Obsessive-compulsive disorder (OCD) is an anxiety disorder characterized by recurrent and disturbing intrusive thoughts, images or impulses (obsessions) that cause anxiety, and repetitive, ritualized behaviours that the person feels driven to perform to reduce the anxiety (compulsions). Most people with OCD experience both obsessions and compulsions, but it is possible to have only one or the other.
People with OCD are worried about bad things happening. The most common theme of their obsessions is worry about harm to self or others. However, the thoughts, impulses, or images are not simply excessive worries about real-life problems. People with OCD often describe their obsessions as “weird” and inappropriate. They will often describe their obsessions by first saying “I know this sounds weird/crazy, but I can’t stop thinking about…”.
The most common themes of obsessions include:
People with OCD try to avoid obsessing by avoiding the situations that trigger them. If they can’t avoid the situation, they try to ignore or suppress their thoughts, images or impulses. If they can’t do that, they try to neutralize them by engaging in compulsions. People with OCD engage in compulsions to stop the “bad thing” from happening. Engaging in compulsions usually brings some temporary relief from anxiety. However, for most people with OCD, compulsions cause even more anxiety in the long run, especially if they are very demanding or time consuming.
Common compulsions include excessive and/or ritualized:
Although most compulsions are observable behaviours (e.g., hand washing), some are not as they are performed as mental rituals; for example, neutralizing an obsessive thought with another by thinking something “good” after thinking something “bad.”
Although some people with OCD may suffer from only one type of obsession or compulsion, most people with OCD have multiple types of obsessions and compulsions.
People with OCD recognize that their obsessions and compulsions are the result of their anxiety and are senseless and excessive. However, because their obsessions make them so anxious, they feel driven to engage in their compulsions.
OCD is often difficult for people to understand, partly because the object of their obsessions is often “weird.” People with moderate to severe OCD are often in significant distress and depressed. Fortunately, OCD is very treatable with cognitive behavioural therapy (CBT). It is sometimes not so easy to tell the difference between OCD and other kinds of problems. The first step towards effective CBT for OCD is a proper and thorough differential diagnostic assessment by a psychiatrist or psychologist.
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