Obsessions & Compulsions Explained

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What do I do if I have obsessive thoughts and compulsive urges?

Obsessions and Compulsions Explained

We all have strange or worried thoughts from time to time. For example, doubts about whether you left the iron on, fears about getting sick and dying, and sometimes, worries about unusual, disturbing, or violent things happening. Sometimes however, thoughts like this can become intense, frequent, and difficult to control.

Thoughts like this can impact people’s behaviour. For example, people who worry about burning their house down might triple (or quadruple) check that they’ve turned the oven off. These behaviours often feel compulsive, and can be time consuming and difficult for other people to understand.

If you have thoughts and urges like this, then it could be helpful to learn more about obsessive compulsive disorder (OCD).

What is OCD?

Obsessive compulsive disorder (OCD) is a disorder characterised by unwanted, intrusive thoughts and behaviours that are intended to get rid of or ‘neutralise’ these thoughts. These kinds of thoughts are called ‘obsessions’ because they can be all consuming and hard to control. The behaviours are called ‘compulsions’ because people can feel compelled to do them.

People with OCD feel compelled to do certain thing because their obsessive thoughts trigger intense anxiety. For example, someone with OCD might feel a strong urge to check that they locked the door, over and over, because their fear of being robbed is overwhelming. Other times, people with OCD wash their hands repetitively because they’re terrfied about getting an infection.

Many people have mild OCD ‘symptoms’, like wanting things to be organised or doubting whether they’ve locked the door. To be classified as OCD however, these symptoms need to be intense, distressing, and significantly interfere with a person’s life.

What Are The Signs of OCD?

Obsessions

  • Obsessions are thoughts, images, or worries that keep coming back into your head, no matter how hard you try to block them out. These thoughts are very distressing; they’re always about something dangerous or upsetting. Obsessions can also be disturbing. For example, people with OCD can have intrusive thoughts about things that they don’t want to do, like hurting themselves or other people.
  • Obsessions tend to be about things that are important to people. People who care about their health might have intrusive thoughts about being contaminated, while those who see themselves as kind and caring might be more likely to have upsetting, violent thoughts.

Compulsions

  • Compulsions are the things that people do in response to an obsessive thought. Compulsions are intended to get rid of or ‘neutralise’ obsessions, by preventing them from coming true or getting rid of the fear that the obsessions cause.
  • Compulsions can be visible behaviours (things you can see people do), like repeatedly checking or washing things. They can also be mental behaviours, like repeatedly praying, counting, or saying things silently in your head.
  • Compulsions are also called ‘rituals’ because most people feel like they have to do them in a very specific way. People with OCD will repeat these behaviours over and over until the ritual has been done ‘just right’ or until it feels like danger has been averted. As a result, compulsions can be very time-consuming, sometimes taking up hours in a person’s day. Compulsions can also have other negative consequences, from developing blisters from repeated handwashing, to being unable to work because of checking takes so much time in their day.

Any of these features may serve as warning signs of OCD, and OCD can present in many different ways. Remember, only a qualified mental health professional can diagnose OCD following a thorough assessment of your personal situation and circumstances. If you’re concerned about the way you’ve been feeling, please don’t delay speaking with your regular healthcare provider or check out our anonymous online test below and see if one of our online courses could help.

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Common OCD Pairings

There are many different types of obsessions, and each type tends occur with a specific set of compulsions. Some examples include:

Some people with OCD feel intensely worried about being contaminated by germs, dirt, insects, asbestos, or bodily fluids. As a result, they try to avoid being exposed to these things and things that other people have touched, like door handles, toilets, or letters. If a person with OCD feels like they’ve been contaminated, they will try to ‘neutralise’ this feeling by repeatedly washing themselves or their work or home environment.

Sometimes people with this type of OCD worry that their food will be contaminated, or that they will accidentally poison themselves or someone they love. As a result, they’ll repeatedly rewash anything they touch and avoid handling food that will be eaten by others.

Other people with OCD have a pathological level of doubt. They doubt that they’ve turned appliances off, locked the door, sent that specific email, or written reports correctly. They have catastrophic worries because of these doubts, for example, that their house will be burned down, or they’ll be robbed or fired. As a result, they check these things over and over, often doubting that they just checked things properly.

Checking compulsions can also be triggered by obsessive thoughts about getting hurt or hurting other people. For example, repeatedly checking that a shadow on the road isn’t a person that they hit while driving, or triple checking that twigs or cracks on the ground aren’t dangerous objects, like syringes.

It’s also common for people with OCD to have obsessive thoughts about a loved one getting hurt, and to worry that these thoughts will somehow cause this harm to happen. For example, if a person has an intrusive thought about someone dying while they walk through a door, then they will have a compulsion to go back and walk through the door again while thinking about their loved one being safe and well. This is called mental ‘neutralising’ or ‘undoing’, as the unpleasant thought is reversed and replaced with a good thought. These symptoms may be associated with a wide variety of everyday activities, including dressing, eating, drinking, reading, sitting, and walking.

People with OCD can also have unwanted and upsetting thoughts of harming themselves or other people. Common examples include violent mental images of injured family members or worries that you’ve forgotten about hurting a stranger. These thoughts are terrifying for the person with OCD and can result in some complex behaviours, such as removing all sharp objects from the house, refusing to drive, and repeatedly reassuring themselves that they haven’t and couldn’t hurt anyone. These kinds of obsessives are completely inconsistent with the person’s true beliefs and values, causing them to experience significant shame, fear, and distress.

Sexual obsessions in OCD are unwanted thoughts, images, or impulses that make you anxious or distressed every time they come into your mind. They are completely inconsistent with a person’s true values and desires, and as a result, are often associated with intense shame, embarrassment, self-loathing, and fear. Common examples include thoughts of molesting children, unwanted images inconsistent with a person’s sexuality, and impulses to inappropriately touch or stare at breasts or genital areas. Most people with this type of OCD respond to their thoughts by reminding themselves that they don’t want to act on their thoughts, and by trying to avoid situations where the thoughts are likely to occur.

How Common is OCD?

Approximately 1% to 2% of the population will be diagnosed with OCD at some point in their life. OCD can develop in both adults and children, although it normally emerges before a person turns 30. Boys usually show their first symptoms at a younger age than girls, so OCD is twice as common in boy children than in girls. In adults, the number of men and women with OCD is equal.  Once a person has developed OCD, it’s rare for it to resolve without treatment.

What is CBT?

Cognitive Behavioural Therapy for OCD

Cognitive Behavioural Therapy or CBT is considered to be one of the leading psychological treatments for OCD. All of our online courses use CBT strategies to help ease symptoms of OCD. Click below to see if CBT can help you tackle your symptoms to improve the way you feel.

How To Deal With OCD

The two most effective treatments for OCD are Exposure and Response Prevention (ERP), a type of CBT specifically developed to treat OCD, and medications called serotonin selective re-uptake inhibitors (SSRIs). Although OCD can be an intense and debilitating disorder, it can be effectively treated. ERP works for around 70% of people with OCD, and medication can significantly reduce the severity of symptoms. People with OCD can also benefit significantly from psychoeducation.

Psychoeducation

Psychoeducation refers to learning about what OCD is and how it works. This kind of information is very important. Many people can feel great relief after learning that their symptoms are a sign of a mental health disorder, rather than an immoral character. Psychoeducation can therefore alleviate some of the shame people with OCD feel, especially for those who have intrusive violent or sexual thoughts. Providing education for families or carers is also helps them understand what OCD is and how they can help.

The most important pieces of information for a person with OCD are:

  • Intrusive and unwanted thoughts are a sign of OCD, not an immoral or violent personality.
  • Having a thought about something is not the same as acting on this thought, and people with OCD are not more likely to hurt themselves or other people.
  • Treatment is effective, and there are many treatment options available. There is a suitable treatment for most people.
  • Recovery is the rule, not the exception.

Exposure and Response Prevention (ERP)

ERP helps people with OCD learn to gradually confront and overcome their fears. It involves:

  • Identifying your obsessions and compulsions.
  • Recognising that while compulsions can ease the anxiety triggered by obsessions in the short-term, they actually maintainanxiety in the long-term (as they prevent you from learning that your worries aren’t likely to happen).
  • Learning to challenge, reason with, give yourself space from your obsessions.
  • Learning how to effectively resist your compulsions, and that when you do, your anxiety (and the urge to get rid of it) will reduce with time.

Because of the distressing nature of OCD, ERP is best done with the support of a clinician with experience treating this disorder.

Medication

A type of antidepressant medication called Selective Serotonin Reuptake Inhibitors (SSRIs) can provide relief from OCD. However, the amount of improvement varies from person to person. Most people who benefit from medication usually find that the obsessions and compulsions are still there, but they are less frequent and distressing. While SSRIs help people manage the symptoms of OCD, they are not a cure, so they are most effective when used alongside ERP.

Examples of medications that have been shown to help with OCD include Fluoxetine (also called Prozac or Lovan), Sertraline (Zoloft), and Clomipramine (Anafranil). These drugs may be marketed under different names outside of Australia.

Interested in learning more?

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