Demystifying Obsessive Compulsive Disorder (OCD)

Written by therapist Elizabeth Erickson, LCSW

Date: 09/03/12

Although the term “OCD” is commonly used to describe people who are very neat, organized, or picky, clinical OCD is often misunderstood.  OCD, or Obsessive Compulsive Disorder, involves having intrusive obsessive thoughts and then feeling compelled to perform rituals to reduce the anxiety related to these thoughts.  People with OCD also may avoid situations that are associated with their fears.  Obsessions may involve germs, illness, social embarrassment, death, natural disasters, violence towards others, inappropriate sexual behavior, and symmetry (odd numbers, placement of objects).

OCD appears to begin with misinterpreted thoughts. An average person thinks about 4000 thoughts a day, and some of these thoughts are unpleasant and intrusive.  In fact, unpleasant intrusive thoughts are experienced by 90-99% of the population.  People with OCD develop obsessions from these common and universal thoughts.  Obsessions occur when intrusive thoughts are misinterpreted in ways that lead the person to become overly anxious. Obsessions are different from normal intrusive thoughts because they occur more often, last longer, and are more distressing.

Since we have 4000 thoughts a day, we are constantly monitoring and judging the thoughts that go through our head, deciding whether each are good or bad, important or unimportant, safe or dangerous. When someone misinterprets normal intrusive thoughts as very important or threatening, she tricks her body into reacting as if this harmless thought is very dangerous.

When someone misinterprets a thought as dangerous, she activates her fight-or-flight system.  The flight-or-flight system releases adrenaline to prepare her to take action to protect herself.  The breathing rate increases, the heart races, the muscles tense up, the mind races, etc.   In short, the mind tricks the body into believing it is in danger and then wants to avoid the “dangerous” thought or feared situation.  The person will then begin trying to fight and actively avoid these thoughts and feared situations.

The problem is that the harder someone tries to not think a thought, the stronger the thought becomes.   Eventually, the thought takes on a life of it’s own.  As a result people can become disabled with fear and consumed with performing ritualistic behaviors that help temporarily reduce their anxiety.

Despite OCD being a disabling disorder, the good news is that people usually get much better with treatment.  Treatment involves education, cognitive behavior therapy, gradual exposure, and response prevention.  Treatment works by reducing fears, reducing urges to perform rituals, and changing the ways clients interpret their thoughts.

Because OCD does not usually get better on it’s own, I encourage anyone with OCD to seek treatment.  I personally enjoy treating clients with OCD because the treatment is so effective.  I usually see noticeable changes in my clients’ anxiety and functioning in a relatively short time.  If you are not able to access or afford professional treatment, I recommend the self-help workbook Getting Over OCD: A 10-Step Workbook for Taking Back Your Life  by Jonathan S. Abramowitz, Ph. D.