Obsessive Compulsive Disorder

What is OCD?

Obsessive compulsive disorder (OCD) affects millions of people from all walks of life. The exact cause of OCD is unknown, however research shows there may be a genetic component. OCD impacts people of all backgrounds, regardless of race, ethnicity or gender and usually appears in childhood, adolescence, or early adulthood. An estimated 1 in 40 adults, and 1 out of every 100 children is affected by OCD. People with OCD experiences obsessions and compulsions. 

Obsessions are intrusive and unwanted recurring thoughts, images, impulses, and doubts that cause distress and feel outside of the person’s control. Common Obsessions in OCD include but are not limited to:

  • Responsibility for harm or mistakes
  • Contamination
  • Violence and aggression 
  • Unwanted sexual thoughts
  • Order and symmetry 
  • Religion and morality (scrupulosity)
  • Perfectionism

Compulsions are repetitive behaviors that the person feels compelled to perform in order to ease their distress or anxiety or suppress the thoughts by neutralizing, counteracting, or making their obsessions go away. These become ingrained habits that take up time and interfere with life. Some of these behaviors are visible actions while others are mental behaviors. Common compulsions include but are not limited to:

  • Checking
  • Decontamination 
  • Ordering/arranging
  • Repeating 

There isn’t always a logical connection between obsessions and compulsions. People with OCD often experience a variety of obsessions and compulsions, and they may spend several hours every day focusing on their obsessions, performing rituals. If left untreated, OCD can be chronic and can interfere with a person’s normal routine, schoolwork, job, family, or social activities. Having OCD can be quite stressful and even debilitating. Proper treatment can help sufferers regain control over the illness and feel relief from the symptoms.    

What is the treatment for OCD?

The most effective treatments for OCD are Cognitive Behavior Therapy (CBT) and/or medication

Exposure and Response Prevention (ERP) is a type of Cognitive Behavioral Therapy specific to OCD and has the strongest evidence supporting its use. ERP involves directly exposing yourself to the thoughts, images, objects, and situations that triggers your obsessional thinking and unwanted internal experience while also resisting efforts to control or eliminate those experiences. 

A third-wave CBT developed primarily by Dr. Steven Hayes called Acceptance and Commitment Therapy (ACT) provides a fresh angle with which to understand and address OCD. ACT is an empirically-based psychological intervention that uses acceptance and mindfulness strategies mixed in different ways with commitment and behavior-change strategies, to increase psychological flexibility. ACT attempts to increase psychological flexibility through 6 core competencies:

  • Willingness & Acceptance
  • Present Moment Awareness (Mindfulness)
  • Self-as-Context
  • Defusion
  • Values
  • Committed Action. 

ACT emphasizes the futility of fighting against obsessions and anxiety and instead stresses the importance of changing how you relate to these and other unwanted private experiences so they don’t stop you from enjoying the present moment or what is important to you. ACT has been suggested to enhance the treatment outcomes of ERP.

The types of medication that research has shown to be most effective for OCD are a type of drug called a Serotonin Reuptake Inhibitor (SRI), which are traditionally used as an antidepressants, but also help to address OCD symptoms. 

Useful Terms

Acceptance: The willingness to experience unwanted and distressing feelings to stay consistent with doing what is valuable, necessary, and/or worthwhile.

Behavioral activation: An approach to depressed mood designed to increase your contact with positively rewarding activities despite the interference of depressed feelings.

Excessive reassurance-seeking: Internal or external attempts to reduce distress of uncertainty/doubt through self-talk, checking behaviors, or questioning others.  

Experiential avoidance: The attempt to avoid thoughts, feelings, memories, physical sensations, and other internal experiences over engaging in experiences that are adaptive and helpful in the long run.

Exposure and Response Prevention (ERP): Involves exposure to the feared stimuli (the exposure part of treatment) and simultaneous prevention of the ritual that is typically performed in the face of the anxiety-provoking stimuli or obsession (the response prevention part of treatment).

Functional analysis: A process that involves studying the behaviors and thoughts that occur before and after the target behavior occurs and assessing the function of each behavior.   

Habituation: A decrease in an individual's response to stimuli after the stimuli are repeated.

Inhibitory learning theory: Based on learning theory, an exposure process where an individual learns safety a safety signal that it is strong enough to inhibit the original fear response and previous obsessional fear. 

Intolerance of uncertainty: A distressing experience to perceived uncertain or ambiguous situations that includes negative cognitive, emotional and behavioral responses including worry and obsessions.

Psychological flexibility: The ability to stay in contact with the here and now despite distressing thoughts, feelings, and bodily sensations, while choosing one's behaviors based on the situation and personal values.

Thought-Action Fusion: The bias to interpret the presence of unwanted mental intrusions as morally equivalent to acting on them, and/or increasing the likelihood of the feared consequence occurring to either oneself or others.