Obsessive Compulsive Disorder (OCD) is a label most are familiar with but few understand. This disorder has been mislabeled as a descriptor for someone who has perfectionistic tendencies and cares too much about order and cleanliness. The phrase “I am so OCD” gets thrown around like it is a quality that someone can have a little bit of. This may be, in part, due to the portrayal of OCD in media where certain characters exhibit symptoms for comedic effect. Characters such as Sheldon Cooper from The Big Bang Theory or Adrian Monk from Monk may come to mind when someone without firsthand experience thinks of OCD. Though these characters may have comical quirks, OCD is far from funny and can be highly disruptive and distressing for individuals living with it.
What is OCD?
OCD is not just a person caring about order, detail, or a desire to have things clean, it is a disorder of the brain which causes the person to feel trapped in an overwhelming cycle of obsessions and compulsions. According to the International OCD Foundation [IOCDF], “obsessions are unwanted, intrusive thoughts, images, or urges that trigger intensely distressing feelings. Compulsions are behaviors an individual engages in to attempt to get rid of the obsessions and/or decrease his or her distress,” (IOCDF, n.d.). This cycle is time consuming and disruptive to the individual’s daily life, and they often do not feel there is a choice of whether or not to engage in it.
What are Obsessions and Compulsions?
Obsessions are thoughts, images, or urges that are disturbing and can create a fear response for the individual experiencing them. In addition to this fear, there can be feelings of disgust, doubt, or an urgency to achieve a “just right” feeling, (IOCDF, n.d.). Obsessions are not visible to others, but for the one experiencing obsessions, they are highly distracting and upsetting. So there is a natural tendency to want to get rid of them. Obsessions can take many forms, and an individual suffering from OCD often experiences multiple categories of obsessions. Common categories include contamination, losing control, harm, perfectionism, unwanted sexual thoughts, and religious obsessions called Scrupulosity.
Compulsions are behavioral or mental actions taken with the goal of alleviating distress caused by the obsession. Compulsions can take the form of outward behaviors such as tapping, washing, ordering, repeating or checking and can also be in the form of mental compulsions such as counting, which are often unnoticed by observers. For instance, fearing germs or contamination may lead to hand washing rituals, or doubting oneself can be followed by checking behaviors. The biggest challenge with compulsions is that they only provide temporary relief and do not eliminate the obsession. Instead, rituals often grow and become more elaborate and disruptive over time.
Why this cycle happens
The cause of OCD is relatively unknown, but there are biological and genetic components recognized in most theories. In the book Mindsight, Daniel Siegel (2010) explains how the OCD brain misfires danger cues in the absence of danger and causes this cycle of obsessions and compulsions to occur. He says, “the activation of survival reflexes and the emotion of fear push our cortical areas to find danger…sometimes when the sense of danger is only our brain’s creation” (p. 242). Producing a misconceived sense of danger, there is a physiological response from the fight-flight-freeze system, the fear-producing amygdala, and the worrying and planning prefrontal cortex. Together, the mind and body tell the person with OCD to get rid of the perceived threat in any way possible.
Treatment for OCD
OCD is complex and affects every individual differently. However, it is treatable, and a person suffering from this disorder can experience relief. One of the most recognized and successful approaches is a form of Cognitive Behavioral Therapy called Exposure Response Prevention (ERP), which involves exposing the person to the obsession while preventing the compulsive response in order to break the link between the two. This is done with a therapist who will help the individual create a hierarchy of exposure-based exercises to address the various areas OCD symptoms are present and, ultimately, help the individual receive freedom from the cycle. In addition to therapeutic intervention, a form of medication called selective serotonin reuptake inhibitors (SSRIs) has been known to be effective (IOCDF, n.d.). Treatment can take form with either intervention or a combination of the two.
As noted above, OCD is no joking matter and can have a severe and debilitating impact on an individual’s life. It is important for people with this disorder to be taken seriously, and support from others is foundational to recovery. It is recommended to consult a professional to determine the best course of treatment and to gain further education on ways these symptoms are being maintained and how to break the bond between obsessions and compulsions.
International OCD Foundation. (n.d.). Retrieved from https://iocdf.org/.
Siegel, D. J. (2010). Mindsight: the new science of personal transformation.New York: Bantam Books.