Obsessive Compulsive Disorder (OCD)
What is Obsessive Compulsive Disorder (OCD)?
Obsessive-compulsive disorder (OCD) is characterized by recurring intrusive and unwanted thoughts (obsessions) that lead to the urge to perform repetitive behaviors or mental acts (compulsions) to alleviate emotional distress. Living with OCD is often described as having a “false alarm” consistently sounding within one’s brain. This “false alarm” causes the brain to overreact and perceive danger where there is none.
While individuals with OCD often logically understand that their intrusive thoughts pose no real threat, their brain makes these threats feel real. The nature of this disorder can make it difficult to live a satisfying and values-driven life, often interfering with relationships and daily functioning.
OCD can take the form of many different “themes”
Contamination OCD
People with contamination OCD tend to have excessive and irrational fears of coming into contact with germs, chemicals, or harmful substances. They often experience intense feelings of disgust and fear associated with contracting or spreading diseases and illnesses, such as COVID-19, HIV, or cancer.
Typical compulsive behaviors include:
- Excessive hand-washing
- House cleaning
- Disinfecting
- Avoiding objects they fear may be contaminated
"Pure O" OCD
“Pure O” OCD is characterized by obsessive thoughts without visibly engaging in compulsive behaviors. This form of OCD can be particularly upsetting and distracting, as individuals try to “think their way out” of distress, leading to repetitive and circular thinking patterns.
Common “Pure O” mental compulsions include:
- Reviewing events repeatedly
- Excessive rumination in attempts to problem-solve or make decisions
- Repeating phrases to neutralize negative thoughts or “protect” against negative events
- Providing self-reassurance
Harm OCD
Harm OCD is characterized by intrusive thoughts or images of causing harm to oneself or others. To reassure themselves that they won’t act on these disturbing thoughts, individuals may engage in compulsions such as avoiding sharp objects, repeatedly checking to see if they have harmed anyone, or engaging in repetitive praying or counting.
Common types of Harm OCD fears include:
- Fear of sexually assaulting a past or future significant other
- Fear of harming someone while driving, either accidentally or on purpose
- Fear of harming a newborn infant
- Fear of self-harm or suicide
Relationship OCD
Relationship OCD is associated with distressing thoughts and obsessions related to romantic relationships. Compulsions often involve attempts to gain certainty about the relationship and can include seeking relationship advice, comparing their relationship to others, using dating apps to explore other options, and “testing” their feelings about their partner by going on dates with other people.
Common types of ROCD thoughts include:
- Doubts about their feelings towards their partner
- Doubts about their attraction to their partner
- Repeatedly wondering if their partner is the “right person” or “the one”
- Fear that their partner may leave them
- Fear that they don’t love their partner or that their partner doesn’t love them
Religious OCD (Scrupulosity)
Religious OCD (Scrupulosity) involves excessive and irrational fears or doubts related to one’s religious beliefs, practices, or morality. Individuals with this condition may engage in compulsive behaviors such as excessive praying, repeating religious rituals, self-imposed punishments, or mentally ruminating on the afterlife.
Common types of intrusive thoughts include:
- Fear of the afterlife and/or punishment by a higher power
- Fear of committing blasphemy or breaking religious laws
- Fear of sinning or doing something immoral
Retroactive Jealousy OCD
Retroactive Jealousy OCD involves experiencing excessive intrusive thoughts related to a partner’s past romantic or sexual experiences. Compulsions associated with this theme may include frequently asking the partner about their past relationships or sexual experiences, comparing oneself to the partner’s exes, checking and researching the partner’s social media profiles for information about their past, and analyzing details, conversations, and scenarios related to the partner’s past.
Common types of intrusive thoughts include:
- Fear that the partner’s exes might have been better, more attractive, or more compatible
- Fear that the partner has not been fully honest about their past relationships or experiences
- Concern about one’s own self-worth, value, or attractiveness compared to the partner’s exes
- Intrusive images of the partner with exes in past romantic or sexual situations
- Fear that the partner may have been “overly promiscuous,” leading to moral judgments about the partner
Existential OCD
Existential OCD is characterized by excessive intrusive thoughts and a preoccupation with questions about the nature of existence, the meaning of life, the concept of time, and the existence of free will. Compulsions associated with this theme may include excessive researching on these topics, mental rumination, and engaging in unwanted philosophical debates.
Common types of intrusive thoughts include:
- Fear that the world is not real, is an illusion, or that they are in a different reality or dream
- Fear about whether their own mind is real and everyone else is an illusion
- Fear and concern about whether humans have free will
- Fear of never knowing their true beliefs, goals, or purpose in life
Pedophilia OCD
Pedophilia OCD is associated with intrusive thoughts and excessive concern about being a child molester or being attracted to children, despite having no desire or intention to harm children. These intrusive thoughts are in direct conflict with the individual’s values and identity. Compulsions may include avoiding contact with children, even their own children or family members, mentally checking their own feelings or thoughts to “see attraction” to children, or researching pedophilia criteria.
Common types of intrusive thoughts include:
- Fears of having an arousal response around children
- Fear of accidentally harming children
- Doubts about their own morality and character because of their intrusive thoughts
- Fear that they engaged in past pedophilia acts
“Just Right” OCD
“Just Right” OCD is associated with the overwhelming need for things to feel “just right” or “perfect”. This theme is often associated with a strong need for rigid order, symmetry, cleanliness, and scheduling. Typical compulsions associated with this theme can include arranging or rearranging objects, repetition of words or actions, continuous checking behaviors, touching or tapping behaviors, and mental rituals such as counting or visualizing actions until it “feels right”.
Common types of intrusive thoughts include:
- Insisting that things must be in the ‘correct’ place and having difficulty tolerating when anything is not
- Engaging in a behavior or task repetitively until it feels “right”
- Making decisions based on what feels “right,” often leading to procrastination due to uncertainty about what is right
- The need for clothing or one’s appearance to look “right”
Mental Illness OCD
This subtype of OCD involves obsessive concerns and rumination about becoming severely mentally ill, never recovering from a mental illness, or questioning the genuineness of one’s current mental health issues. Compulsions may include constantly looking up information about various mental health conditions, regularly monitoring oneself for signs of mental illness and frequently seeking confirmation from others or professionals about the accuracy of one’s diagnosis.
Common types of intrusive thoughts include:
- Worrying about becoming insane, going “crazy”, or losing control
- Excessive concern that they have been incorrectly diagnosed with a mental health condition
- Anxiety about becoming psychotic or acquiring a debilitating mental illness
Treating Obsessive Compulsive Disorder
Personalized Treatment Plan:
A personalized treatment plan acknowledges that each individual’s OCD theme, intrusive thoughts, and life circumstances are unique and warrant careful consideration. The impact of OCD varies greatly from person to person. A tailored treatment plan views you as a holistic person, customizing therapy to align with your goals, values, and individual life circumstances.
Dr. Ballas’s Approach:
- Holistic View: Treatment considers all aspects of your life, including mental, emotional, and physical health.
- Customization: Therapy is tailored to your specific OCD themes and intrusive thoughts.
- Client-Centered Progress: You determine the pace and direction of your treatment, while Dr. Ballas provides expert guidance and support.
- Goal-Oriented: The focus is on helping you achieve your personal goals and improving your overall quality of life.
Through psychoeducation, common misconceptions and myths about OCD will be clarified helping you to:
- Better Understand OCD: Gain a deeper knowledge of OCD, including its symptoms and triggers.
- Learn About Your Symptoms and Triggers: Identify what specifically triggers your OCD and how it manifests in your life and impacts you.
- Understand Treatment: Discover how treatment works and how it will help you manage your OCD.
This collaborative approach ensures that treatment is relevant, effective, and empowering, helping you achieve a better life on your terms.
Evidenced-Based Treatments: Effective treatment of OCD exists and has been shown to lead to symptom relief and a more satisfying and fulfilling life.
Exposure and Response Prevention (ERP): This is considered the “gold standard” treatment for OCD. In ERP, individuals are gradually exposed to their feared objects or situations in a safe environment. They learn to tolerate their anxiety during these exposures without engaging in compulsions. Through therapy clients can:
- Reduce Fear: Become less afraid of their triggers
- Choose Healthy Behaviors: Opt for behaviors aligned with their true values instead of compulsions
- Gain Freedom: Achieve greater freedom from OCD, leading to an improved quality of life
ERP involves:
- Building a Hierarchy: Creating a list of feared situations/circumstances and gradually engaging in exposures of increasing difficulty.
- Response Prevention: Utilizing tools and techniques to prevent compulsions.
- Types of Exposures: Conducting imaginal exposures (mental exercises) and in vivo exposures (real-life situations).
Acceptance and Commitment Therapy (ACT): New research has explored the effectiveness of combining Acceptance & Commitment Therapy (ACT) with Exposure and Response Prevention (ERP) for a comprehensive approach to treating OCD. ACT teaches you to experience unwanted thoughts, feelings, and sensations without trying to control or eliminate them. This approach helps those with OCD gain greater psychological flexibility, allowing obsessive thoughts to be viewed as “just thoughts” rather than actual threats that need a response.
ACT focuses on developing psychological flexibility through:
- Mindfulness: Being present and aware of your thoughts and feelings
- Willingness: Accepting the presence of unwanted thoughts and feelings without resistance
- Acceptance: Embracing thoughts and emotions as they are, rather than trying to change or avoid them
As a result, individuals learn to accept the presence of emotions and uncertainty associated with their intrusive thoughts. This leads to an ability to refrain from performing compulsions, enabling them to live a more productive life aligned with their values. Combining ACT with ERP provides a holistic and effective approach to managing OCD.
