What is OCD?
Obsessive-compulsive disorder (OCD) is characterized by two key components, obsessions and compulsions. These involve unwanted, repetitive, and intrusive thoughts and repeated attempts to reduce the distress these thoughts create. Often, those with OCD understand their thoughts as irrational or exaggerated yet still feel compelled to carry out rituals to prevent dreaded outcomes. Another core component is the personal distress and functional impairment that obsessions and compulsions can create in everyday life. This then often leads to experiencing various negative emotions such as fear, anxiety, shame, guilt, and helplessness.
OCD is fairly common, with around 2-3% of people experiencing OCD symptoms at some point in life, that is roughly 1 in 33-50 people. Many influential figures have been open about their experience with OCD, such as David Beckham, Leonardo DiCaprio, and Amanda Seyfried. Having OCD does not define or diminish a person’s character, abilities, or achievements.
Obsessive Thoughts
Obsessive thoughts are not always to do with fear of contamination and may manifest in less explicit ways. Often, these thoughts are related to uncertainty, responsibility, and identity, and can take the form of distressing harm-related, relationship, moral or religious, existential, or sexual intrusive thoughts. Here are some examples of common obsessive thoughts:
- “What if I lose control and hurt someone I love?’
- “What if I forgot to lock the door and someone breaks in?”
- “What if I don’t actually love my partner?”
- “What if nothing is real?”
Intrusive thoughts are not a reflection of an individual’s character or intentions.
Mental Compulsions
Compulsions are repetitive behaviours or mental acts an individual feels the need to perform in response to an obsession, or according to rules that must be applied rigidly. The primary goal of these behaviours is to prevent or reduce anxiety, or to prevent a dreaded event from occurring. Whilst these rituals may provide short-term relief, in the long run they teach individuals that these thoughts are dangerous and that uncertainty must be avoided. Common compulsions include excessive washing, checking, and counting but can also present as the following:
- Mental reassurance– trying to convince yourself that the feared outcome will not happen.
- Rumination or overanalysis- spending long periods of time analysing a thought in order to solve or neutralize it.
- Thought neutralization– trying to cancel out a ‘bad’ thought with another image or thought.
- Mental reviewing– going through past events in detail to ensure nothing bad happened.
This list is not exhaustive as compulsions can manifest in many different forms, varying between individuals.
Therapy for OCD
Research has shown that OCD symptoms can be meaningfully reduced. In particular, Exposure and Response Prevention (ERP), a form of exposure therapy, has been found to be especially effective. ERP focuses on building tolerance to uncertainty triggered by obsessive thoughts while learning how to resist performing compulsive rituals.
In our clinic, treatment combines ERP with third-wave behavioural therapies, such as Acceptance and Commitment Therapy (ACT) and mindfulness-based strategies. A central goal of therapy is to strengthen a person’s sense of agency and self-efficacy by helping the individual recognize that while they cannot control every thought that arises, they can choose how they respond to it.
