Obsessive Compulsive Disorder

Obsessions are:

Recurrent and persistent thoughts, impulses or images, which are intrusive and cause anxiety or distress.

They are not just excessive worries about real-life problems.

The person wants to get rid of the obsession (tries to ignore it, suppress it, or do something to counter it).

The person is not delusional.

Compulsions are:

Repetitive behaviors (e.g., checking) or mental acts (e.g., counting) that a person feels driven to perform in response to an obsession.

These are aimed at preventing or reducing distress or preventing a dreaded event. However, they are not connected in a realistic way with what they are supposed to prevent, or are excessive.

Symptoms of Obsessive-Compulsive Disorder (OCD)

Obsessions and/or compulsion.

The person recognizes these are excessive or unreasonable.

They cause marked distress, are time-consuming, or interfere with functioning, social activities or relationships.


One in 40 people will suffer from OCD at some point in their life.


Changing thoughts:

There are different types of OCD, but in almost all, the sufferers tend to overestimate the probability of negative events and believe that they could not cope if these occurred.

They tend to have an exaggerated sense of responsibility and need for safety. For instance, one may believe that he/she will likely catch a disease from touching the surface of a common area and would not be able to stand being sick or would die. Others believe that leaving an appliance turned on while they are not home is bound to cause a fire which would burn the whole building, and they could not cope with the loss and guilt. Yet, others believe that because they have a thought this means they somehow want to do the action and are likely to do it, and may be a bad person (e.g., “I could kill my baby”, or “I could jump in front of an oncoming train”).

Thoughts associated with compulsions tend to be unrealistic. Examples are: “If I count to 100, nothing bad will happen”, “If I wash my hands 100 times per day, I will never get sick”, or “If I don’t check that every appliance is unplugged before leaving home and/or that the door is locked, I am being irresponsible”.
These unrealistic thoughts need to be challenged.

Changing behaviors:

The core treatment for OCD is called “Exposure and Response Prevention” (ERP).

When one suffers from OCD, the obsessive thoughts, images or memories, are associated with anxiety, and the compulsion serves to reduce that anxiety. For instance, one may obsess over their loved one being hurt.
This causes anxiety. To cope, they engage in counting, which they believe protects their loved one. The belief is self-reinforcing since each time they count nothing happens, and their anxiety is reduced. What this person does not learn, not intellectually but mostly emotionally, is that there is no relationship between the safety of their loved one and the counting, and that there is a risk that needs to be accepted that their loved one could die at any time (acceptance of reality). The only way to learn this emotionally is to refrain from engaging in the compulsion, ideally with the gentle guidance and support of a therapist experienced in ERP.

Optional additional treatment strategies

Relaxation and Deep Breathing.


Selected Book References

Freedom from obsessive-compulsive disorder: A personalized recovery program for living with uncertainty.
Jonathan Grayson (2003).
Penguin Group Inc. ISBN 1-58542-246-0

The OCD workbook, second edition.
Bruce Hyman, Ph.D., & Cherry Pedrick, R.N. (2005).
New Harbinger. ISBN-13 978-1-57224-422-1