Obsessive Compulsive Disorder

What is OCD?

Obsessive-Compulsive Disorder, or OCD, involves having obsessive thinking patterns that can include unwanted thoughts, images, or urges that make a person feel anxious, uncomfortable or distressed (obsessions) and repeated mental and/or physical behaviors intended to reduce the anxiety or discomfort (compulsions). These obsessions and compulsions are time consuming and cause impairment in functioning and or excessive distress for the individual.

Common forms of OCD

• Uncertainty/Fear of Scary Outcome: Sufferer worries "What if [insert outcome] occurs?" The fear centers around a specific "theme" or multiple themes, such as one's sexuality, possibility of or desiring harm on others, being a "bad" person, and many more (the list is endless, as people with a predisposition for OCD equally have a predisposition for creativity!)
  
  It is common for an OCD sufferer with this form of OCD to avoid songs, articles, books, movies/videos, pictures, words, and situations associated with their theme of worry. While the list of possible compulsions is endless, common compulsions for this form of OCD are seeking reassurance from others that the feared outcome will not occur, self-reassurance, mental reviewing and checking, excessive researching (often on internet) about the validity of one's fears.

The most common areas of avoidance for this form of OCD are close contact with others viewed as potentially contaminated and objects with which other people come into contact, with intensified avoidance around objects/locations associated with bodily waste and frequent public use, such as restrooms, doorknobs, trash cans, light switches, and restaurants. Common compulsions are excessive hand washing and showering with excessive use of soap, excessive use of hand sanitizer, visually scanning the ground for "contaminants" while walking, mental reviewing, self-reassurance, reassurance seeking, taking "safe" paths to go from one place to another, excessive disinfecting of home and washing of clothing.

• Disturbing, Unwanted, Morbid Thoughts or Images. Often involves worries about what the intrusive thoughts mean about the OCD sufferer.

It is common for sufferers of this form of OCD to attempt to avoid thoughts associated with this theme, which paradoxically leads to more frequent and intense intrusive thoughts/images. Additionally, sufferers will avoid symbolic reminders of their theme, such as songs, videos/movies, books and other media depicting their theme. If worried about their capacity to act on the morbid thought/image or that the intrusive thought itself means that they secretly desire or want to act on the thought/image, the sufferer commonly avoids being in situations in which they might act on the thought/image (avoids being near children, holding knives near people, petting their dog, etc). Common compulsions are having "good," neutralizing or "fix it" thoughts that temporarily cancel out the "bad" thought, seeking reassurance from others, self-reassurance, distracting oneself from the thoughts, repeating actions while having "good" thoughts. As people with the predisposition for OCD equally have a predisposition for creativity, the list of possible compulsions is infinite.

• Bodily or Sensory Discomfort, Feeling “Wrong” or Feeling of Incompletion

It is common for sufferers of this form of OCD to avoid situations that might "trigger" urges to perform compulsions, such as avoiding walking through specific areas of one's home or beginning an activity that might trigger the need for completion. Common compulsions are repeating actions until it feels "right" or a "good" number of times (versus a "bad" number of times), moving objects in a specific way, stopping and waiting until it feels right to transition to next step in activity, repeating steps through doorway, combining specific repeated movements with a thought to make it feel right, and demanding that loved ones or others repeat specific phrases or words or perform certain actions before moving on with next action.

How OCD thrives: OCD exploits the sufferer’s instinct

The OCD sufferer responds to their "false alarms" in the intuitive way. By listening to their feelings, which tell them to escape (compulsions) and avoid.

Escaping and avoiding maintains and strengthens OCD over time through negative reinforcement (relief) and prevents the healthy learning (and associated healthy brain changes) that would happen if the sufferer remained in the presence of their OCD related fears, discomfort or other difficult emotions.

Essential in overcoming OCD (How is OCD treated?)

Remaining in the presence of the stimulus (including thoughts) that automatically elicit negative emotions (Exposure) without escaping from unwanted emotions (Response Prevention). Exposure and Response Prevention (ERP), the evidence-based treatment for OCD, involves planned activities with the goal of facing these triggers.

This allows for habituation (getting used to or bored of the triggers) and violation of predictions (things person expects to occur do not and/or the person builds confidence in one's ability to cope).

We engage in ERP with our clients in a collaborative way. This means clients are not forced, tricked or pressured to move beyond where they are ready and every step in treatment is agreed upon before proceeding. We understand that ERP treatment is among the most difficult (but among the most effective) types of treatment and that coming to treatment requires courage and trust in your clinician.