Obsessive Compulsive Disorder (OCD) is a condition in which people get stuck in a cycle of obsessions and compulsions. Many people with OCD try to hide their condition and may not seek treatment due to embarrassment or shame. OCD affects people of all ages and backgrounds, including approximately 2 – 3% of people in the United States. Most people with OCD have both obsessions and compulsions although in some cases they may have just one or the other.
OCD can lead to anxiety, depression, isolation, low self-esteem, and other negative emotions and behaviors. For many OCD sufferers, their obsessions and compulsions take up an inordinate amount of time and energy, robbing them of an opportunity to live a more full and happy life.
Obsessions are unwanted thoughts that may trigger anxiety or distress, including thoughts related to perfectionism, order, contamination/germs, fear of harming others, and intrusive sexual, violent, or religious thoughts. People with OCD perform compulsions to temporarily relieve themselves of the anxiety associated with their obsessions. A person with a fear of germs, for example, may spend hours in the bathroom meticulously cleaning themselves. While this reduces their short-term anxiety, in the long run it causes their OCD to get worse.
Common compulsions include excessive checking, cleaning, ordering (e.g., making sure things are “just right”), counting, and repeating certain words to oneself. People with OCD often avoid situations that trigger their obsessions and may seek reassurance from others that everything is OK.
Everyone has obsessions and compulsions at times. What makes OCD different is the persistence of obsessions and compulsions and the negative impact they have on one’s life. Whereas most people can let go of an unwanted thought after a while (e.g., “Did I forget to lock the front door?”), those thoughts get stuck in the minds of people with OCD and repeat over and over again. It’s hard to be a good partner or friend if everything in your house has to be arranged “just right” before you can relax and have a conversation, or if you can’t share a couch with anyone due to your fear of germs.
Fortunately there are a number of treatment options for people who suffer from OCD. Many people find medication helpful. You can talk to your doctor or psychiatrist about that. Psychotherapy and support groups can be helpful as well:
- Cognitive Behavioral Therapy (CBT) is a pragmatic form of therapy that helps people replace unhelpful thought patterns with healthier ways of thinking. The client and therapist work together in CBT to set treatment goals. One CBT technique shown to be particularly helpful for OCD is called Exposure Response Prevention (ERP). This involves exposing the person with OCD to whatever it is that causes them distress and encouraging them not to perform a compulsion in response. While this may sound scary and will cause an increase in the person’s anxiety in the short term, in the long run, the person’s anxiety should decrease.
- Another form of therapy that may be combined with CBT to treat OCD is known as Acceptance and Commitment Therapy (ACT). ACT emphasizes psychological flexibility and committing to one’s values. In ACT, the therapist might ask the OCD sufferer if it’s worth it to tolerate their anxiety in the short-run so that they may lead a happier, more fulfilling life in the long run.
- Support groups: Remember that you are not alone. At least 3 million Americans (probably more) suffer from OCD. If you think you have OCD and it’s causing problems in your life, reach out for help. Many people find joining OCD support groups helpful. These groups can help you feel less isolated and meet others who have similar thoughts and concerns as you. The OCD SF Bay Area website (http://www.ocdbayarea.org/) has a listing of support groups in the Bay Area. The International OCD Foundation website (https://iocdf.org/) has lots of good information as well.
John “Andy” Bradshaw, Associate Marriage & Family Therapist #101517 (supervised by Dino Di Donato, MFT #39831) focuses on the treatment of OCD and anxiety at Market Street Center for Psychotherapy. You can contact him at (510) 599-9845 or firstname.lastname@example.org.
- American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Washington, DC: American Psychiatric Publishing.
- Murdock, N. (2013). Cognitive therapy. In Theories of counseling and psychotherapy: A case approach (3rd ed., pp. 313-350). Boston: Pearson.