Obsessive Compulsive Disorder Information
Unsure if your difficult thoughts are due to OCD? See the boxes below for more information OCD and treatment, including types of OCD that can be hard to spot. Our clinicians have experience working with a wide variety of obsessive compulsive presentations.
Recognising Mental Compulsions In OCD
•OCD can be difficult to spot and can sometimes present without any overtly noticeable compulsions. •Instead, many suffering with OCD engage with hidden mental compulsions, where they might not yet recognise these thought processes as compulsive acts (see below for examples). •Undoing a "bad" thought with a "good" thought. •Repeating phrases or mantras (either as thoughts, silently under your breath, or out loud). •Mental Reviewing or Checking - e.g., reviewing your memories to see if the door was locked; or sometimes this mental reviewing can be scrutinising a memory to see if something bad happened, e.g., worrying you have done something immoral.
What If I Have No Compulsions?
•Sometimes mental compulsions are not "ritualised", so they can be harder to spot. That is, the compulsion is not enacted in the same way each time. •e.g., many struggling with OCD present with their compulsion being the act of engaging in internal mental debates, where they compulsively analyse the meaning of their thoughts, their reaction to their thoughts, or fretting about whether the thoughts are real or not (previously known as "pure obsessional OCD" or "Pure-O". •E.g., experiencing intrusive thoughts about an anxiety provoking topic (e.g., "Do I really love my partner?") prompting compulsive debating with their mind to "disprove" it.
What Does Treatment Involve?
•Exposure and Response Prevention (ERP) uses exposure (either real life or imagined) to triggers that evoke obsessional anxiety. During exposure, the client refrains from engaging in their compulsions (response prevention) in order to learn that not only is the anxiety and discomfort manageable, but to provide disconfirmatory evidence against their obsessional fears. •Cognitive Therapy (CT) involves identifying and challenging maladaptive appraisals of intrusive thoughts in attempt to substitute them with more reasonable interpretations, by re-evaluating intrusive thoughts without attempting to alter them. •While research shows that ERP (CBT) is the most effective treatment for OCD, we understand that it is not the treatment for everyone, however it is not always a necessary component for treatment to be effective, and we will work with you to try and find a way forward.
More Types of Mental Compulsions
•Compulsive Prayer •Counting/Numbers •Mental Word Games •Thinking thoughts in reverse to "undo" them •Mental hoarding of information •Compulsively creating mental pictures, maps, lists •The majority of individuals experiencing mental compulsions also report automatic compulsions - where they might no longer remember why they are doing it, or what the immediate trigger was.
Types of Obsessions/Intrusive Thoughts?
•Many with OCD worry about the content of their intrusive thoughts, particularly those experiencing intrusions surrounding more taboo, violent, "unacceptable" or "blasphemous" themes. •This can make them reluctant to seek help - fearing judgement, or worrying their intrusive thoughts mean they are a "bad" person. •E.g., intrusive thoughts of unwanted or taboo sexual thoughts; identity (e.g., obsessively worrying that they're lying to themselves about their sexuality or gender identity); and intrusive thoughts of violent imagery or urges, or "blasphemy". •What If I Have No Obsessions? A substantial amount of individuals with OCD actually report their compulsions are not predominantly driven by obsessional anxiety, but instead are driven by "sensory discomfort", including things not looking "just right", or premonitory urges they can feel in their body (e.g., an unpleasant sensation in their chest or throat) compelling them to enact their compulsion.
Why Do We Use Exposure?
•The aim of exposure and response prevention is to not only to become less distressed by your intrusive thoughts and obsessions by habituating to them, but it allows you to finally convince that the fearful part of your mind (that part of your mind that won't listen to your logic, that tells you to engage in the compulsion "just in case") of the following: •The thoughts are not dangerous and do not come true; the compulsive urge, anxiety, and sensory discomfort will fade; •The compulsion is not necessary to prevent feared outcomes from occurring; that you will not lose control; •That you can cope with discomfort. •Most importantly perhaps, by resisting the urge to engage in your compulsions in response to obsessive thoughts, your brain will have a sudden realisation: that you're not responding to the obsession in the way you usually do, where it will subsequently realise that you have a greater repertoire of responses to your obsessions than just compulsions, and therefore it cannot automate the onset of these compulsions after all. Where with time, ERP aims to gradually restore your sense of free will over your actions, allowing you to choose how you will respond to obsessions: with compulsions, or without.
Other Forms of Compulsions?
•Compulsive handwashing or cleaning •Reassurance seeking (e.g., visiting a doctor to check for a feared illness) •Avoidance of certain situations or people (e.g., because they worry they might lose control) •Somatic checking (e.g., checking their bodily reaction to an intrusive thought to see how they react to it - e.g., worrying they are aroused by the intrusion). •Excessive list making •Obsessive urges to "confess" for their intrusive thoughts or minor slights •Needing to touch things •Compulsive rearranging of items •Compulsive staring (e.g., to obsessively "test" their reaction to an intrusive thought. •Compulsive checking (e.g., doors, locks, ovens).
Other Forms of Obsessions?
•Worrying they have a disease •Relationship concerns - (e.g., worrying if they find their partner attractive) •Existential obsessions - (e.g., worrying if they really exist) •"Need to know" obsessions - (e.g., discomfort at not knowing something or having every detail) •Contamination fears •Worrying they will lose control and harm themselves or others, deliberately or accidentally •Sexual obsessions (e.g., intrusive thoughts with a theme of violence, taboo, or otherwise inappropriate) •Obsessions about their morals, desires, beliefs •Religious and/or Superstitious obsessions •Symmetry and exactness (e.g., something needing to look "just right").
OCD Related Issues?
•Body Dysmorphia - preoccupation with body image concerns, with repetitive behaviours (e.g., excessive checking of mirrors, reassurance seeking from others) •Hoarding •Trichotillomania - recurrent pulling out of one's hair •Excoriation (skin-picking) •Tics or Tourette's syndrome; Social anxiety; Autism Spectrum (ASD); Health Anxiety; Eating disorders; Impulse control issues; fear of vomiting; and depersonalisation/derealisation - feelings of being disconnected from one's body, or feelings of being in a dream like state.