Obsessive Compulsive Disorder (OCD) can be debilitating and overwhelming. Having a firm grasp on how OCD maintains itself empowers us to recover from the disorder. This means getting clear on what obsessions are, what compulsions are, and how OCD grows.
At its core, OCD is a cycle of obsessions and compulsions.
Obsessions are unwanted and intrusive thoughts, images, or urges that trigger discomfort. The discomfort that shows up varies person to person, but for simplicity sake - let's call the discomfort anxiety.
In response to that rising anxiety, the sufferer engages in a compulsion. A compulsion is aimed at lowering or neutralizing feelings of distress. Again, compulsions vary widely. They can be a hidden behavior (a mental compulsion) - or, something others could see.
The issue with compulsions is two fold. First, they only provide temporary relief. The cycle will most definitely come back around again. Second, they grow and maintain OCD by teaching our brain that the obsession was ‘dangerous’. In the moment, it feels like a compulsion is the answer. But, it's actually a counterproductive pattern that drives us further away from living our values.
A silly (but hopefully helpful) way to think about the OCD cycle is thinking of OCD as a monster. It preys on things that are important to you, and scares you with thoughts that are counter to your values. The monster's food source is compulsions. Every ritual is like a protein bar for your OCD. In treatment, your job is to starve the OCD monster as often as possible - and show it you’re not afraid of its antics.
In order to treat OCD, it's important to identify your compulsions. Compulsions typically fall into four categories: overt compulsions, avoidance, reassurance seeking and/or confessing, and mental rituals. The examples listed below are only a few of the many potential compulsions.. Anything can be a compulsion if its aim is to escape the discomfort from an obsession.
Overt compulsions are rituals others can see. Some compulsions that fall into this category are: hand washing, going in/out of doors, tapping, touching, re-writing, etc. re-arranging, going back to check the stove, researching online, checking door locks, etc.
Hit & Run Themed OCD Example
Avoidance is a sneaky compulsion. Because of continuous symptoms, one may have designed their life to avoid certain triggers. Unfortunately, this still fuels the disorder. This could show up as: hiding knives, avoiding playgrounds, avoiding gardening tools, not holding a friend's baby, not looking at a number because it's unlucky, avoiding driving on a busy road, avoiding touching the throat, avoiding looking closely at a body part, etc.
Harm Themed OCD Example
Reassurance Seeking and Confessing often happens with family and friends. The responder may be used to answering these types of questions in times of high distress. They are often repetitive questions that the sufferer seems to know the answer to, but asks anyway. Examples are: asking family members if they have symptoms of sickness, asking family members if they’ve washed their hands, asking a partner to confirm the stove was off, sharing an intrusive memory with a parent to make sure they still love you, etc.
Moral Scrupulosity Themed OCD Example
Mental Rituals are hidden (or private) behaviors done in an attempt to neutralize an obsession. They can be quick and almost feel automatic. Some examples are: compulsive prayer, self-reassurance, mental checking, counting, mental review, ruminating, self-punishment, etc.
Real Event OCD Themed Example
Mapping out what compulsions you engage in is a great first step. After you build awareness, you can begin reducing compulsions and shrinking the “OCD Monster”. From there, you're on the way to freedom from OCD.
Madeline Moersch, LCSW is a psychotherapist in private practice in Los Angeles, CA specializing in the treatment of OCD and Anxiety Disorders.