Caryn Gill, LPC

What is OCD, Anyway?

What is OCD? 

Obsessive-Compulsive Disorder is a mental health disorder characterized by the presence of obsessions and compulsions. 

If you want to comprehend Obsessive-Compulsive Disorder, the easiest way to understand it is to break the name down. Obsessions are recurrent and unwanted thoughts, images, and urges that are experienced as intrusive and disturbing. Because of their unwanted and recurrent nature, obsessions are accompanied by distress, anxiety, fear, and/or disgust. This subjective experience of obsessions is what separates obsessions from preferences, intense interests, and personality traits. For example, the commonly used phrase “I’m obsessed with that band!” is referencing an interest that brings pleasure, whereas an obsession in the OCD-sense, for example “I can’t stop having images of my loved ones being hurt,” is experienced as unwanted and distressing. Another key aspect of obsessions is that they are recurrent. They happen frequently throughout the day. 

Now, if you were experiencing distressing thoughts over and over again and you felt like you couldn’t stop them, it would be totally understandable to want to get rid of them or prevent them from coming back. If the thoughts caused you to question your perceptions, it is natural that attempts to do away with those doubts would follow. 

This is where the compulsions come in. 

Compulsions are behaviors that someone does repetitively to try to neutralize the distress caused by obsessions, to prevent their obsessional fears from occurring, or to get rid of the thoughts altogether. Compulsions can often include avoiding situations that could trigger obsessions as well. Unlike behaviors that provide people with pleasure or are a part of something that they enjoy or find value in, like rituals as part of a religious practice or tidying your house due to desires to have a neat living space, compulsions are not enjoyable. Individuals often feel like they have no choice but to engage in these compulsions or else their feared consequence will occur. Again, let’s break down the word “compulsion”– individuals with OCD feel compelled to do these behaviors. They would rather not, if given the option. 

Unfortunately, all this time spent engaging in compulsions and avoiding triggering situations can interfere with your life. This is where the Disorder part of the term OCD comes in, and this is what separates OCD from having the occasional intrusive thought or occasional need to do certain behaviors. The “disorder” threshold is crossed when obsessions and compulsions take up more than an hour per day, cause intense distress, and/or interfere with engagement in important tasks. 

Where does it come from? 

The exact cause of OCD is still unknown. However, research shows that OCD could be attributed to structural differences that affect communication between front parts of the brain and deeper structures of the brain. Genetics could also play a role in the development of OCD. More research is still needed, and organizations like the International OCD Foundation are continuing to study the factors that contribute to the causes of OCD. 

What’s the treatment? 

The first-line treatment for OCD is Exposure and Response Prevention, a specific type of Cognitive Behavior Therapy. Medications, particularly Serotonin Reuptake Inhibitors (SRIs), have also been demonstrated to be efficacious in the treatment of OCD. Studies have shown that anywhere from 50-70% of individuals who engage in ERP recover from OCD (Law and Boisseau 2019). 

If ERP and medication can be considered the “gold” and “silver” standard, respectively, then treatments like Acceptance and Commitment Therapy might be considered the “bronze” standard. Like everything else in the field of behavioral health, more research is needed! 

Law C, Boisseau CL. Exposure and Response Prevention in the Treatment of Obsessive-Compulsive Disorder: Current Perspectives. Psychol Res Behav Manag. 2019;12:1167-1174

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