Obsessive Compulsive Disorder (OCD) is an anxiety disorder the causes the person to experience unwanted, and intrusive thoughts to come into the persons mind that causes them to become increasingly anxious. The person then begins to perform compulsive, ritualistic behaviour in order to rid themselves of those unwanted emotions. Over time, the behaviours give more meaning to the thoughts, causing the person to feel stuck in a loop between thoughts, feelings and behaviours.

What are obsessions?

Obsessions are reoccurring thoughts, images or impulses that come into your head, which seem to intensify the more you try to push them away. These obsessions tend to only exist around areas that the sufferer cares about, which in turn make the person begin to feel extremely anxious and out of control. For example, “I really love my partner, but I am worried that I cheated on them last night”. Obsessions can exist around almost anything, although common traits include those centred around feeling overly responsible for something, desperately wanting certainty around a particular subject or generally feeling distressed by the content that comes into person head. To control these obsessive intrusions, the sufferer begins actively performing behaviours to rid themselves of such thoughts, giving those very thoughts more meaning than if they learnt to simply ignore them.

What are Compulsions?

Compulsions can be anything that the person does to neutralise or take away the unwanted feeling that originates form the obsession. Common examples include repeatedly checking, seeking reassurance from loved ones, self soothing and reassuring through mental checking, washing, rumination and avoidance. Compulsions can be broken down into two different types of compulsions, those that we can see that take place outside of the body, and those that happen solely inside of the head, known as rumination or mental problem solving. Compulsions give the illusion to the person that they can take away the anxiety experienced from the obsession, but in fact it is the compulsions which make the person more anxious in the longer term.


Before reading over the different types of OCD below, we want to clarify that this is simply just to help you make sense of your symptoms. Although it can be helpful to obtain some clarity around your OCD symptoms, it is also important to recognise that most peoples symptoms are likely to encompass two or more of the below themes. It is also common to display symptoms from almost every theme, so if this is you, please don’t panic. A more accurate way of viewing your condition is to think of your OCD as hijacking any area of your life that you care about. This is what causes the symptoms to manifest.


responsibility

If you have OCD you may have an over inflated sense of responsibility. This means that you believe you have the power to either cause or prevent bad events that are personally important to you. ‘Magical’ thinking, which is the act of performing special actions to prevent something happening (an extreme form of superstitious thinking), is closely related to this. It makes you feel more comfortable, as if you had more influence and control over what happens. With responsibility OCD, the sufferer places great importance on what they do, their actions, their thoughts, their decisions, most elements in their life become a challenge, as they often feel what they do will end up with catastrophic consequences. Things feel like life and death, like it does for any type of OCD.


contamination

Contamination OCD refers to the fear of becoming personally contaminated through one’s own actions, being contaminated by others, contaminating others, or different combinations of any of these. The fear of coming into contact with either real or magical things viewed as harmful. The real things may include viruses, bacteria, bodily waste or secretions, people who appear ill or unclean, poisons,· radiation, or toxic chemicals.The magical things may include bad luck, the names of illnesses, or the misfortunes of others. Often this can lead to a sufferer displaying the very common behavioural compulsion of hand washing although this is but the tip of the iceberg. Other behaviours can include avoiding certain places which my ‘feel’ contaminated, mentally ruminating about events, washing the entire body time and time again, asking others for reassurance. The list goes on.


checking and counting

Checking rituals can be a result of all types of obsessions, including fears of harming accidentally, fears of harming impulsively, or sexual obsessions. The purpose of compulsive checking is to reduce distress associated with uncertainty or doubt over feared consequences for oneself or others. For example, a person who worries about causing harm by not being careful enough, may have the thought that if they check that the door is locked, they will be assured that no one will break in.

Whereas some checking is cued by specific situations (e.g. leaving the house) and reminders (e.g. light switches), in other instances it is performed in response to random thoughts that just pop into the mind and are considered dangerous. People with these types of obsessions, may believe that if they think of a bad event, it is more likely to happen. Counting rituals is often a compulsion with many suffering from OCD. This is also closely related to feeling that everything needs to be symmetrical, counting a certain number of times until it feels right, or the inability to walk through a door threshold until it feels safe to do so.


Those suffering with Scrupulosity hold strict standards of religious, moral, and ethical perfection. For example, if held in a black and white view, certain passages in the Bible and other religious texts may carry with them intense burdens of condemnation. In holding a strict view of these religious verses, the Scrupulosity sufferer experiences not just intense guilt, but also anxiety about the threat of eternal punishment for having violated religious precepts. Without having chosen to experience these obsessions (OCD thoughts being both intrusive and unwanted), the individual experiencing Scrupulosity feels an overwhelming urge to take whatever compulsive action offers the promise of relief.

scrupulosity


Perfectionism is one of the most common personality traits in OCD. Indeed, some researchers have described obsessive-compulsives as the ultimate perfectionists. There is an element of perfectionism that runs throughout almost any sub type of OCD. Perfection simply doesnt exist, howecer, this doesn't stop many people striving for what they believe perfect to be. Occasionally an individual may feel that trying to do everything perfectly is the main driver behind their OCD experience, in which case this would be classed as 'perfectionist' OCD as a sub type. 

perfectionism 


This form of OCD can manifest from an irrational belief that one has the power to control and prevent dangerous situation’s from happening and the distorted belief that one can control and prevent outcomes by doing safety seeking behaviours to prevent the imagined scenario from happening.

magical thinking


The imagination can play a great role in this type of OCD. The sufferer may have a fearful image pop in to their minds, and they become worried that the image may of happened. They struggle to separate imagination from reality.

false memory 


This form of OCD is driven by the need to find the right answer. Pure O tends to manifest as a question followed by the need for certainty that leads to obsessional mental rumination. Like any compulsion, rumination can take up many hours of an OCD sufferers day. Where this type of OCD differs is that compulsions are purely non observable, meaning that they all take place within the mind through mental problem solving. Many clients that suffer from Pure O describe feeling exhausted almost all of the time. This is due to the amount of brain activity, and glucose that is being used during a period of rumination. The pre-frontal cortex is also over active during mental problem solving (the frontal region of the brain), leading to confusion and experiences of mental cloudiness. 

Purely Obsessional OCD (Pure O)


Some people with OCD have obsessions surrounding the way objects are arranged.  These people may feel very uncomfortable when confronted with situations where objects are misaligned or in disarray. On a related note, some people may be made uncomfortable when something does not appear perfect. They may not be able to tolerate having written something where the letters may be shaped imperfectly. Individuals with obsessions about symmetry and exactness may have magical thinking associated with their concerns. For example, they may worry that their mother will have accident unless things are in the right place. In other cases, the need for symmetry may just “feel right”.

Symmetry OCD


A common form of OCD is health obsessions. The sufferer cannot find the reassurance they so desire and obsess they may have an illness that is life threatening. No matter how much reassurance they have they always doubt it. Common compulsions can include researching, seeking reassurance from loved ones and repeatedly visiting the doctor or hospital for tests and check ups.

health related ocd


Common Obsession and Compulsion Pairings


Contamination Obsessions and Washing Rituals

These obsessions often present themselves when the person has come into contact with something that they perceive to be contaminated. Often this can include objects that other people may have touched, such as phones, pens, chairs, toilets and in some more severe cases an entire place or country can feel contaminated. Often particular concern varies from person to person, but may involve a fear of contamination with germs, dirt, faeces, urine, saliva, bodily fluids, insects and rodents, asbestos, or HIV to name a few. The compulsion with this type of obsession is usually centred around ritualistic hand washing or excessive amounts of time spent showering. Some will go as far to wash in bleach, in order to remove the feeling that they are contaminated. Through associative thought patterns, the person may also feel that they are then contaminating people around them, often loved ones, fuelling more meaning to the intrusive thoughts.


Pathological Doubts and Checking Compulsions


Although checking compulsions often start with leaving the house, and having to repeatedly check things like whether the window and doors are locked before leaving, this typeof OCD regularly becomes increasingly time consuming. Other thought processes that may lead to the person feeling anxious can include leaving household appliances on. Examples include the gas stove, plug switches, lights, curling tongs and hair straighteners etc.

The consequences for the person are usually related to feeling like their home may be burgled, burnt down, or generally that an intruder will invade their personal space, sometimes including the fear that the intruder will poison them or their loved ones. Other doubts can include worrying that they have harmed someone when driving, or thinking that they may be walking on dangerous objects like shards of glass or syringes.


Magical Thoughts and Neutralising Rituals


These obsessions typically revolve around having constant intrusive thoughts of either themselves or a loved one coming to harm. However, as intrusive thoughts stem from the imagination, it is common to also experience intrusive thoughts such as:

  • Whether the person exists

  • The meaning of life

  • Whether there is a Heaven or Hell

  • Thoughts that feel like memories

  • Thoughts around certain numbers being lucky or unlucky

The manifestation of compulsions around these intrusive thoughts include walking back through door thresholds and thinking certain thoughts to neutralise the unwanted thoughts, mental problem solving, ruminating internally until the person finds a particular answer, or counting repeatedly until the anxiety subsides and the person feels ‘just right’. There can also be a tendency for every day activities to become increasingly difficult, such as walking, talking, eating, reading, socialising and washing.


Violent Thoughts and Associated Rituals

In such cases the person experiences unwanted intrusive thoughts about harming themselves or others. This can include worrying that the person has harmed people in the street, family members, children and vulnerable people, as well as invasive and graphic thoughts about losing control and harming themselves, such as gouging there own eyes out. Many of the ritualistic behaviours to reduce anxiety is to hide sharp objects, avoid being along with people or public places. This pairing leave many feeling exasperated by the intrusive thoughts, as the content will be inconsistent with that person’s morals, leading to a lack of motivation for life, low self self worth and feeling critical of themselves. In these cases the abhorrent nature of the thoughts can make seeking treatment a scary concept.


Sexually Abhorrent Thoughts and Associated Rituals

One of the most common types of OCD centres around experiencing intrusive thoughts of a sexual nature towards others that are inconsistent with someones true values. This can include thoughts including rape, molestation of children and abuse, having incestuous thoughts about family members, having sex with pets or unwanted homosexual thoughts. Due to the nature of such thoughts, people experience many emotions including anxiety, disgust, shame and intense guilt. Common compulsions include avoiding any situation that may trigger such thoughts, mentally checking their own arousal levels and reassuring themselves that they would never act on such thoughts. In some cases, the imagination can become so strong, that the person may experience illusionary feelings of being aroused or even thinking that they have already committed the abhorrent act, and are now likely to be arrested for their crime.