Obsessive-Compulsive Disorder (OCD)

We provide effective, empirically-based OCD Treatment. Before we start looking at what OCD is, understand that about 1 in 100 people suffer from OCD. Some estimates are as high as 1 in 40. That’s a lot of people.  If you go to a Phillies game on a good day, there are more than 40,000 people there. At 1 out of every 100, that is 400 people! So, you are certainly not alone.

There is no need to label yourself either. We need to name the condition in order to productively talk about it and we need to research it in order to be able to effectively treat it. Please know that while you may have OCD, it is treatable and does not reflect who you are.  You are not weak. Some of the most courageous people I have met have OCD. You are not your OCD, but you may have it and you will benefit from treatment.

The American Medical Association (AMA) and the American Psychological Academy (APA) recommend Exposure/Response Prevention (E/RP) as the first-line, psychological treatment of choice for OCD.  OCD responds best to a specialized CBT treatment primarily using exposure/response prevention.

What are obsessions?

Obsessions are defined as thoughts, images, or urges that come repeatedly without request. They are stubborn and almost always create uncomfortable anxiety and distress. The person having the obsession finds them intrusive and doesn’t want them. He may attempt to ignore or suppress these thoughts, images, or urges or tries to neutralize them through some other thought or action (compulsion).

It is not obsessive to have occasional thoughts about anything you fear or about the safety of loved ones but watch out for a demand for perfect certainty. You know how you can’t really read people’s minds or predict the future 100% of the time and you get along just fine. It is the same with certainty, you can’t really have that either, but you can and do also get along fine without it.

What are compulsions?

Compulsions are repetitive behaviors like hand washing, checking, ordering, or mental acts like counting, praying, or any other activity that is designed to reduce the anxiety produced by the obsession. The behaviors and mental acts are all designed to reduce anxiety or prevent feared consequences. The compulsions, also called rituals, become excessive, as we will see below.

Compulsions do not include harmless religious rituals, bedtime stories, or the like. Look more at the context. Reading to a child at the same time each night is different than having to read at the same time each night because you are trying to neutralize or stop something bad from happening.

Example Scenario of OCD

Now that you have some understanding of what obsessions and compulsions are, let’s look at the cycle of Obsessive-Compulsive Disorder in the form of contamination.  We’ll call this made-up character Bill.

Action

Bill opens the door to the bathroom at work with a tissue in his hand (to protect him from contamination) but thinks that he feels something wet come through the tissue. He looks at his hand and doesn’t see any moisture.

First Obsession

Bill thinks, “I don’t see anything, but what if it dried quickly after I got it on me and it’s still there, dry, and toxic.”

Bill has experienced obsessions regarding fear of contamination to chemicals, and pesticides in particular, for about 3 years. 

You may have noticed that Bill didn’t see any moisture on his hand and his logical mind said, “Move on,” but he didn’t. Why?

The disorder is telling him that before he moves on he must be certain, absolutely perfectly certain of no toxin. This creates the doubt that what he senses and experiences is true, no moisture.

The only method any of us have for knowing is our best logical guess. That leaves us to face some risk in this life. Risk is a normal part of living even if we don’t want it. Who do you know that has the ability to have perfect safety? It doesn’t exist and we do not need it to live a full life. Bill has stopped trusting his senses and experiences and is opting for his mind’s distorted virtual reality. Effective OCD treatment will teach Bill E/RP.

People who don’t have OCD would have moved on without needing more evidence. They would have lived with what they considered a very small risk. But Bill is now anxious and stuck because he has OCD. This distorted thinking demands something that can never be accomplished as a requirement for being ok! Perfect certainty!

We all live with the low-probability risk of dying from a toxin we can’t see. Trying to find certainty that there is no risk will cause you to worry your life away. Try it! Bill is being fooled by an OCD distortion. The distorted thinking tells him that he can have the perfect choice of no risk, though no one else on earth gets it. This is why it is a disorder and makes him look past reality. The truth is that perfect certainty is simply not attainable, nor do we need it.

Second Obsession

This is in the form of an image. Bill sees himself getting sick, missing work, perhaps getting fired or maybe even dying!

 At this point, Bill is very anxious. Although his (and our) nervous system is complex and wonderfully efficient and effective his (and our) perception guides what signals to send to the nervous system. Can you guess what Bill’s stress response is hearing? It is hearing, “Danger of illness, unemployment, or even death!”

Remember that obsessions are thoughts, images, or urges that come repeatedly and that are stubborn and almost always create uncomfortable anxiety and distress.

His distress comes in the form of very high anxiety and an urgent need to fix the problem. He is reacting as if all his obsessions (thoughts) are imminent. How would that make you feel?

His high anxiety sets the stage for his next move when confronted with apparent danger. If anxious, there must be a danger, so get rid of it (this is called emotional reasoning in this case). Keep in mind that his perception is that he is in immediate, life-threatening danger and he must be certain that this is not true. Watch what happens!

Compulsion

Bill sees an obsessive image of himself getting sick, missing work, perhaps getting fired, or dying (all negative predictions about the future)! He has an unshakeable urge to fix this danger. His efforts to fix this are his compulsions. Do you remember what a compulsion is?

Compulsions are repetitive behaviors like hand washing, checking, ordering, or mental acts like counting, praying, or any other mental act that is designed to reduce the anxiety produced by an obsession. The behaviors and mental acts are all designed to reduce anxiety or prevent some feared consequence or to otherwise neutralize the obsessive thought. The compulsions, also called rituals, will become excessive. 

OCD hand washing compulsion

Bill’s compulsion in the form of a behavior, hand washing. Bill uses 3 paper towels, taken carefully from the dispenser, to turn on the handle of the water faucet and then to squirt soap from a dispenser. He begins to feel his anxiety go down slowly as he washes his hands for the fifth time. He pays special and exhausting attention to what he believes is the affected area. Finally, he feels better.

As he cautiously dries his hands he has a thought, “What if I didn’t get all?” Although he tries to talk himself out of it with reassuring thoughts, he washes his hands five more times. Then he thinks, “What if I have just spread it?” Bill continues to cycle through these “what if” questions and washing his hands five times.

It will never stop. Demanding certainty is the engine of OCD. It will only keep saying, “What if?” and handing him another possible negative problem that will make him wash as a way to try to get certainty of no risk. This will make the virtual reality repeat until he somehow gets out of the virtual reality of living with no risk.

Conclusions to the Scenario on OCD

There is no Perfect Certainty

The bottom line is, Bill will never become perfectly certain. He will finally say, “This is good enough,” and walk away. He will walk away because he is too tired, embarrassed, or humiliated and his hands are chapped and cracked. Nevertheless, he is still not perfectly certain. Walking away is what a person who does not have OCD would have done in the first place. This is what Bill will need to learn as his OCD tries to fool him. OCD treatment, primarily using E/RP, is the recommendation of choice.

Having OCD Takes Time and Quality Away from Your Life

You may have noticed how many times Bill washed his hands and that it might interfere with his life. In fact, it is likely to increase. This is also an important element in deciding if you have a problem with OCD that could benefit from treatment. The compulsions must take more than an hour a day of your time, cause distress, or interfere with the social, occupational, or other important areas of your life.

Furthermore, symptoms that you are experiencing cannot be better attributed to the psychological effects of drugs, medications, or other medical conditions. There are many other disorders that can be present with symptoms like OCD, but that are not OCD. It is best to find a professional to make a formal identification of OCD. In fact, OCD is still misdiagnosed and is often treated inappropriately.

Types of Obsessions in OCD

OCD content can vary greatly.  If the human can think of something, they can also obsess about it. Some say that OCD is only limited by the imagination. Below are a few well-known areas of obsessive concern.

 Note that none of the these lists are exhaustive, so please check with an expert who specializes in the treatment of OCD if you have questions.

Obsessions of Contamination

Bodily fluids or waste, household chemicals, environmental chemicals, germs, dirt, garbage, radiation, particular places or people, certain thoughts, certain events.

Obsessions of Harm to Self/Other

Losing control and harming others, losing control and harming self, causing harm to others/self through thoughts, negligence, or carelessness, doubt if you have harmed someone in the past.

Obsessions of Aggression

Fear of harming self/others intentionally, fear of going crazy and harming others, fear of shouting or writing out embarrassing obscenities, fear of making obscene gestures, of having insulted or offended someone.

Obsessions of Perfection 

Questioning if you have told the truth perfectly, questioning if others have understood you perfectly, keeping your possessions in perfect order, wanting to have a perfect appearance.

Sexual Obsessions

Fear of having forbidden perverse thoughts, images, or impulses, fear of acting out sexually or being sexually excited by children, fear of desiring or having sex with animals.

Religious Obsessions

Fear of being sinful or blasphemous on purpose, fears of having acted sinfully, having undesirable thought about religious deities.

Health and Body-Focused Obsessions

Believing that parts of your body are ugly or disfigured, asymmetry of parts of your body, fear of brain damage, fear of a serious undiagnosed illness.

Neutral Obsessions

Excessive awareness of your own thoughts, counting for no special reason, bothered by certain sounds, words, or music, excessively aware of normal bodily functions like blinking, breathing, or heart beating.

Magical Obsessions

Having bad luck, lucky/unlucky numbers, colors, or multiples of numbers.

Types of Compulsions in OCD

Decontamination Compulsions

Washing your hands or body repeatedly and excessively. Using gloves, paper, or some other item to touch or pick things up. Disinfecting yourself and your possessions or having others disinfect themselves. Changing or having others change clothes frequently in order to avoid contamination. Also, frequently avoiding touching others or things for fear of contamination.

Perfectionistic Compulsions

Keeping your things perfectly neat and clean, not using newly purchased items for fear of messing them up, avoiding using rooms, closets, or anything storage space once it has been arranged perfectly, saying things perfectly.

Checking Compulsions

Checking locks, doors, windows, stoves, car doors, headlights, water faucets, electrical appliances, extinguished cigarettes, and matches. Repetitively praying or crossing oneself. Checking what you have read, columns of numbers, your memory, the item you think you may have left behind, or food for fear of contamination.

Undoing Compulsions

Repeating something with a good thought in it, rethinking thoughts, thinking thoughts in reverse, performing actions or movements in reverse, touching things in a special way.

Mental Compulsions

Thinking thoughts in a specific or special way, knowing or learning everything on a specific topic, creating specific thoughts or images, checking memory for past harm to self/others.

Counting Compulsions

Counting while performing certain activities, repeating behaviors a certain number of times, performing behaviors odd or even numbers of times.

Touching or Movement Compulsions

Posing or gesturing in a certain way, move in specific ways while doing specific activities, tic or grimace in a special way, touch, tap or move your body in a certain fashion.

Protective Compulsions

Warning others repeatedly of potential harm or danger, confessing to having done things that may have caused harm to others, asking others repeatedly if things will turn out ok or will turn out well for you.

Body-Focused Compulsions

Checking for imperfection or problems with your body in the mirror, checking your body for symmetry, cutting your hair for long periods of time to get it perfect. Frequently seeking medical consultations for possible illnesses, frequent self-exams, frequent reading on the internet about illnesses you fear that you have.

Hoarding Compulsions

Saving items simply because they belong to you or a loved one. Saving broken, irreparable or useless items. Experiencing an inability to throw out items due to fear of accidentally throwing away something important.

Please remember that these lists do not reflect, by any means, the full scope of content in which obsessive and compulsive thoughts and behaviors can manifest.  You are unique and your OCD content can also be unique.

Conclusion

It is best to consult a professional if you suspect that you have OCD after reading the above lists. A professional can help you figure it out and guide your treatment. Given my experience over the years, it is likely that you may have been suffering for a long time without knowing that you have OCD or you may not have been receiving appropriate treatment. Our service areas include, but are not limited to, Philadelphia, Montgomery County, PA, the Main Line, and surrounding zip codes, such as 19152, 19114, and 19149. Finally, please contact us to arrange an evaluation.

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You’re encouraged to get in touch directly with us to get yourself on the road to managing your issues.

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