Obsessive-Compulsive Disorder is a condition where a person experiences recurrent and unwanted thoughts and mental and/or behavioural compulsions.
Everybody experiences intrusive thoughts, probably more regularly than anyone would care to admit. However, it’s the belief system that people with OCD create and attach to these thoughts that provoke distress.
Intrusive thoughts are linked to the experience of OCD and can revolve around themes such as:
- Harming somebody or yourself (Harm OCD)
- Having sexually inappropriate thoughts
- Fears that you are a bad person or that you have done something bad to somebody (Pure-OCD)
- Fears of contamination
- Concerns with keeping those around you ‘safe’
- Being responsible for something ‘bad’ happening
- Questioning your sexual orientation (HOCD)
- Hyper-responsibility for thoughts and behavior (moral scrupulosity)
- Concerns about ‘the rightness’ of relationships (ROCD)
- Concerns about ‘ordering’ things in a particular way or symmetry- both mentally or physically (Just-right OCD)
- Repetitive and rapid thoughts that ‘loop’ without any logical endpoint
- Excessive fears that somebody dear to you could die suddenly
- Fears that you might be a pedophile (POCD)
Obsessions can also come in the form of mental images or urges.
The unwanted thoughts (the obsessions) are commonly referred to as intrusive thoughts, which come into the mind and decide to stay, causing much distress and discomfort to the person thinking them.
There are two types of compulsions; overt and mental compulsions.
Overt compulsions are behavioural, and so can be observed visually (e.g. somebody touching wood repetitively).
Mental compulsions include excessive rumination and can be particularly challenging, because unlike overt compulsions, they cannot be seen. Many people who experience mental compulsions often don’t always recognise these thoughts as compulsions, rather they are labelled as a ‘deep thinker’ or someone with ‘a busy mind’. Some examples of OCD compulsions are:
- Behavioural touching routines (such as touching wood)
- Creating excessive routines that interrupt daily living (having to walk up and down the hallway six time before you can touch the door handle to leave the house)
- Excessive cleaning rituals
- Excessively checking any manner of things such as doors, locks, taps, the rearview mirror of a car, expiry dates on food, that sleeping children are breathing
- Excessively ‘googling’ matters of concern
- Seeking reassurance from other people
- Excessive rumination (the process of continually thinking about the same thoughts)
- Scanning your thoughts, feelings, and body sensations, to check if they are “appropriate”
- Problem solving – trying to think your way through or out of a thought or trying to solve something that is not solvable
- Writing notes to understand your thoughts and linking these together
- Constantly replaying past conversations to convince yourself that you responded appropriately
- Constantly replaying actions to make sure you turned off an appliance, locked a door etc.
Having a healthy amount of routine in your day is a good thing, but it’s when the routine starts to impact your daily living, capacity to get to places on time, and relationships, that it can become an issue.
For those of you who have OCD reading this screaming ‘fuck yes, it’s exhausting!’ at your screen—we hear you. And it’s not just the exhaustion, it’s also the content of the thoughts themselves. Having distressing thoughts can be really scary and unbearable, mainly because these thoughts conflict with our core beliefs. These are referred to as ‘ego-dystonic’ thoughts.
Ego-dystonic thoughts are thoughts we have that are contrary to our core beliefs and values.
When we have thoughts that don’t align with our belief system, they can provoke strong emotional reactions. For example, somebody with OCD who is in love with their partner may have an intrusive thought about whether the relationship is ‘right’. This can then lead to them catastrophising about whether they ‘actually’ love their partner or not.
As a way to manage these thoughts, people with OCD develop mental rituals or behaviours to ’stop’ or ‘neutralise’ the distressing thoughts. Unfortunately, the compulsive behaviour only reinforces the obsessions, and feeds the OCD cycle. Here’s a diagram of what we’re talking about:
One of the cruel things about compulsions is that often they provide temporary relief from the cyclic obsessions of doubt, uncertainty, anxiety, and ‘what if’ questions. But in fact, it only reinforces the compulsions, and therefore the obsessions, and so begins the merry-go-round…
Imagine your brain is a record player. You have millions of records that represent your thoughts that play every day. One day, a record is playing and the pin suddenly gets stuck, leading the record to jump and loop over, and over, and over the same section of the song or ‘thought’ again, and again, and again. If you can’t lift the pin on the record player to change its position, it will keep looping over the same section relentlessly. Because you’re repeatedly exposed to this section of the song or ‘thought’, you likely can’t get it out of your head.
And what happens when our thoughts repeat? We start to believe that these thoughts must have significance therefore we must pay attention to them because our brains only latch onto thoughts that are important, right? WRONG DONKEY KONG!
It’s important to acknowledge that thoughts are just that…thoughts. We have thousands of them each day but not all of them deserve attention. For more on this check out the Mythbusting section.