Obsessions & Compulsions Can Consume Your Life
Written by Lauren Helm, Ph.D.
OCD Awareness week is October 8th – 14th, an international effort started by the International OCD Foundation (IOCD) to spread awareness about Obsessive-Compulsive Disorder (OCD), which is estimated to affect 1 in 100 adults in the U.S. It is characterized by obsessions and/or compulsions that cause significant distress or impairment, or last more than 1 hour per day, on average. For each individual, OCD can look somewhat different, but the obsessions and compulsions that characterize OCD share certain features that we can learn to recognize with educated awareness. If you or someone you know has been diagnosed with OCD, you are probably aware of the tremendous suffering the disorder can cause. However, there are often many obstacles to getting diagnosed and treated. Not knowing the possible signs of OCD or that there are effective forms of treatment can block many from getting the treatment they need. This blog is intended to spread the word about some of the ways that OCD can manifest, and some of the ways that you or a loved one may seek help.
Getting to Know Obsessions
Do you struggle with thoughts or images that you found disturbing or unwanted, that repeatedly invade your mind, leaving you exhausted, worn thin and on edge from the endless battle they invite? Perhaps these thoughts are so opposite to who you see yourself to be, they make you shudder, and cringe at the fact that they crossed your mind…and yet they will not leave you alone, returning again and again, no matter how much time you spend monitoring your thoughts, no matter how hard you try to push them away when they appear, and how much energy you expend at attempts to ban them from your awareness.
You might feel confused or disgusted when you find yourself imagining doing something uncharacteristically sexual or violent, and terrified by the fear that you will act on the impulse. You might be unable to overcome the fear that you will accidentally cause someone harm or death, such as causing an accident while driving or dropping a sleeping infant. You might be tortured by terrible, frightening or disgusting images that violate your mind, the immoral or blasphemous images “tainting” who you are. Thoughts of contamination or of becoming ill might plague your mind, making your body and the environment feel constantly unsafe and in need of cleansing.
These examples of obsessions are not all inclusive, but are examples of common types of obsessions that those with OCD may experience. Obsessions are intrusive, unwanted thoughts, images, impulses and doubts that cause substantial distress and suffering, such as intense anxiety, shame, guilt or disgust. Although obsessions manifest somewhat differently for each individual, the common themes that underlie unwanted thoughts, images or impulses can be thought of as violations of the integrity of the body, mind, spirit, or sense of self/identity. Obsessions may be thoughts about contamination or illness, causing violence or harm to others, violating others, losing control, imperfection, engaging in religious blasphemy or moral violations, or unwanted sexual thoughts. The person suffering from obsessions does not actually act on these thoughts, but is often tortured by the fear of doing so and of what these thoughts mean about their character. Some people with OCD are preoccupied with “doing the right thing,” avoiding harm, or maintaining “purity” of the body (and/or mind or spirit), and the content of obsessions often feel particularly incongruent with who they are, adding to the spiral of confusion and distress, and fueling the motivation to heavily guard against these thoughts. To find relief, many individuals begin engaging in compulsions. A vicious cycle is created - the more that threatening, unwanted thoughts are pushed away, the more they return with ferocity and power.
Getting to Know Compulsions
Do you feel an uncontrollable urge to arrange things until they feel “just right,” becoming upset or agitated if you are prevented from doing so? Or perhaps the need to wash your hands again and again to eradicate a sense of contamination, experiencing a sense of urgency and need to get rid of the feeling of being “dirty” as thoroughly and quickly as possible? Do you have a hard time leaving the house without repeatedly checking that the door has been locked more than once or twice, even driving back home long distances because of lingering doubt? Do you find yourself compelled to count to a certain number, or in multiples, to get your mind to finally let go of an obsession, or to feel safe again? Do you feel you have to eat the food on your plate in a certain order or specific rotation of your plate else you won't eat because of anxiety? Are you always asking others for reassurance to make things feel “right again,” to the point that both you and others are feeling burnt out from the constant need for reassurance? Do you compulsively mentally rehash events again and again, in a sort of mental loop without reprieve, looking for a way to prevent a feared outcome?
To contend with the power of obsessive thoughts, images or impulses, those with OCD may engage in compulsions, which are mental or physical behaviors that are intended to neutralize or reduce distress caused by obsessions, as well as the perceived likelihood of acting on obsessive thoughts/impulses. Compulsions can be thought of as a coping strategy, a way of getting relief from the overwhelming nature of obsessions. The short-term emotional relief that comes after engaging in compulsions is thought to reinforce continued obsessions and compulsions in the long-term. Compulsions themselves can be distressing, extremely time-consuming, and difficult to resist, leading those who suffer from OCD to feel at the mercy of their obsessions and compulsions.
The Cost of OCD
Both obsessions and compulsions can eat into individual’s lives, taking up more than 1 hour per day (sometimes occupying most or all of a person’s waking hours in severe cases). Not only do obsessions and compulsions cause emotional distress, they also can interfere with a person’s ability to function socially, within the workplace, or academically. Family members or loved ones are also often affected, as it can be hard to watch their loved one with OCD suffer, and to not know how to help. Sometimes, others in the person with OCD’s life can unknowingly reinforce obsessive-compulsive behaviors when trying to help.
Treatment for OCD
The good news is, there are effective psychological and pharmacological treatments for OCD. Research strongly supports use of cognitive behavioral treatment (CBT) with Exposure and Response Prevention (ExRP or ERP) for helping those with OCD get relief -- a therapist who uses ERP will help someone with OCD to confront and respond differently to obsessions and the distress obsessions cause, and to avoid compulsions and other behavioral patterns that reinforce or maintain OCD. Additionally, SSRI medications have been found to reduce symptoms in OCD (you can ask your medical doctor or psychiatrist for more information about medication treatment options for OCD).
As mentioned above, OCD Awareness week is happening soon, and the IOCDF has events that will occur throughout the week in various cities. IOCDF's website has information about about events happening near you, as well as informational resources and tools. A very informative list of common obsessions and compulsions can be found on the IOCDF website here. IOCDF also has a search tool for finding therapists in your area that work with OCD. The American Association for Anxiety and Depression (ADAA) also has free educational resources and links for support groups, apps, and a therapist search tool.
If you are concerned about possible signs of OCD in yourself of someone you care about, please know that there is hope! You are not alone, and there are many resources available for support.
Although it can be very helpful to learn about signs of OCD, and tempting to self-diagnose, please remember that a diagnosis of OCD can only be made by a qualified and credentialed mental or medical health professional. If you do not already have a treatment provider who treats OCD, the first step is to find a qualified mental health professional (preferably someone who specializes in OCD). You can ask your family doctor or primary care doctor for referrals. A medical doctor (MD) can also discuss medication treatment options with you - it may be helpful to work with a psychiatrist who specializes in working with OCD if possible.
In order to find a psychotherapist who can perform CBT and ERP, you may search online therapy directories that focus on OCD and anxiety, such as online directories offered by ADAA or IOCDF, or your local state psychological association. It can be helpful to know what to look for in a potential therapist, because not all therapists use the type of treatment modality that is recommended as first-line of treatment (exposure and response prevention). This article by the IOCDF provides tips for what to look for during your search for a therapist, and what you might ask a potential therapist. Finding a treatment provider that you trust can help you stick it out even during the really challenging up's and down's that will inevitably be a part of your recovery process.
In addition to seeking therapy and/or medication treatment, you may look into local support groups for OCD as well. OCD Seattle, a local organization, has information about support groups in the Seattle area.
If you'd like to speak with Dr. Lauren Helm, a licensed clinical psychologist at Rise Psychology, for help with OCD, anxiety, or related issues, please click here. Dr. Lauren Helm is trained in using CBT and exposure therapy to treat OCD.
Clark, David A.; & Radomsky, Adam S. (2014). Introduction: A global perspective on unwanted intrusive thoughts. Journal of Obsessive-Compulsive and Related Disorders. Available online 18 February 2014. DOI: 10.1016/j.jocrd.2014.02.001 http://www.sciencedirect.com/science/article/pii/S2211364914000128 ↩
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