Obsessions and compulsions: Obsessive Compulsive Disorder

Obsessions and compulsions revolve around anxiety and anxiety reduction. Obsessions are essentially persistent unwanted intrusive thoughts or images, that create significant discomfort, distress, and anxiety. Compulsions are mental or physical acts that people perform to try to "neutralise" the obsessional thought, which temporarily reduces their anxiety and distress.

Obsessions
Obsessional intrusive thoughts occur again and again despite a person's strong efforts to stop them. A characteristic feature of obsessional thoughts is that they are usually opposite to the personality of the person who has them. For instance, a particularly caring and responsible person might have thoughts about harming others, or someone with a strong sense of morals might have sexually explicit thoughts or images. Common themes of intrusive obsessional thoughts concern:

  • Contamination and illness
  • Doubts about having performed some act, such leaving a door unlocked, or accidentally injuring someone
  • Sex and sexuality
  • Blasphemy
  • Violence and aggression
  • Order, such as wanting things to be arranged in a particular fashion

The vast majority of people have occasional intrusive thoughts, which come and go without great distress. For people with Obsessive Compulsive Disorder (OCD), however, intrusive thoughts are highly distressing, disturbing, or unsettling. Because of this, sufferers try very hard not to think the thoughts, which paradoxically causes the thoughts to intrude even more.

Compulsions
To reduce the distress of unwanted intrusive thoughts, people with OCD experience strong urges to perform compulsions that "undo" or "nuetralise" their thoughts. For instance, someone with obsessional thoughts about contamination may wash their hands again and again. Other kinds of compulsions may not be logically connected to the obsession that triggers them. For instance, people may mentally count backwards from 10 to reduce their anxiety about intrusive sexual imagery, or tap a certain number of times to reduce their anxiety about gruesome thoughts. People with OCD can become very frustrated with themselves, because they know that their compulsions are illogical and excessive, but they find it very difficult to stop. Common kinds of compulsions include:

  • Washing and cleaning
  • Counting
  • Checking, eg checking locks or checking that appliances are turned off
  • Seeking reassurance
  • Repeating actions, eg tapping, counting, stepping
  • Ordering or lining things up

Compulsions can take up a significant amount of time and effort, both physically and mentally. Evidence-based treatment for OCD is demanding, but can be effective at reducing the distress and frequency of obsessional intrusive thoughts. With time and persistence treatment can also help people to gain control over their compulsions.

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