What is it?

Obsessive-compulsive disorder (OCD) is a pattern of unwanted thoughts and fears (obsessions) that lead to repetitive behaviours (compulsions). These obsessions and compulsions interfere with daily activities and cause significant distress.

Symptoms:

Obsessive-compulsive disorder usually includes both obsessions and compulsions. However, it’s also possible to have only obsession symptoms or only compulsion symptoms.

You may or may not realise that your obsessions and compulsions are excessive or dysfunctional, but they take up a great deal of time and interfere with your daily routine and work, school, and social life.

Obsessions: 

These are repeated, persistent and unwanted thoughts, urges or images that are intrusive and cause anxiety or distress. You may try to reduce the anxiety by engaging in certain compulsive behaviour.

Some common themes of Obsessions

• Fear of contamination or dirt
• Doubting and having difficulty tolerating uncertainty
• Needing things orderly and symmetrical
• Aggressive or anxious thoughts about losing control and harming yourself or others
• Unwanted thoughts, including aggression, or sexual or religious subjects 

Some examples:

• Doubts that you’ve locked the door or turned off the stove
• Intense stress when objects aren’t orderly or facing a certain way
• Thoughts about shouting obscenities or acting inappropriately in public

Compulsions: 

These are repetitive behaviours that you feel compelled to perform, in order to reduce anxiety related to your obsessions, or prevent something bad from happening. These acts do not bring pleasure, and provide only temporary relief from anxiety. 

Compulsions may include creating rituals or rules to follow that help control your anxiety when you are having intrusive thoughts. These compulsions are usually excessive, not realistically related to the problem you are trying to fix, and make the person dysfunctional. 

Some themes commonly seen in Compulsions: 

• Washing and cleaning 
• Counting 
• Orderliness 
• Demanding reassurance
• Checking 

Some examples: 

• Checking doors repeatedly to make sure they are locked 
• Silently repeating a word, prayer, or phrase 
• Hand-washing until your skin becomes raw 
• Counting in certain patterns 

ERP-Therapy for OCD: 

Exposure and Response Prevention (ERP) is a type of therapy which is most commonly used to treat OCD. 

The ‘Exposure’ in ERP refers to exposing yourself to the thoughts, images, situations and objects that start your obsessions and/or make you anxious. 

The ‘Response Prevention’ includes making a choice to not engage in compulsive behaviour once the anxiety or obsessions have been “triggered.”

This is done under the guidance of a therapist, though eventually there are exercises to do yourself that help manage the symptoms.

ERP is the process of not only strategically and purposefully exposing yourself to things that make you anxious, but also making a choice and committing to confront your anxiety and obsessions. When you don’t do compulsive behaviours, you can experience a drop in anxiety levels. 

This natural drop in anxiety that occurs when you stay ‘exposed’ and ‘prevent’ the compulsive ‘response’ is called Habituation.