with OCD controlling?
People with OCD are not necessarily controlling of others. However, they may feel the need to control certain aspects of their environment or their own behavior in response to their obsessions. This compulsion to control things is often a way to manage anxiety, not an attempt to control others.
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