OCD is the fourth most common psychiatric condition. It consists of obsessions and compulsions that take up an excessive amount of time and cause significant distress. Obsessions are unwanted thoughts relating to the fear of something bad happening or other upsetting thoughts. By definition, in OCD, obsessions are followed by a compulsion. Frequently, the compulsions are mental and not observable by others. A few examples are saying prayers, counting, or repeating words or phrases. Compulsions may also be using avoidance or seeking (generally excessive) reassurance.
Individuals often realize that the worries are excessive and not based in reality. In order to manage these worries, a person generally follows it with a compulsion, that is a behavior to diminish the worries. The person feels strongly that he/she does not do it, that the worries will actually happen. Again, people often realize that the worries are excessive. OCD tends to worsen in times of greater stress. While it may wax and wane, it is a chronic condition and generally will not go away on its own.
Understanding OCD and Obsessive Worry
Drs. Martin Seif and Sally Winston have made THE clearest presentation, to date, on what happens and maintains OCD and chronic worry.
They state that three factors are involved. The first is referred to as a “Sticky Mind.” They feel that that this is genetically loaded and triggered/exacerbated by acute and chronic physical and emotional stress. Conditioned anxiety triggers may also play a part. A very important component of Sticky Mind is what they call “Anxiety Sensitivity.” They define this as:
* “Fear of symptoms of arousal, unwanted thoughts, and odd sensations.
* Intolerance of doubt and uncertainty.
* Intolerance and over-interpretation of distress and discomfort.
* A heritable trait which is expressed most strongly under conditions of stress and
develops a life of it's own.”
The second factor of Sticky Mind is called “Paradoxical Effort.” It has long been stated that “What you Resist Persists.” In other words, the harder one tries to “change their thoughts, control their minds, relax their bodies, affirm their positivity, relieve stress, wrestle to fix the content of their thoughts,” the more stuck they become. An analogy is trying to do these things is like pulling your hands away from one another while your fingers are in a Chinese finger trap.
The third factor of Sticky Mind may well be the most important factor and is called “Entanglement:”
* “Treating the content of the worry as if it is valuable or meaningful information.
* Struggling against the worry thoughts instead of observing them mindfully.
* Treating worries as answerable questions when they are not.
* Confusing a thought with a fact.
* Believing that certainty is achievable and uncertainty is intolerable.”
They also point out that:
* “Certainty is a FEELING, Not a Fact.
* The quest for certainty is hopeless.”
Seif and Winston that obsessions and compulsions are only meaningful in relation to each other. They point out obsessions are thoughts that increase anxiety, where compulsions are behaviors (both physical AND mental0, provide TEMPORARY relief from the anxiety. This process has long been understood as Negative Reinforcement, which is NOT the same thing as Punishment. What is critical to understand that Every time one does a compulsion, it strengthens the OCD.
When one understands that the content of obsessive thoughts are meaningless, one can learn to notice those thoughts without responding to them. This takes time and practice. This can greatly assist in helping people understand how doing Exposure and Response Prevention (ERP) will help them learn that the obsessive thoughts are in fact meaningless and not dangerous.
Common OCD Obsessions and Compulsions
OCD can manifest in many ways. People frequently have multiple obsessions and compulsions. These lists are not every obsession or compulsion.
Some common obsessions are:
Contamination These obsessions may involve germs, disease, urine/feces, dirt, etc. There is usually the fear that the person and/or others will get sick and/or die.
Losing Control These obsessions involve the fear of losing control and saying and/or doing something that the person finds unacceptable, including having violent obsessions.
Harm These obsessions may involve the fear of someone getting hurt because the person wasn't adequately careful. This may be in supervising others and/or forgetting to lock a door, turn off the stove, etc.
Perfectionism Concern about evenness, things being "just so," forgetting/losing things, etc.
Unwanted Sexual Thoughts These are unacceptable thoughts that go against the person's value system.
Scrupulosity These may be religious obsessions concerned with offending God, praying correctly, hyper-morality, etc.
Others Concern with lucky/unlikely numbers, colors.
Some common compulsions:
Washing and Cleaning Excessively washing or cleaning or doing so in a ritualized manner
Checking Rechecking that things were done, like locking the door, turning off the stove, that a mistake wasn't made, that one didn't/won't harm others, etc. This can also be a mental checking.
Repeating Rereading or rewriting, repeating things like going in/out of doors, repeating body movements like tapping, touching, blinking, etc. This also can be a mental process.
Mental Compulsions Overly reviewing events, praying, counting, "Undoing" something "bad" (like a word or thought) with something "good."
Other Compulsions Seeking excessive reassurance, putting things or doing things until they "feel right," avoiding situations that trigger obsessions.
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Mike Miller, PhD, LICDC