What is Obsessive-Compulsive Disorder (OCD)?
OCD is a term used often in popular culture, but it may be helpful to clarify just exactly what OCD is. It is not just when people are clean and organized or meticulously arrange the clothing in their closet by color; it is a potentially extremely distressing psychological disorder. It stands for obsessive-compulsive disorder and like the same implies it typically includes obsessions and then some type of compulsive behavior.
Obsessions are recurrent and persistent thoughts, urges, or images that are experienced as instructive and unwanted and that caused marked anxiety or distress, which the individual then attempts to ignore or suppress.
Compulsions are repetitive behaviors such as handwashing, ordering, checking, or mental acts (e.g., praying, counting, repeating words silently) that the individual feels driven to perform in response to an obsession aimed at preventing or reducing distress or preventing some dreaded event or situations.
The compulsive behavior is an attempt to stop the obsessive thoughts, but it doesn’t work, at least not for long, and people can find themselves stuck in a cycle of engaging in compulsive behaviors, sometimes for hours of their day to the determinant of their work, relationships, etc. Not everyone with OCD experiences both obsessions and compulsions, sometimes they just experience obsessive thoughts, which is sometimes referred to as "pure O."
The Mindfulness Workbook for OCD, which I often use with clients, lists several different unofficial subtypes of OCD:
Contamination OCD: obsessive thoughts about germs that can lead to excessive hygiene behaviors
Responsibility/checking OCD: obsessive thoughts related to being irresponsible in some way that can lead to excessive checking behaviors
Just right OCD: obsessive thoughts related to symmetry and organization that can lead to behaviors that "fix" things
Harm OCD: obsessive thoughts of a violent nature such as fears about harming others or yourself; it is not the same thing as experiencing thoughts of suicide or homicide as the fear is related to loss of control and not indicative of an actual desire to cause harm
Sexual orientation OCD (HOCD): obsessive thoughts related to not being certain of your sexual orientation; it is not the same thing as "questioning" as the fear is related to uncertainty, not about being of a certain orientation
Pedophile OCD (POCD): obsessive thoughts about being a pedophile; it is not the same thing as actually being attracted to minors
Relationship OCD (ROCD): difficulty tolerating uncertainty about the quality of a relationship and the genuineness of your feeling about another person; it is not the same as "normal" doubts as the fear is about a lack of certainty not about the relationship or partner themselves
Scrupulosity OCD: obsessive thoughts about failing to adhere to the rules of a religion or philosophy
Hyperawareness OCD: somatic obsessions or obsessions about things such as breathing, blinking, swallowing, body position, physical sensations, ringing in the ears, eye "floaters"
There is also obsessive-compulsive personality disorder (OCPD), which is not characterized by obsessive thoughts or compulsive behaviors, but rather an overall pattern of preoccupation with orderliness, perfectionism, and mental and interpersonal control, at the expense of flexibility, openness, and efficiency.
The gold standard of treatment for OCD is exposure and response prevention (ERP). ERP involves exposing yourself to the obsessive thoughts without responding with the compulsive behavior. For example, someone with contamination OCD might touch a doorknob without washing their hands. This is an example of an in vivo exposure or an exposure that happens in real life. There are also imaginal exposures, which you practice in your imagination. Imaginal exposure can be useful when it is not realistic to exposure yourself to your obsessive thoughts through some kind of action. For example, if someone has harm OCD, they might imagine stabbing a loved one. Therapists will often have people with OCD create a hierarchy of the things that cause distress with the most distressing thing at the very top of the list and work their way up starting with the least distressing thing. The idea is that you habituate to the distress and that it subsides.
I also like to integrate mindfulness-based interventions into the treatment of OCD. Put simply, mindfulness is being present with your experience without judgment or with kind awareness. This can be incredibly helpful in terms of treating OCD. How? It can help people learn how to be present with their obsessive thoughts without being distressed by them. For example, someone who has sexual orientation OCD and is concerned about thoughts they have related to homosexuality can use mindfulness or nonjudgmental awareness to recognize that these thoughts are simply mental events. See oftentimes, people with OCD are overidentified with their thoughts. They may think that even having a certain thought, such as homosexual thoughts for example, makes them bad and try to stop or control these kinds of thoughts through mental compulsions, but this typically increases distress. Mindfulness teaches people with OCD how to be present with their thoughts without identification, thus reducing distress and eliminating the need for compulsions.
You can learn more about OCD here, at the International OCD Foundation, or Beyond OCD. In terms of workbooks, I recommend the Mindfulness Workbook for OCD. You may also be interested in the app NOCD. You can also check out my book!
Please note that the information in this blog is intended for informational purposes only. It should not be used as a substitute for psychological or medical care. If you are looking for professional help, visit my resources page for guidance on how to find a therapist. If you are experiencing a mental health emergency, call 911 or go to the nearest ER.