FAQ

Obsessive-Compulsive Disorder, or OCD, is characterized by obsessions and compulsions. Obsessions are intrusive, unwanted and repetitive thoughts or images that create distress. In an effort to reduce the distress associated with these thoughts or images, the person engages in compulsions. Compulsions are any mental or physical act that is done with the intention of reducing anxiety. Some common examples of compulsions include checking, arranging, washing and re-doing. Compulsions can also occur internally. Internal compulsions or “mental compulsions” include engaging in reassuring self-talk, distracting from thoughts, ‘thinking positive’, counting and repeating a mantra, among others. Avoidance also plays a large role in OCD and helps maintain the anxiety associated with intrusive thoughts. For example, a person who has an intrusive thought about hitting someone with their car might avoid driving.

OCD affects men and woman equally, although males are more likely to be diagnosed at a younger age. OCD does not vary by race or ethnicity. Approximately 1 in 100 adults suffer from OCD and approximately 1 in 200 children suffer from OCD.

OCD is treated with exposure and response prevention (ERP). During exposure therapy a person is exposed to thoughts, images or situations which trigger obsessions. The person is then aided in resisting the urge to engage in compulsions. For instance, a person with the obsession “what if I hit someone with my car” might be asked to go on a drive. When the obsessions arise, he would allow himself to experience the anxiety while being sure not to go back and check the spot where he fears he hit someone. The goal of ERP is to slowly build tolerance for obsessions and for the anxiety they bring up. As a person learns to tolerate higher and higher levels of anxiety they free themselves from the obsessive-compulsive cycle. Obsessions no longer feel as intrusive and unwanted and OCD is no longer an obstacle. Anxiety is significantly reduced during this process but this is never the aim of ERP.

Almost everyone struggling with OCD is responding to obsessions in some way—even if that response is subtle. For instance, distracting (ex: checking your phone), trying to ‘figure out the obsession’ by ruminating or reassuring yourself are all compulsive responses.

During the ERP process, you will learn how to “spoil” or undo mental compulsions. For instance, if you automatically reassure yourself when an obsession arises (ex: “this bathroom looks clean”) you would then actively bring up another thought that ‘undoes’ the reassurance and brings the anxiety back to the fore. (ex: “there are billions of invisible germs in this bathroom”). I work with the “Golden Rule” of never aiming to control an internal experience such as a thought or a feeling. However, a skilled therapist can help you differentiate between automatic, intrusive thoughts versus thoughts that take mental energy and are part of an active process. For instance, going over the pros and cons of a particular decision takes mental energy and does not happen automatically. When active mental compulsions are occurring, a person can learn not to engage.

Harm: fear of harm coming to self or others Sexual: fear of engaging in taboo sexual behaviors such as pedophilia Violent: fear of losing control or engaging in violence towards self or others Contamination: fear of coming into contact with dirt or germs Hyper-awareness of automatic body processes such as breathing, urinating, swallowing Homosexual: “what if I’m gay/lesbian” ‘Not Just Right”: feeling unsettled until performing a compulsion (i.e. tapping an object a number of times until it feels right) Existential-focused obsessions: trying to compulsively ‘figure out’ spirituality, the universe, your purpose etc. Relationship-focused (ROCD): compulsive doubting related to whether your partner is right for you Scrupulosity: obsessions related to religious or moral themes

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