By Hannah O’Grady, LCSW
When you conjure about images of OCD, what comes to mind for you? Do you think of someone excessively cleaning, washing their hands dozens of times a day, organizing and re-organizing items around their home? While a focus on cleanliness and organization can be a symptom of OCD, there are a myriad of other ways that this diagnosis presents. The core components of OCD are the obsessions and the compulsions.
Obsessions
An obsession is a recurrent and unwanted intrusive thought, image or urge that is associated with anxiety and distress. These thoughts are ego-dystonic, meaning they are inconsistent with one’s sense of self and character. Unlike the stereotype of OCD, these obsessions are not just focused on cleanliness/contamination. Rather, they can commonly be focused on safety, harm to oneself and others, violence, morality and religion. Research shows that majority of people occasionally experience intrusive thoughts and are able to recognize them as such. However, for those with OCD, these thoughts feel more real and come with higher levels of distress and discomfort.
Compulsions
Compulsions are what individuals with OCD do in response to their intrusive thoughts. Compulsions can be overt, such as checking the stove to make sure it is turned off, excessive hand washing, and avoiding sharp objects for fear of hurting someone. However, compulsions can be covert as well and can include rumination, repeating phrases and mantras in your head, and mental review (repeatedly replaying events in your head). For those with OCD, these compulsions only provide temporarily relief and can actually reinforce and increase the frequency of intrusive thoughts.
Intolerance of Uncertainty
In life, so few things are certain. Of course, we can be confident about many things, however, certainty can be hard to find. For anyone, intolerance and discomfort with uncertainty can lead to feelings of anxiety. For those with OCD, the desire for certainty plays a crucial role in the development and maintenance of their symptoms. When someone with OCD experiences an intrusive thought, they want to be certain that these thoughts are not and will not come true; this ultimately is what drives someone with OCD to engage in compulsions. For example, if someone has intrusive thoughts around accidentally leaving the door unlocked, they may repeatedly check the locks over and over again, hoping to eventually feel certain that they have locked the door. However, this feeling of certainty rarely comes, or if it does, it is fleeting.
Treatment for OCD
Treating OCD often involves a combination of medication (typically SSRIs) and therapy. The most common therapy for OCD is Exposure and Response Prevention (ERP). ERP entails gradually exposing clients to their fears while helping them not engage in their compulsions. Overtime, clients learn to tolerate this discomfort and uncertainty without having to engage in ineffective coping mechanisms. Mindfulness has also proven to be effective for OCD. With mindfulness techniques, individuals can learn to increase awareness and acceptance of their thoughts, without having to respond to them.
