Obsessive-Compulsive Disorder (OCD) is an anxiety disorder in which painstaking measures are undertaken to eradicate provoked anxiety. OCD is maintained behaviorally. As humans, our instinctual response when feeling any negative emotion such as anxiety or guilt is to seek an immediate remedy. For an individual living with OCD, this means behaviorally making a choice to perform an action or to mentally ruminate to alleviate the anxiety. Anxiety is alleviated through washing hands after touching a potentially contaminated doorknob, hiding all the knives in the house to reduce the chance that one may harm family members, or reassuring oneself that “I would never do anything like that.” These actions serve the distinct purpose of quelling the anxiety associated with these unwanted thoughts and are understandable from an instinctual perspective as they are effective short-term anxiety relievers. When short-term relief is sought and achieved, these unwanted thoughts inevitably recur. When an individual with OCD engages in compulsive relief-seeking behavior, they are increasing the likelihood that these thoughts will recur. As a result, the cycle of obsessive thoughts, associated anxiety and compulsive efforts to relieve anxiety perpetuates.
Forms of OCD
There are three basic forms of OCD including Classic OC (washing hands, checking), Responsibility OC (overly concerned for the safety or well-being of others) and Pure-O (unwanted thoughts and mental rituals or ruminations).
Classic OC is the most popularized version of OCD and typically includes the subset of either Contamination OC or checking behavior. Individuals living with Contamination OC engage in excessive washing and/or cleaning behavior to alleviate their fears of contracting germs or other contaminants. Others become preoccupied with threats related to safety such as checking door locks, checking to see if the stove is off or checking to see if electrical appliances have been unplugged. In any of these situations, the distinguishing feature of Classic OC is the presence of observable rituals intended to pacify the overwhelming present threat.
Responsibility OC centers on the idea that one is responsible for the protection of others. Actions must be taken to ensure the safety of loved ones or complete strangers. A prototypical example of this form of OCD is in the individual who drives around the block 25 times to check to make sure that he has not run someone over. Another example of Responsibility OC would be an individual who picks up loose trash on the street to ensure no one can trip or put themselves in harm’s way. In addition to anxiety, individuals with Responsibility OC experience an immense amount of guilt, believing that they should or could do more to protect others.
Pure-O (short for the purely obsessional form of OCD) is similar to the other two forms of OCD in the presence of unwanted, incessant obsessive thoughts. What differentiates Pure-O from other forms of OCD is the content of these thoughts and methods utilized to alleviate accompanying anxiety. Unwanted thoughts typically are related to one or more of the following themes:
-Sexuality (Am I gay? What if I’m attracted to a member of the opposite sex?)
-Violence toward self or others (What if I lost control and jumped out of my apartment window? Would I ever murder my wife?)
-Relationship substantiation or Relationship OCD (Am I in the right relationship? Do I really have feelings for my partner?)
-Mental health (What if I go crazy and end up in a mental institution? Am I schizophrenic?)
-Existential or Meaning of life (Why are we here? Is time infinite?)
-Moral code or Being honest (I must confess every wrong thing I have ever done. Was I being completely honest earlier today?)
-Adhering to religious doctrine (Did I say the She’ma correctly? Have I sinned today? Will I go to hell for failing to living up to God’s standards?)
-Molestation or pedophilia (Have I ever had an inappropriate thought about my child? Would I ever molest a child?)
-Repetitive songs or words (What if this song never goes away? Am I going to have this word stuck in my head forever?)
The most effective behavioral treatment for all forms of OCD is exposure therapy. Exposure therapy entails progressively confronting anxiety-provoking thoughts or other environmental stimuli, and refraining from engaging in the short-term relief-seeking behavior (checking the stove, assessing feelings for romantic partner, washing hands, avoiding contact with children or confessing to a loved one). Individuals are encouraged to not only refrain from this unhelpful behavior, but to engage in exposures, or a response which typically increases short-term anxiety (loosely locking the door at night, confronting contaminants or magnifying a partner’s flaws). As willingness to entertain these unwanted thought increases and less effort is put toward seeking relief, the anxiety naturally subsides after a short time. As exposure exercises are repeated daily, the power that these threatening ideas hold dissipates as anxiety subsides.
Underlying the success of treatment is adopting an attitude of acceptance of uncertainty. Essentially individuals learn to tolerate anxiety associated with not knowing the answer to the question. This task is difficult but attainable. Treatment progresses at the rate that the OCD sufferer is willing to go. It is recommended that the treatment principles discussed in this article be attempted under the care of a qualified mental health professional.