What is OCD?
What is Obsessive Compulsive Disorder?
The best way of describing OCD is something like this. “From the second I wake up to the second I go to bed, I am bombarded with intrusive thoughts that cause me anxiety and distress. Yet, I can’t escape them because they are in my head. No matter how hard I try, they seem to get worse. It’s like the harder I try to get rid of them, the worse they get.”
The truth is, for OCD to exist, you must care about whatever subject that your brain has latched onto. It is because you care so much that you get caught in performing rituals repeatedly to get rid of the thoughts, but this doesn’t get you very far, as I am sure you know by now.
OCD has three main symptoms, obsessions, emotional distress, and compulsions. Occasionally the compulsions may lead to temporary short-term relief, but this will be short-lived.The core belief is an essential piece of the puzzle, as this will be driving many of your obsessions.
The OCD Cycle
Here is a step-by-step guide to the OCD cycle and what happens for someone with OCD.
The core belief is particularly important for people with OCD, as this is encompasses the core drivers behind almost all obsessive compulsive symptoms. It is important that for true management and recovery from OCD, a person’s core belief is both identified correctly, as well as effectively challenged.
Obsessions are reoccurring thoughts, images, impulses or worries 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” or “I would never want to harm my children, but I am worried that I may want to, or could do by accident”.
Obsessions can exist around almost anything, although common traits include those centred around feeling overly responsible for something or others, 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.
Compulsions can be anything that the person partakes to neutralise or take away the unwanted feeling that originates form the obsession and unwanted emotion. 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 (overt), and those that happen solely inside of the head (covert), known as rumination or mental problem solving. Compulsions give the person a false sense of control, making them feel like if they only perform the compulsion perfectly or one more time, then they will be relieved of the anxiety. However, in the longer term this only sets the person up to fail and in turn experience such intense unwanted emotions more regularly.
The emotional response for someone with OCD is a key contributing factor within the OCD cycle. Without intrusive thoughts being compounding by such overwhelming emotions, it is likely ignoring the thoughts would be considerably easier. One of the key brain areas that becomes activated during the emotional response is the amygdala, a part of the brain that becomes active when we are in danger. Although in everyday life this is an extremely helpful part of the brain, for those with OCD the amygdala begins to fire to perceived threats, rather than real ones. Due to the intensity of emotions such as anxiety, dread, guilt and shame this becomes an increasingly alarming, scary and overwhelming experience. Due to such high levels of distress, the person begins performing ‘compulsions’ or ‘rituals’ to reduce the unwanted emotions.
The OCD sub-types can be a good way of making sense of your experience. It is common to experience two or more of such themes, with many people experiencing significantly more.
Responsibility or Harm OCDIf 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 OCDContamination 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 subjects 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.
Checking and CountingChecking 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.
Religion and Spirituality OCDThose 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.
PerfectionismPerfectionism 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 doesn’t exist, however, 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. The areas of a person’s life that often become negatively impacted include academia, work, relationships, cleaning and other days to day tasks, although strictly speaking perfectionist can latch onto anything the person values.
Magical ThinkingThis 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 is based in superstition, a trait that lives within all of us. However, for someone with OCD, magical thinking is often compared to the analogy of ‘superstition going mad’.
False Memory OCDThe 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. Over a period of time, someone with this form of OCD can become increasingly confused as to what is real and what is not. Also, a person’s sense of self identity can also become very weak.
Purely Obsessional OCD (Pure O)This form of OCD is driven by the need to find the right answer or to neutralise a thought until it feels ‘just right’. ‘Pure O’ tends to manifest as a question followed by the need for certainty that leads to obsessional mental rumination and problem solving. 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. Other forms of ‘Pure O’ includes performing specific mental actions or neutralisations to ‘correct’ or ‘get rid’ of a particular thought.
Symmetry and OrderlinessSome 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”.
Health related OCDA 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.
Paedophilia OCD (POCD)This type of OCD relates to obsessions around intrusive thoughts that they are sexually attracted to children, or that they have, or mat sexually harm a child. It is not uncommon for people with this type of OCD to feel depressed, due to the abhorrent nature of their obsessive thinking. Although in truth, these thoughts mean nothing about the individual, the very existence of such intrusions make the person feel like there must be some deeper meaning to them, as if they are no longer the moral person that they once thought they were. Those with POCD often begin spending lots of time in their head trying to work out the validity of their thoughts, as well as avoid spending time around children.
Sexual Orientation OCDOften overlapping with relationship OCD, the person is bombarded with intrusive thoughts that they may be gay. Although the person may have some clarity of their sexual orientation, they doubt that they really know and therefore often spend hours online researching, seeking reassurance from others and in some cases ending their current relationship. Other thoughts my centre around an unclear sense of self, with many individuals saying that they feel confused as to who they really are anymore. It is also common to experience guilt, as the person feels that there is nothing wrong with being gay, but can’t help but be afraid of the idea regardless.
Somatic OCDThis is a common, but less known about type of OCD whereby the individual becomes overly focussed on normal bodily functions such as blinking, swallowing, and breathing in themselves and others. They can also become hyper focussed on their own peripheral vision and sight. Over time, the person begins to feel that what was once automatic, bodily sensations now have a manual quality to them, whereby the person experiences anxiety upon either becoming aware or unaware of such sensations.
Cognitive Distortions are biased perspectives that you may hold about other people, yourself, and the world around you. Although some may be subtle, others can have a very negative impact on your quality of life. It is common to experience multiple cognitive distortions if you experience OCD.
All or Nothing Thinking
Black and white thinking will stop you from seeing all of the grey areas in a situation. You are likely to perceive a situation as perfect or utterly awful based on perfectionism, with very little in between.
Overgeneralization means that you are likely to come to a general conclusion based on a single incident or a single piece of evidence. If something terrible happens just once, you expect it to happen over and over again. Although this is not reality, it much very much feels this way to you.
If you engage in filtering (or ‘mental filtering’), you will take the negative details of a situation and magnify them while filtering out all positive aspects.
Blaming and Poor Personal Responsibility
If you engage in blaming, you hold other people responsible for your emotional pain. You may take the opposite track and instead blame yourself for every problem — even those clearly outside your control.
Heavens Reward (the cosmic scorekeeper)
Heaven’s reward is a false belief that a person’s sacrifice and self-denial will eventually pay off as if some global force is keeping score, sometimes compared to the concept of Karma. If you work hard and don’t experience the expected payoff will usually feel bitter when the reward doesn’t come. Heaven’s reward works both ways, and it can be upsetting for you if ‘bad’ people get away with things, as it means the world is unfair.
If you engage in catastrophizing, you expect disaster to strike, no matter what. This is also referred to as magnifying and can also come out in its opposite behaviour, minimizing. When catastrophizing, you may hear about a problem and use what-if questions such as “What if tragedy strikes?” or “What if it happens to me?” and imagine the absolute worst occurring.
Should Statements and Demands
Should statements (“I should pick up after myself more…”) appear as a list of ironclad rules about you or how other people ‘should’ behave’? People who break the rules make a person following these ‘should’ statements angry. You may also feel guilty when you violate your own laws.
Thought-Action Fusion, or Thought-Event Fusion
If you experience this distortion, you may feel confused about what is real and what is your imagination. Often due to increased rumination or checking behaviours, you are likely to become less trusting of your mind, leading to growing feelings of uncertainty and emotional distress. If the thought is about memories, you are likely to think the events through and question your actions, sometimes called ‘False Memory’ OCD.
Emotional reasoning is where you take your feelings at face value. Simply put, you believe that ‘because I feel this way, it must be true.’ This can be highly problematic if you have OCD, as your emotions are not regulating correctly, which means you will believe things simply because what you are feeling rather than staying with facts.
Personalization is when you take things too personally. If you have OCD, then you are going to be a sensitive person. Such heightened emotions can make you feel like you have offended others, are disliked, or that you may have somehow embarrassed yourself, even you may not be sure how these things have come about.
Neuroplasticity and its role in successful OCD treatment
You may have heard of the saying, our brain is made of plastic or malleable. This refers to the brain’s ability to physically change to adapt to new situations and the implementation of newly learned skills.
Our brain has the fantastic ability to learn throughout our lifetime, whereby through changing our behaviour, we can essentially reprogram the way our brain works biologically. The brain can break and reformulate new, healthier pathways, creating more consistent changes with a less anxious life. We now know that this also includes the development of many anxiety disorders, including OCD. The most exciting thing is that Science backs it up!
We continually update all of our treatment programs based on the latest research. All of our treatment programs utilize these findings. We use this knowledge, explore the scientific conclusions and educate clients about what it means concerning their OCD to start making the brain work for you rather than against you.
There is empirically solid evidence to show that intensive therapy lends itself to the efficacy of neurological changes. For this reason, we see speedy results when conducting intensive treatment with our clients.
Dr Saxena concluded: “Our study reinforced the efficacy of the treatment, and now we've shown how it works in the brain."
We have BEEN THERE. We have RECOVERED. We can SHOW YOU HOW.
All of our treatment programs have been created by qualified therapists with a combined 35 years of experience of what it is like to live with OCD. Although we appreciate our professional training, we believe that there is no replacement for the first-hand experience of living with the disorder.
We use the most proven treatments for OCD to help you regain control over your life and your suffering. Every treatment program includes:
- Cognitive Behavioural Therapy (CBT)
- Exposure Response Prevention Therapy (ERP)
- Rational Emotive Behavioural Therapy (REBT)
- Acceptance and Commitment Therapy (ACT)
- Mindfulness Based Stress Reduction (MBSR)
- A relapse prevention program to take home
- Premium reading materials
- Follow up support
- All individually tailored to suit your specific needs, even when attending our group treatment.
All delivered to you in a safe, private and comfortable environment. We also provide options for online therapy and can even send an OCD expert to work with you in your own home.