We often talk about being obsessed with something, like a song, a food, a person. Though it is true that it may be hard to get your mind off of these things, they are not necessarily upsetting to think about. In the case of obsessive-compulsive disorder, or OCD, the obsessions always cause anxiety. OCD obsessions are intrusive thoughts, images or urges that you do not want to have and cause significant distress. The obsessions, unlike worries in generalized anxiety, can be a little strange, like wondering if you may have hurt someone accidentally, thinking something bad might happen if you don’t do or say something, worrying about your cloths being contaminated and getting you or someone you care about sick.
Most obsessions fall into these categories:
- Contamination, fears you will “catch something” or be poisoned by touching a surface or object
- Harm or aggression, thinking you caused or will cause physical or emotional harm to yourself or someone you care about
- Forbidden sexual or religious thoughts, that threaten your sense of being a good or decent person
- Symmetry or exactness, having a general sense of discomfort unless things are “just so,” or done in a certain way
Compulsions are the things you do to attempt to decrease the anxiety that the obsessions cause. They are repetitive behaviors or mental acts that you have a strong urge to do. They are unlike a normal routine, in that they take up more time than you would like them to. Much like obsessions, you may know they are excessive or unreasonable, but this does not make them any easier to resist.
Common compulsions are:
- Checking that you did not forget something, make a mistake, cause harm or turn something off.
- Cleaning or washing your hands or body, cloths or belongings, or using hand sanitizer
- Repeating like touching or tapping things, going in and out of doorways, blinking or body movements, rereading, erasing or rewriting things.
- Ordering or arranging things like having all your cloths color coded, things lined up at right angles, or your room or desk arranged in a certain way.
- Mental compulsions like making mental lists, using or avoiding certain numbers, words or phrases, repeating prayers, trying to remember things.
Exposure and response prevention therapy (ERP) is a form of cognitive-behavioral therapy that has been shown to be highly effective in treating OCD. You can learn more about this type of therapy by listening to a Podcast with Dr. Jonathan Abramowitz, a leading expert in the treatment of OCD.