What is OCD?

What is Obsessive Compulsive Disorder?

Obsessive Compulsive Disorder (OCD) is a disorder characterised by person experiencing intrusive and unwanted thoughts that cause them distress. Common emotions include anxiety, anger, shame and guilt that subsequently lead to compulsive behaviours performed in order to rid themselves of the intrusion. Obsessions can be very challenging to control, with the person often experiences an increase in obsessions, rather than a decrease over time. In the short term, compulsions may reduce a range of unwanted feelings, but in the long term the obsessions and compulsions are likely to get worse.

Compulsive behaviours can include one or more of the following: checking, reassurance seeking, avoiding, washing, mental problem solving, mental recall and mentally neutralising any unwanted thoughts. Compulsions can very quickly become time consuming, exhausting and lead the person to feel depressed and unmotivated. The is particularly true for those that experience obsessions around harming others, sexual orientation and sexual abuse. Although OCD can centre around areas such as contamination, physical checking and counting, these symptoms merely scratch the surface when it comes to how many people experience their obsessions and compulsions. For such behaviours to be classified as OCD, symptoms need to be intense, emotionally distressing and significantly interfere with a person’s life.

The OCD Cycle

The OCD cycle offers a step by step understanding of how OCD unfolds for the individual. By clicking on the sub headings, you can read a little more around each of the steps that make up the experience of OCD.
(Please click the labels to read more)

Obsessions are reoccurring thoughts, images, impulses or worries that come into your head, which seem to intensify the more you try to push them away. These obsessions tend to only exist around areas that the sufferer cares about, which in turn make the person begin to feel extremely anxious and out of control. For example, “I really love my partner, but I am worried that I cheated on them last night” or “I would never want to harm my children, but I am worried that I may want to, or could do by accident”.

Obsessions can exist around almost anything, although common traits include those centred around feeling overly responsible for something or others, desperately wanting certainty around a particular subject or generally feeling distressed by the content that comes into person head. To control these obsessive intrusions, the sufferer begins actively performing behaviours to rid themselves of such thoughts, giving those very thoughts more meaning than if they learnt to simply ignore them.

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Compulsions can be anything that the person partakes to neutralise or take away the unwanted feeling that originates form the obsession and unwanted emotion. Common examples include repeatedly checking, seeking reassurance from loved ones, self-soothing and reassuring through mental checking, washing, rumination and avoidance.

Compulsions can be broken down into two different types of compulsions, those that we can see that take place outside of the body (overt), and those that happen solely inside of the head (covert), known as rumination or mental problem solving. Compulsions give the person a false sense of control, making them feel like if they only perform the compulsion perfectly or one more time, then they will be relieved of the anxiety. However, in the longer term this only sets the person up to fail and in turn experience such intense unwanted emotions more regularly.

2 of 4 The emotional response for someone with OCD is a key contributing factor within the OCD cycle. Without intrusive thoughts being compounding by such overwhelming emotions, it is likely ignoring the thoughts would be considerably easier. One of the key brain areas that becomes activated during the emotional response is the amygdala, a part of the brain that becomes active when we are in danger. Although in everyday life this is an extremely helpful part of the brain, for those with OCD the amygdala begins to fire to perceived threats, rather than real ones. Due to the intensity of emotions such as anxiety, dread, guilt and shame this becomes an increasingly alarming, scary and overwhelming experience. Due to such high levels of distress, the person begins performing ‘compulsions’ or ‘rituals’ to reduce the unwanted emotions. 3 of 4 Marker Text The core belief is particularly important for people with OCD, as this is encompasses the core drivers behind almost all obsessive compulsive symptoms. It is important that for true management and recovery from OCD, a person’s core belief is both identified correctly, as well as effectively challenged. 4 of 4

OCD subtypes

Before reading through the different sub types, we want to clarify that this is simply just to help you make sense of your symptoms. Although it can be helpful to obtain some clarity here, it is also important to recognise that most people’s symptoms are likely to encompass two or more of the below themes. It is also common to display symptoms from almost every theme, so if this is you, please don’t panic as this is completely normal.

Responsibility or Harm OCD

If you have OCD you may have an over inflated sense of responsibility. This means that you believe you have the power to either cause or prevent bad events that are personally important to you. ‘Magical’ thinking, which is the act of performing special actions to prevent something happening (an extreme form of superstitious thinking), is closely related to this. It makes you feel more comfortable, as if you had more influence and control over what happens. With responsibility OCD, the sufferer places great importance on what they do, their actions, their thoughts, their decisions, most elements in their life become a challenge, as they often feel what they do will end up with catastrophic consequences. Things feel like life and death, like it does for any type of OCD.

Contamination OCD

Contamination OCD refers to the fear of becoming personally contaminated through one’s own actions, being contaminated by others, contaminating others, or different combinations of any of these. The fear of coming into contact with either real or magical things viewed as harmful. The real things may include viruses, bacteria, bodily waste or secretions, people who appear ill or unclean, poisons, radiation, or toxic chemicals. The magical subjects may include bad luck, the names of illnesses, or the misfortunes of others. Often this can lead to a sufferer displaying the very common behavioural compulsion of hand washing although this is but the tip of the iceberg. Other behaviours can include avoiding certain places which my ‘feel’ contaminated, mentally ruminating about events, washing the entire body time and time again, asking others for reassurance.

Checking and Counting

Checking rituals can be a result of all types of obsessions, including fears of harming accidentally, fears of harming impulsively, or sexual obsessions. The purpose of compulsive checking is to reduce distress associated with uncertainty or doubt over feared consequences for oneself or others. For example, a person who worries about causing harm by not being careful enough, may have the thought that if they check that the door is locked, they will be assured that no one will break in.

Whereas some checking is cued by specific situations (e.g. leaving the house) and reminders (e.g. light switches), in other instances it is performed in response to random thoughts that just pop into the mind and are considered dangerous. People with these types of obsessions, may believe that if they think of a bad event, it is more likely to happen. Counting rituals is often a compulsion with many suffering from OCD. This is also closely related to feeling that everything needs to be symmetrical, counting a certain number of times until it feels right, or the inability to walk through a door threshold until it feels safe to do so.

Religion and Spirituality OCD

Those suffering with Scrupulosity hold strict standards of religious, moral, and ethical perfection. For example, if held in a black and white view, certain passages in the Bible and other religious texts may carry with them intense burdens of condemnation. In holding a strict view of these religious verses, the Scrupulosity sufferer experiences not just intense guilt, but also anxiety about the threat of eternal punishment for having violated religious precepts. Without having chosen to experience these obsessions (OCD thoughts being both intrusive and unwanted), the individual experiencing Scrupulosity feels an overwhelming urge to take whatever compulsive action offers the promise of relief.

Perfectionism

Perfectionism is one of the most common personality traits in OCD. Indeed, some researchers have described obsessive-compulsives as the ultimate perfectionists. There is an element of perfectionism that runs throughout almost any sub type of OCD. Perfection simply doesn’t exist, however, this doesn't stop many people striving for what they believe perfect to be. Occasionally an individual may feel that trying to do everything perfectly is the main driver behind their OCD experience, in which case this would be classed as 'perfectionist' OCD as a sub type. The areas of a person’s life that often become negatively impacted include academia, work, relationships, cleaning and other days to day tasks, although strictly speaking perfectionist can latch onto anything the person values.

Magical Thinking

This form of OCD can manifest from an irrational belief that one has the power to control and prevent dangerous situation’s from happening and the distorted belief that one can control and prevent outcomes by doing safety seeking behaviours to prevent the imagined scenario from happening. Magical thinking is based in superstition, a trait that lives within all of us. However, for someone with OCD, magical thinking is often compared to the analogy of ‘superstition going mad’.

False Memory OCD

The imagination can play a great role in this type of OCD. The sufferer may have a fearful image pop in to their minds, and they become worried that the image may of happened. They struggle to separate imagination from reality. Over a period of time, someone with this form of OCD can become increasingly confused as to what is real and what is not. Also, a person’s sense of self identity can also become very weak.

Purely Obsessional OCD (Pure O)

This form of OCD is driven by the need to find the right answer or to neutralise a thought until it feels ‘just right’. ‘Pure O’ tends to manifest as a question followed by the need for certainty that leads to obsessional mental rumination and problem solving. Like any compulsion, rumination can take up many hours of an OCD sufferers day. Where this type of OCD differs is that compulsions are purely non observable, meaning that they all take place within the mind through mental problem solving. Many clients that suffer from ‘Pure O’ describe feeling exhausted almost all of the time. Other forms of ‘Pure O’ includes performing specific mental actions or neutralisations to ‘correct’ or ‘get rid’ of a particular thought.

Symmetry and Orderliness

Some people with OCD have obsessions surrounding the way objects are arranged. These people may feel very uncomfortable when confronted with situations where objects are misaligned or in disarray. On a related note, some people may be made uncomfortable when something does not appear perfect. They may not be able to tolerate having written something where the letters may be shaped imperfectly. Individuals with obsessions about symmetry and exactness may have magical thinking associated with their concerns. For example, they may worry that their mother will have accident unless things are in the right place. In other cases, the need for symmetry may just “feel right”.

Health related OCD

A common form of OCD is health obsessions. The sufferer cannot find the reassurance they so desire and obsess they may have an illness that is life threatening. No matter how much reassurance they have they always doubt it. Common compulsions can include researching, seeking reassurance from loved ones and repeatedly visiting the doctor or hospital for tests and check-ups.

Paedophilia OCD (POCD)

This type of OCD relates to obsessions around intrusive thoughts that they are sexually attracted to children, or that they have, or mat sexually harm a child. It is not uncommon for people with this type of OCD to feel depressed, due to the abhorrent nature of their obsessive thinking. Although in truth, these thoughts mean nothing about the individual, the very existence of such intrusions make the person feel like there must be some deeper meaning to them, as if they are no longer the moral person that they once thought they were. Those with POCD often begin spending lots of time in their head trying to work out the validity of their thoughts, as well as avoid spending time around children.

Sexual Orientation OCD

Often overlapping with relationship OCD, the person is bombarded with intrusive thoughts that they may be gay. Although the person may have some clarity of their sexual orientation, they doubt that they really know and therefore often spend hours online researching, seeking reassurance from others and in some cases ending their current relationship. Other thoughts my centre around an unclear sense of self, with many individuals saying that they feel confused as to who they really are anymore. It is also common to experience guilt, as the person feels that there is nothing wrong with being gay, but can’t help but be afraid of the idea regardless.

Somatic OCD

This is a common, but less known about type of OCD whereby the individual becomes overly focussed on normal bodily functions such as blinking, swallowing, and breathing in themselves and others. They can also become hyper focussed on their own peripheral vision and sight. Over time, the person begins to feel that what was once automatic, bodily sensations now have a manual quality to them, whereby the person experiences anxiety upon either becoming aware or unaware of such sensations.
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Cognitive Distortions

Cognitive Distortions are biased perspectives that we can come to believe about others, and the world around us. Although some may be subtle, others can have an extremely negative impact on a person’s day to day quality of life. For those the experience OCD, the following cognitive distortions are often present.

All or Nothing Thinking (also known as black and white thinking)

This distortion manifests around a person’s inability or unwillingness to see the shades of grey that make up the world and our experiences. Based in perfectionism, this distortion leads to extreme thinking, such as something being brilliant or awful or that if everything isn’t perfect that it must be a total failure.

Overgeneralization

In this cognitive distortion, a person comes to a general conclusion based on a single incident or a single piece of evidence. If something bad happens just once, they expect it to happen over and over again. Although this is not based in reality, it much very much feels this way to the person.

Filtering

A person engaging in filter (or “mental filtering) takes the negative details and magnifies those details while filtering out all positive aspects of a situation.

Blaming and Poor Personal Responsibility

When a person engages in blaming, they hold other people responsible for their emotional pain. They may also take the opposite track and instead blame themselves for every problem — even those clearly outside their own control.

Heavens Reward (the cosmic scorekeeper)

The final cognitive distortion is the false belief that a person’s sacrifice and self-denial will eventually pay off, as if some global force is keeping score. This is a riff on the fallacy of fairness, because in a fair world, the people who work the hardest will get the largest reward. A person who sacrifices and works hard but doesn’t experience the expected pay off will usually feel bitter when the reward doesn’t come.

Catastrophising

When a person engages in catastrophizing, they expect disaster to strike, no matter what. This is also referred to as magnifying, and can also come out in its opposite behavior, minimizing. In this distortion, a person hears about a problem and uses what if questions (e.g., “What if tragedy strikes?” “What if it happens to me?”) to imagine the absolute worst occurring.

Should Statements and Demands

Should statements (“I should pick up after myself more…”) appear as a list of ironclad rules about how every person should behave. People who break the rules make a person following these should statements angry. They also feel guilty when they violate their own rules. A person may often believe they are trying to motivate themselves with should’s and shouldn’t’s, as if they have to be punished before they can do anything.

Thought-Action Fusion

The person experiences such intense intrusive thoughts that they begin to get confused with what is ‘real’ and what is in their imagination. Often spoken about when a person is experiencing false memories symptoms, simply having a thought can feel the same as doing the act itself. Although this can latch onto anything, common obsessions revolve around harming others, child abuse and other abhorrent or embarrassing acts.

Emotional Reasoning

This is where the person takes things that others do and say far too personally. They may also perceive their own actions to have far more importance than they really do. This can lead to feelings that they may have offended others, are disliked, or that they may have somehow embarrassed themselves, although they may not be sure how these things have come about.

Personalization

This is where the person takes things that others do and say far too personally. They may also perceive their own actions to have far more importance than they really do. This can lead to feelings that they may have offended others, are disliked, or that they may have somehow embarrassed themselves, although they may not be sure how these things have come about.

For a full list of cognitive disortions in ocd, please download our eguide here

Neuroplasticity and it’s role in OCD

You may have heard of the saying, our brain is made of plastic, or malleable. This refers to the brains ability to physically change to adapt to new situations, as well as the implementation of newly learnt skills. We now know that this also includes the development of many anxiety disorders. Our brain has an amazing ability to learn, whereby through changing our behaviour we can essentially reprogram the way our brain works, biologically. The brain can break and reformulate new, healthier pathways, creating changes that are more consistent with a less anxious life. The most exciting thing is that the Science backs it up!

During all of our therapeutic programs we utilise this knowledge, explore the scientific findings and educate clients as to what it means in relation to their OCD, in order to start making the brain work for the person, rather than against them.

Further empirical research supports these findings. Dr Saxena , a Psychiatrist of the University of California, San Diego, School of Medicine concluded that after 4 weeks of intensive treatment for patients with OCD, patients showed significant improvements in their OCD symptoms, and their ability to function, based on PET scans. Result success was also found in patients that had previously not responded successfully to standardized CBT.

Dr Saxena concluded: “Our study reinforced the efficacy of the treatment, and now we've shown how it works in the brain."

Accessing effective treatment for OCD

We have been there. We have recovered. We can show you how.

All our intensive treatment programs are written by a range of fully qualified professionals that have first-hand experience of living with the disorder. We believe that this is particularly important when working with OCD as there truly is no replacement for the experience gained from living with OCD day in day out. Our programs include a wide range of therapeutic tools and techniques, from a range of different therapies. In our experience this is most effective way of working successfully with OCD, as in our experience a one size fits all approach to OCD just doesn’t cut it. Below is a list of what is included in every one of our intensive therapeutic programs:

  • Psychoeducation, including an introduction into Neuroplasticity
  • Mindfulness Based Stress Reduction (MBSR)
  • Cognitive Behavioural Therapy (CBT) & Exposure Response Prevention Therapy (ERP)
  • Rational Emotive Behavioural Therapy (REBT)
  • Acceptance and Commitment Therapy (ACT)
  • Compassionate Focussed Therapy (CFT)
  • Talking therapy

All delivered to you in a safe, private and comfortable environment.
Read more about our treatment options

To find out more, please see our treatment options page here, or alternatively, get in touch

Not sure you have OCD? Take our free assessment here.

Check out our range of free eguides, including a more in depth look at Understanding Obsessive Compulsive Disorder (OCD)