What is Obsessive Compulsive Disorder (OCD)?

Most people think that OCD is all about hand washing, organizing, repetition, and perfectionism. But OCD can manifest itself in so many different ways. The truth is, it is not at all about the way that it shows itself. It is about two things: Obsessions and Compulsions. An obsession, also known as an intrusive thought, is when you cannot get an unreasonable thought out of your mind. A compulsion is when you feel as if you have to do something. You can theoretically have “Pure O” or “Pure C” OCD, in which you only have obsessions or compulsions. But if you have an obsession and you routinely do things in order to avoid the object of your obsession or to make the obsessions go away, that behavior is considered a compulsion. And if you have compulsions, they are normally proceeded by a thought, which usually counts as an obsession. You should always consider the possibility that what seems like an obsession is actually a phobia or trauma trigger, or the result of generalized anxiety, which are also discussed extensively on this site. While many people are ashamed to admit that they have such a problem, or they are afraid that they will be judged or labeled, you will be surprised to find that Dr. Young has fairly significant bouts of OCD. But you don’t get to find out which type unless you come in.

There are a few common (although unofficial) categories of OCD. But please note that the specific type of OCD is generally irrelevant, as all forms of OCD are treated with the same treatment, which is modified to fit the symptom patterns, circumstances, and preferences of the person being treated.

Contamination OCD involves obsessive thoughts about your body being contaminated with, for example, germs, chemicals, blood, feces, urine or other substance, or a disease such as cancer or HIV. This often results in a person constantly washing their hands, using hand sanitizer, or taking steps to avoid touching certain objects that others are generally okay with. They also tend to ask for reassurance over, and over, and over again – “do you think I’m sick… am I going to be okay?”

Check, repeating, or counting OCD involves all forms of compulsively repetitive behaviors. This might include, among many other forms, an obsessional need to organize objects in even or odd numbers, to return repeatedly to check and make sure doors are locked or stoves are turned off, to turn a light switch on and off a certain number of times, to take one step backward periodically while walking, or to obsessively pick through different cans of the same soup at a grocery store. There are obviously countless ways that this form of OCD can manifest.

Relationship OCD involves obsessing about whether or not your partner loves you, or whether or not you love or should stay with them, even in the face of generally positive interactions. This frequently involves an unbearable urge to get away from your partner for no particular reason (although sufferers typically conjure up reasons); an unreasonably strong obsession with minor flaws in your partner; an intense fear that your partner is going to leave you in the absence of any reasonable evidence – even when you do not have a history of being abandoned. This form of OCD is usually misdiagnosed as a fear of commitment or abandonment that comes from early childhood trauma.

Harm OCD involves intrusive thoughts about hurting yourself or others. Many people with harm OCD are too ashamed to seek help, or they fear that they will be arrested, committed to a mental hospital, or abandoned by their loved ones. They often get rid of the knives in their house, lock themselves out of their children’s rooms at night, refuse to drive a car, or leave their partner for fear that they will hurt them.  It should be noted that people with this type of OCD have no interest in actually committing such an act against themselves or anyone else and it is not a pleasant thought. Those who genuinely enjoy such thoughts are typically very different from people OCD. You cannot be arrested for having thoughts of any kind. You cannot be involuntarily committed without a convincing reason to believe that you will actually carry out a severely violent act on an identifiable victim or yourself. If you genuinely do not want to hurt another person, even if you have the intrusive thoughts, and you do not have severe combat-related PTSD, bipolar disorder, or a psychotic disorder with a history of violence. We will not believe that you are a threat to anyone. But we can most likely help you, because we use the best treatment available. And it has been proven to work for many, many people.

HOCD involves obsessing about the possibility that you might be LGBT, despite the lack of any evidence whatsoever that you are. Many people with HOCD are afraid that they will suddenly have an uncontrollable urge to fondle someone of the same sex, or that they will suddenly have to leave their spouse because of a sudden change in sexual orientation.

Intrusive Sexual thoughts (I know, not a real catchy name like the other ones) involve repeated intrusive thoughts that involve sex and that are perceived to be unacceptable. Many people with this type of OCD think about sexually touching children (in the complete absence of any interest or intent), or their own parents, their minister, or a stranger who does not want to be touched. This is different from a fetish or pedophilia in that the object of the thought is sexually unappealing and is in fact appalling. People with this type of OCD have no interest whatsoever in touching such a person.

Children with OCD

Children who have OCD are typically very difficult to parent. They have incredibly difficult (you will here the work “difficult” a lot) time transitioning between activities, following instructions, getting out of the house in the morning, going to bed at night, and eating. They are often described as “impossible.” Some wash their hands constantly. Others ask for reassurance about everything. Others won’t wear socks with seams (all socks) or wear pants or shirts in certain colors or textures.  Others lose their sh*t when you makes an “ing” sound at the end of a word, or you don’t kiss them a certain number of times when you get home from work. These kids are often misdiagnosed with Oppositional-Defiant, Attention-Deficit, Generalized Anxiety, Autism spectrum, or even Bipolar Disorder. The point is, as much as you love them, sometimes you might imaging knocking yourself unconscious in order to escape the frustration of parenting a child with OCD. Don’t do this. There is a better way…

What works

Obsessive Compulsive Disorder is considered one of the most treatable problems that psychologists work with.  The most effect treatment is referred to as Exposure and Ritual Prevention (ERP, EX/RP, or ERP).  Although some people do not get better with Ex/RP, for most people, no other approach even comes close in terms of effectiveness.  This is the approach that we use to treat OCD, although it must be noted that we are completely comfortable with taking it as slowly as you would like, and we will begin with a much slower, more supportive approach if you would prefer. Or we can jump right into it if you are less patient. It is up to you.

The term Exposure and Ritual Prevention is often interchanged with the term Cognitive Behavioral Therapy (CBT).  While it is a form of CBT, it is a very specialized form of it.  Most therapists who use Cognitive Behavioral Therapy use a more generic form that is quite different from true Exposure and Ritual Prevention.

General Cognitive Behavioral Therapy is a phenomenal therapy for many problem areas, particularly anxiety and depression.  Studies of CBT for OCD have shown positive effects, and if you cannot find a provider who uses Exposure and Ritual Prevention, general CBT is the next best thing.

What does not work

Unfortunately, many treatment providers use approaches that have not been shown to be effective for OCD, such as psychoanalysis/psychodynamic therapy, or play therapy for children.  Some use even more unproven strategies such as chiropractic, Reiki, energy healing, and eliminating gluten intake.  While these approaches are generally not harmful, they usually fail, and often lead OCD sufferers to feel hopeless and helpless against their problem. As a result, many people who receive these treatments lose faith, do not seek further help, and are forced to live with their problem.

Other approaches, such as Supportive “talk” therapy, are good for when you are trying to cope with a loss or chronic illness, or when you are trying to make a difficult life decision. But they have not been shown to have any significant effect on OCD in particular. It is however important to note that it is sometimes better to begin with a more supportive, less goal-oriented approach at the beginning of therapy so that you can slowly work your way up to being comfortable enough with EX/RP. We are very supportive of this approach. It is completely up to you.