Understanding OCD

Obsessive Compulsive Disorder (OCD) is a relatively common but considerably misunderstood diagnosis. OCD is frequently portrayed as an obsessiveness regarding organizing and symmetry. You’re probably familiar with someone pronouncing, “I’m so OCD” as they describe a certain peculiarity. While widely known by name, the reality of OCD is unfortunately largely unknown. Often even those suffering symptoms of OCD are unaware their symptoms are a part of OCD.

To quickly describe OCD, we might say that OCD is characterized by patterns of emotional distress and some action or actions to relieve that distress. Difficult to satisfy, OCD demands repetitive cycles which lead to a tell tale spiraling of thoughts and behaviors. This may sound simple, but can play out in many different ways. Sometimes the trigger for distress will be an event, a person, an image, an object, or most commonly a spontaneous intrusive thought. Regardless of the trigger, someone with OCD will experience a sharp increase in emotional distress related to the trigger. 

They may begin spiraling through thoughts, physically feeling anxious, or immediately feel a thought get “stuck”. A thought or image getting stuck is the Obsessive part of OCD. Something happens (either internally or externally) and it becomes the center of the mind’s focus. It feels as though it will remain the focus until it is dealt with and somehow resolved. Seemingly, the only relief from an obsession’s distress is to perform a ritual or rituals until the distress resolves. 

The ritual response is the Compulsive part of OCD. Rituals come in all sorts. Commonly understood rituals associated with OCD might be frequent washing or checking behaviors. However, these are only a tiny representation of what OCD rituals may entail. Compulsions may either be “public” or “private. Public rituals are those that someone outside of you might be able to see. They may include:

• washing

• checking

• repeating words or actions

• verbal reassurance seeking

• tapping or repetitive motor movements

• confessing thoughts or actions

• praying

This is only a partial list. Rituals may include some of the above or any other actions done in response to the distress of a trigger with the goal of reducing that distress. 

For many OCD sufferers, rituals only occur as private experiences. Private rituals are rituals that are unobservable by others. These rituals occur within the mind. They may be repetitive logic checking, repeating words, thinking of certain images, counting, praying, undoing thoughts, or countless other examples. You might hear someone describe the term Pure O which stands for a type of OCD with only intrusive thoughts and no behavioral ritual. Pure O is not an official diagnosis, however, and frequently those with a Pure O form of OCD will still have one or more mental rituals. 

A final important element associated with OCD is the occurrence of intrusive thoughts. Intrusive thoughts are unwanted and often disturbing thoughts, impulses, or images that one spontaneously thinks. It’s important to understand that intrusive thoughts are extremely common. In fact, 95% of all people report having intrusive thoughts. Intrusive thoughts are often disturbing in nature and often involve themes of being responsible for harm (either to self or others accidentally or purposefully), personal sexuality, taboo sexual areas, religion, or other personally important themes. Because of this they provoke intense feelings of fear, disgust, and shame which in turns leads to them becoming “stuck” in OCD. Once a thought becomes stuck, the OCD cycle begins. OCD sufferers are also reluctant to share intrusive thoughts due to the taboo nature of many thoughts. Finding a therapist with OCD specific experience is important as they will understand the difference between an intrusive thought associated with OCD and thoughts reflective of someone’s character.

Fortunately, OCD is one of the more treatment responsive mental health diagnoses. Treatment strategies including Exposure and Response Prevention, Cognitive Behavioral Therapy, and Acceptance based theories have all been demonstrated as effective for OCD. With my clients, I utilize Acceptance and Commitment Therapy (ACT) along with gentle and client-paced exposure practices. Together, we create a plan to take on OCD with curiosity and confidence. You will learn to recognize your own unique OCD processes and strategies for managing the waves of distress OCD brings. You can learn to move from a space of reactivity and avoidance of OCD triggers and towards a space of hopefulness, confidence, flexibility, and a value oriented life.