Obsessive Compulsive Disorder (OCD) is a condition characterized by obsessions, which are typically experienced as intrusive and bothersome, and/or compulsions, which are performed in response to obsessive thinking, and/or with the aim of reducing distress. In those with OCD, obsessions and compulsions are time-consuming, typically cause significant distress, and lead to impairment in major areas of everyday functioning (e.g., relationships, occupation, self-care).
Obsessions and compulsions can be unique and varied, but generally fall into one of several broad categories (Leckman et al., 2010):
- Over-Responsibility, Harm/Checking
- Aggression, Religious, Sexual
Examples of types of obsessions and compulsions appear below.
Individuals with obsessive thoughts about attaining symmetry or ordering items in their environment often are worried that some negative outcome will arise if items are not arranged in a particular order. Some individuals report experiencing uncomfortable sensory phenomena and perform compulsions until they attain a “just-right” feeling or “complete” sensation.
Individuals with obsessive thoughts about contamination tend to believe that they will become sick as a result of encountering contaminants in the environment. Cleaning is often a compulsive behavior that accompanies obsessions about contamination as the behavior may serve the purpose of reducing the risk of coming into contact with germs.
Over-Responsibility, Harm/Checking or Counting
Individuals experiencing intrusive thoughts related to responsibility or harm tend to believe that an action they have taken, or an action they might refrain from taking, might result in loss or harm to another individual. For example, a person might think they left the stove on, which could lead to others becoming injured if a fire were to start, or if the door were left unlocked their home might become burglarized. Others might have obsessive thoughts that a comment they made offended someone or if they stop an activity on a certain number another person will be harmed. Individuals with these types of thoughts tend to compulsively check their environment, may avoid certain numbers, or seek reassurance from others (e.g., return home to check that the stove is turned off, the doors are locked, eat 10 chips instead of 9 chips, apologize excessively).
Aggression, Religious, Sexual
Individuals who have obsessions in this domain tend to experience intrusive thoughts that they consider inappropriate, such as thoughts about explicit sexual acts, fear of being a pedophile, concerns about their sexual orientation, violence against others, and demeaning thoughts about others. Individuals experiencing these types of obsessions may engage in mental rituals to try and neutralize these thoughts.
It is important to note that a clear link between particular obsessions (e.g. encountering contaminants) and compulsive behavior (e.g., cleaning) is not always evident. For example, some individuals with OCD report engaging in compulsive cleaning but do not endorse experiencing intrusive thoughts about germs (Julien et al., 2006).
Dr. Chok uses a combination of Exposure and Response Prevention (ERP) Therapy and Cognitive Therapy (CT) when working with individuals with OCD.
ERP is a popular approach to treating OCD because it has been associated with a high success rate (Foa & Kozak, 1996). Exposure and response prevention therapy involves assisting clients in making contact with situations that typically bring about obsessions and compulsions and learning to let their bodies experience discomfort until it dissipates. With the support of a therapist and repeated contact with such situations, individuals typically begin to feel less and less distress. Individuals in therapy learn that they can change their thoughts and sensations without engaging in rituals, which typically are used to reduce distress prior to treatment. Exposure and response prevention works well for many individuals who pursue this treatment, but it is less effective for those who only experience obsessions, but do not engage in compulsive acts (Rachman, 1976a).
Cognitive Therapy is also used to treat OCD, and can be helpful for those whose main difficulty is obsessive thinking. Individuals with OCD have been found to often experience cognitive biases, such as an inflated sense of responsibility, magnification of potential threats in the environment, thought-action fusion (e.g., “If I think someone might get in accident, it will be more likely to happen,” and “thinking about inappropriate sexual behavior is just as bad as doing it”), and an excessive need to control one’s thoughts (Abramowitz et al., 2006; Wheaton et al., 2010). Cognitive therapists work with individuals with OCD to help them alter these maladaptive thinking patterns, which in turn can lead to a reduction in obsessive thinking and distress.