Obsessive Compulsive Disorder (OCD) can be very distressing and puzzling for years until you find out what is actually happening. I see people who suspect they may have OCD or who have already received treatment in the past. But many times people come to me to find out in our work together that OCD is really behind what causes them anxiety and distress. I myself struggled with OCD as a child and then again as a young adult without knowing what was happening until I received training as a therapist and then therapy for OCD myself. It was such a liberating life-changing experience that I decided to focus in my own therapy practice on supporting people with OCD as well.
Obsessions and compulsions can come in many different forms and only some forms tend to be better known and recognized.
For example obsessions can be:
What if my hands are dirty and I might get sick or get my baby sick?
What if I leave that knife lying around and then I might grab it without wanting to and stab someone?
What if I didn’t lock the door and someone will break in?
What if I am not really straight, or not really gay and I’m ruining my life or I’m lying to my partner?
What if I suddenly hurt someone without wanting to?
What if I would be happier with another partner even though my partner is great?
What if I have to do this just right otherwise I will feel terrible and everything is ruined?
What if I have to do something a certain number of times or otherwise something terrible will happen?
There are as many possible obsessions/doubts as there are people who live with OCD. It’s important to know that obsessions are connected to important values that we have and that OCD uses to make us doubt ourselves. OCD threatens us to make us believe we may be vulnerable to not live up to our values or that some imaginary terrible thing will happen to us.
In response to the obsessions, people with OCD engage in compulsions in order to neutralize the fear and discomfort that the obsessions bring with them.
Compulsions can be for example:
Washing your hands over and over again for very long times.
Making sure there are no knives lying around.
Checking the door lock many times and locking and unlocking it over and over again.
Checking your attraction to the same sex or the opposite sex and reassuring yourself that you are truly attracted to the sex that matches your sexual orientation.
Avoiding situations where OCD tells you you might involuntarily harm someone such as driving a car, playing with children, going to sleep while other people are around.
Ruminating over “flaws” in your partner or in your relationship and comparing the relationship over and over again to an imaginary other relationship or a relationship with another imaginary partner.
Checking for physical feelings of attraction.
Doing things over and over again until they feel “right“ and avoiding situations where something may not feel “right.“
Doing things a certain number of times such as saying a certain phrase, flipping a light switch four times, stepping only on the cracks in the pavement etc. so that nothing terrible will happen.
OCD is very inventive and can come up with many compulsions that in the moment seem to make the fear and discomfort get better but because OCD essentially creates a situation where we “try to fix something that’s not broken“ the compulsions are never enough and the doubt always returns.
Without treatment for OCD it can be a very painful condition to live with and it can also become worse over time due to the conditioning and learning part of it.
There are two evidence-based treatment approaches for OCD both of which I have training and experience in.
The more well-known one in the United States is Exposure and Response Prevention (ERP). The other one is Inference Based Cognitive Behavioral Therapy (I-CBT).
Both of these approaches are based in principles of cognitive behavioral therapy.
ERP works with exercises that are carefully planned and help you learn to tolerate the fear and discomfort that OCD creates in order to be able to stop engaging in compulsions and breaking the cycle of obsession and compulsion. The exercises in ERP are carefully planned and individualized and will help you learn to feel empowered and able to face your fears and not be caught in the OCD cycle anymore.
I-CBT is a treatment approach that works without exposures and helps analyze the specific OCD sequence of doubt, feared consequence and compulsion and how these play out for you. You will learn how this sequence is based in an imaginary narrative that OCD has created and that uses your values and vulnerable self to keep you doubting the part of reality that is linked to OCD. In I-CBT you will learn to trust your senses and your common sense that you are able to use in all aspects of life that are not affected by OCD and apply them to the OCD doubt and resolve the doubt by dismantling the OCD narrative and taking away the grip of fear that it holds over you.
Another very helpful approach that I use in my work for OCD is acceptance and commitment therapy (ACT). ACT is based in an ability to take steps toward valued goals with acceptance of life and our internal processes as they are, commitment to valued goals and mindfulness. It is a great supportive approach for OCD work in such that it helps you focus on the bigger picture of the life you enjoy and that you want to live and continue building.