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OCD

Obsessive compulsive disorder can cause a lot of distress and get in the way of you living the life you want. If you’re dealing with these symptoms, I know you’re struggling with a unique kind of misery.

Are my symptoms OCD?

We have an idea from mainstream media what OCD looks like. The typical example involves fear of germs or maybe having things arranged in a certain way or put in a specific order. But OCD can actually look really different from person to person.

The symptoms that define OCD involve both intrusive thoughts and rituals or compulsive behaviors. OCD sets up a cycle of anxiety through obsessions (the thoughts) and behaviors done to cope with the anxiety (the compulsions) that comes from the obsessions.

The cycle starts with an intrusive thought. Intrusive thoughts are unwanted thoughts that pop into your mind and present some kind of negative outcome. The content of this thought can be anything. It might be about germs or getting dirty but it might also be about making a mistake or a worry that you said the wrong thing or that your partner doesn’t love you (or that you don’t love them) or that you did a terrible thing in the past. These thoughts are scary and bring up anxiety. 

Compulsions or rituals are the behaviors that are done right after the intrusive thoughts to manage anxiety.The typical example is cleaning or checking the doors or the stove. Other common behaviors are taking photos to have evidence that you did something, internet searching, and avoidance.

But what I actually see most often are mental rituals. When I talk to people who describe overthinking, many times what’s actually happening is a mental ritual. Rumination, worry, figuring it out, replaying past events, and self-reassurance are all examples of mental rituals. Rituals might involve trying to figure out why you have these thoughts, what they mean about you as person, if they’re true or not and how you can find out if they’re true.

If these symptoms sound like you, feel free to reach out to me for a consultation so we can talk more.

Examples of common obsessions and compulsions

Some common obsessions include:

  • Fear of contamination from germs, bodily fluids, or household chemicals
  • Fear of losing control and acting on an impulse to blurt out something inappropriate or an impulse to harm someone
  • Fear of harming others through not being careful enough or being responsible for something terrible happening to others (fire, burglary, dropping something that might cause someone to trip and hurt themselves)
  • Fear of forbidden sexual thoughts (about incest, children, homosexuality, or aggression)
  • Fear of offending God or concerns about morality
  • Fear of developing a serious disease
  • Perfectionism, including fears of losing or forgetting things, indecision, and concerns about evenness

Some common compulsions/rituals include:

  • Washing and cleaning
  • Ruminating
  • Figuring it out
  • Internet searching
  • Mental review of conversations or interactions
  • Prayer
  • Counting or special numbers
  • Checking
  • Arranging things until they feel “right”
  • Repeating body movements (tapping, blinking)
  • Repeating routines (setting items down, getting in and out of chairs, going through doors)
  • Seeking reassurance from others

How do you treat OCD?

The gold-standard intervention for OCD is called exposure and response prevention (EX/RP). This treatment has decades of research to support it and is the most effective strategy for decreasing symptoms of OCD. Exposure therapy is designed to help you systematically confront things that you’re afraid, giving yourself a chance to learn that anxiety is temporary and the thing you’re most afraid of is unlikely to happen. Exposure is about getting out of old patterns so that new learning can occur. The second part of EX/RP is response prevention. This means working together to eliminate time consuming rituals.

With exposure therapy, you’re always in the driver’s seat. I’ll be right there with you on the passenger side, giving directions, encouragement, and sometimes pushing you out of your comfort zone but you control the treatment process. We work together to develop exposure tasks to help you get the most out of treatment. I’ll never suggest an exposure task that I wouldn’t do myself and whenever possible, we’ll do them together to start. You are not alone in this!

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