Obsessive Compulsive Disorder is a debilitating anxiety disorder characterised by intrusive and unwanted repetitive thoughts and images (obsessions) which compel a person to do the same things over and over again (compulsions)
Obsessional thoughts and images are extremely distressing and disturbing. Rituals and compulsive behaviours can become a major distraction causing much distress, doubt and uncertainty.
WHAT ARE OBSESSIONS?
Obsessions in OCD are intrusive and unwanted thoughts, images and urges that happen over and over again. These persistent, never ending obsessions make a person feel they have no control over their thoughts and images and can generate feelings of extreme anxiety, distress and despair.
We know that intrusive thoughts or urges are common in the general population. Who has not worried that they may have left a door unlocked or left the cooker on? Purdon and Clark (1993) in a well known study listed common intrusive thoughts found in a non clinical population.
What this research has helped us to understand is that in OCD it’s not the thought that is the problem but the meaning that people give to the thought and how they react to it.
Compulsions in OCD are repetitive behaviours and thoughts which a person feels compelled to perform. Some compulsions can be seen and are overt e.g repeatedly checking a door is locked or washing your hands over and over again. Some compulsions are unseen and covert Unseen compulsions usually take place in the mind e.g counting. Many people often carry out their compulsions in secret.
Generally, compulsions are carried out in response to perceived threats of harm or something bad happening. They are repeated over and over again until someone “feels” clean or just right or comfortable.
COMMON TYPES OF OBSESSIONS
Obsessions in OCD are very varied but there are some common types and themes. The list below gives some order to the many different fears and is from a paper by Clark, David A.; & Radomsky, Adam S. (2014). Introduction: A global perspective on unwanted intrusive thoughts. Journal of Obsessive-Compulsive and Related Disorders.
- Germs/diseases e.g herpes, hepatitis, HIV
- Bodily fluids
- Household chemicals
- Environmental contaminants e.g asbestos, radiation
- Fear of harming others by being violent or aggressive e.g stabbing your child or partner
- Fear of harming yourself
- Fear of blurting out insults or obscenities in public
- Fear of stealing things
- Overwhelming fear of causing something really bad to happen to loved ones and other people e.g a fire, a burglary, death.
- Fear of something bad happening because you were not careful enough e.g dropping something and causing an accident
- Fear that a bad or nasty thought may cause physical harm to someone
- being overly precise, orderly or rigorous e.g having everything perfectly symmetrical
- worrying about losing or forgetting detail when throwing something away
- worries about losing things e.g wallet or purse
- worries about what you need to know or remember
- worries about what to keep or what to throw away e.g hoarding paper, clothes
Unwanted sexual thoughts
- worrying incessantly about your sexuality e.g being gay, transgender etc
- worrying about being a paedophile or acting inappropriately towards children
- worrying about perverse sexual images or thoughts
- preoccupation with what is considered to be right and wrong or morality
- worrying about being blasphemous or being offensive to God or other religious icon
Other types of obsessions
- overly concerned about getting a physical illness or a disease e.g cancer, death and dying
- overly concerned about causing someone else to get a physical illness or disease and dying
- extreme worries about good and bad outcomes associated with patterns, numbers, letters, colours, clothes etc
COMMON TYPES OF COMPULSIONS
There are many types of compulsions, the most common being checking and cleaning but there are a huge array of distinct and differing forms. The list below is taken from the NICE Guidelines published in 2005.
- Checking to make sure no harm comes to anyone e.g plugs, switches, doors, putting away knives etc
- Checking you have not harmed yourself
- Checking that something terrible has not happened e.g driving back to check you have not caused an accident
- Checking that you have not made a mistake e.g re-reading emails, letters etc
- Checking your body
Washing and cleaning
- Excessively washing your hands, face or arms
- Excessive bathing, showering, grooming, brushing teeth or toilet routines
- Excessively cleaning
- Taking excessive precautions to avoid, remove or prevent contact with contaminants e.g trying to avoid asbestos, blood, dog or human faeces.
- Rereading or rewriting letters, emails, books etc
- repeating routines
- repeating body movements e.g tapping, walking
- repeating tasks in multiples e.g taking 3 steps at a time, touching a door 7 times, checking a lock 9 times
- Mentally reviewing events to prevent bad things happening
- Praying to prevent bad things happening
- Counting to prevent smething bad happening
- Cancelling or replacing letters, numbers, patterns so that nothing bad happens e.g seeing a bad letter and looking for a good letter to neutralise it
Order and Symmetry
- Putting things in order or arranging things so they are “just so” and it feels right e.g ornaments, books or clothes hanging in a wardrobe
- counting steps
- counting aloud
- counting items
- mental counting
- special significant numbers e.g everything needs to be in 3’s
- inability to discard items because of a perceived threat or feeling of something bad happening if they do.
It is estimated that between 1 and 2 per cent of the population suffer with OCD. It is a serious disorder but is treatable.
Recovery is possible but sometimes it can be a struggle. Whatever happens please do not give up, take heart from ‘OCD Beard’ whose story is inspirational.