An obsession is an unwanted intrusive thought. The type of thought may present itself as an idea, image, impulse, urge, memory, or other internal information, and you experience it as unwanted and distressing.
A compulsion is a behaviour designed to reduce or avoid discomfort that comes from your experience of an obsession. This behaviour may be physical, such as washing or checking, or mental, such as reviewing or neutralising.
For the condition to be considered a disorder, you have to experience impaired functioning, reduced quality of life, and lost time from attending to your obsessions and compulsions. Unfortunately many people do not seek help because they worry that is a silly problem or that they are going mad. Many do not talk to their doctor and do not find out that there is help available.
These are all descriptions of worrying thoughts. They could be worries about a disaster happening to a loved one and maybe in words, such as “something awful is going to happen to my son” or it could be a mental picture or image of something terrible happening. Or they can consist of feared impulses, such as worrying that you might succumb to the urge to harm someone. In fact, long experience with OCD has shown us that obsessional urges are never carried out.
The most common areas of concern in obsessions are dirt and disease, violence, other kinds of harm coming to people, sex and religion. Because the thoughts are unpleasant or frightening, they make the person with OCD feel very uncomfortable and anxious. Most often the discomfort aroused leads to person to do something to stop or control the anxiety in order to feel better. These actions are called rituals.
These are actions or behaviours the person feels compelled to carry out. There are two types. First those that can be observed, for example, hand washing or checking. These are the two most common forms of compulsion.
The other form is purely mental and these thoughts are felt as unwanted and intrusive. The actions taken to cancel out the discomfort are known as ‘neutralising’.
Another way of reducing the discomfort created by the obsessional thoughts is to ask others, such as members of their family or their doctor, for reassurance about their fears. Sometimes people also spend time trying to reassure themselves.
The fear of being around people or in situations that arouse a fear of being near germs or contamination can cause the person with OCD to avoid certain situations or people. This can mean that a persons life becomes limited as more things need to be avoided.
Like reassurance-seeking, the person with OCD might ask others to complete their rituals for them and those individuals become part of the maintenance of the problem.
We all have intrusive thoughts, this is true even for thoughts about harming someone or being violent. Researchers have compared intrusive thoughts in those with OCD and those without. There does not appear to be much difference in the kinds of thoughts reported. The difference lies in the meaning attached to the thought by those who have OCD. Those without OCD seem able to quickly dismiss the thoughts. People with OCD interpret the thought as meaning something very threatening, e.g. that they must be wicked to have a thought like that or that merely having that thought is likely to make it happen.
Research is at an early stage but it seems that people with OCD have extremely high standards, particularly in the area of morality and responsibility. This heightened sense of responsibility could have developed for a variety of reasons, e.g, being given a lot of responsibility at an early age, or feeling to blame for something that went wrong or life events that bring more responsibility e.g birth of a child.
People with OCD use the rituals to neutralise their distress at the upsetting thought, images or impulses. The rituals work in the short-term in reducing the anxiety and distress but in the long-term it takes more to reduce the anxiety and distress. It becomes a strong habit and eventually your whole life is taken up with rituals and avoidances. Also you never get to find out that the fear isn’t as bad as you thought and that nothing bad happened anyway.
The model for the CBT understanding of OCD is that everyone has unpleasant intrusive thoughts but that a person with OCD interprets these thoughts as meaning something terrible:that the feared outcome is very likely, that they might be responsible for harm coming to someone, that they might want to act on an irresistible urge. They might see themselves as a terrible person for having these thoughts. They don’t want to have these thoughts and so try hard to suppress them. We know that this thought suppression makes the thoughts stronger and more present.
CBT will help you discover your vicious cycles.
It will help you to see what happens if you stop the unhelpful ways of coping so you can discover if the feared outcome occurs and that the fear subsides on its own.
To help you view your intrusive thoughts differently and as just thoughts. We will use Mindfulness to learn that it is possible to train your mind to focus on what you want it to.