CBT Psychotherapy Ltd

Cognitive Behavioural Therapy (CBT). Treatment for anxiety disorders and depression.

Obssessive Compulsive Diroder (OCD)

Do you identify with any of the points below? 

  • Do you spend large periods of your day worrying that you have forgotten to do something properly?
  • Do you have an intense fear of germs or contamination?
  • Do you spend large parts of your day cleaning or checking that you have performed certain tasks correctly (e.g. locking the door, turning off the cooker, etc)?
  • Do you feel distressed if household items are not in their 'proper place'?
  • Do you regularly experience distressing thoughts or images that are very difficult to get out of your mind?
  • Do you feel pressure to perform certain rituals to avoid the possibility of negative events occurring?
  • Do you worry that you will be held responsible for a negative event and go to extreme lengths to avoid this (e.g. check things over and over, perform superstitious rituals)?

If the do identify with some or all of the above points you may be experiencing obsessions and compulsion.

Am I experiencing obsessions and compulsions?

If you experience obsessions and compulsions, it is likely that you will recognise some of the symptoms described below.
 
Feelings/ Unpleasant sensations.
 
Anxious / panicky
Frustrated / uneasy
Contaminated / unclean / dirty
Guilty / ashamed / disgusted
Under pressure / responsible
Physical Symptoms
Butterflies in your stomach / nauseous
Heart races / mind races
Dizzy / light headed
Tense body / muscular pain
 
 
Thoughts
I'm dirty / contaminated
I'm going to become ill / cause others to become ill
I could get burgled
What if I've left the cooker / iron / radio on?
It'll be my fault if I don't do something (to avert danger)
I'm a terrible person to think this way
I won't be able to cope unless I get this place straightened out
 
Behaviour Patterns
Check over and over that you have completed a task properly
Avoid leaving the house last so you don't have to lock up
Ask others to check you have turned all the appliances off properly
Repeatedly shower or wash your hands
Avoid touching objects that make you feel dirty
Say silent prayers in attempt to avoid disasters
Make sure everything is in its correct position
You try to push distressing thoughts and images from your mind

If you do identify with some or all of the above you may be experiencing obsessions and compulsions. However don't be alarmed, this is very common and there that you canb do in CBT that will help.

What are obsessions and compulsions?

Many people have habits and superstitions that they perform to avoid misfortune. For example, people often avoid walking under ladders or 'touch wood' to fend off bad luck. Obsessions and compulsions are essentially a more extreme form of this. It is when people begin spending large periods of time every day performing behaviours aimed at minimising danger, that they are described as experiencing obsessions and compulsions.

Obsession is the word used to describe when someone experiences unwanted thoughts, impulses, or images that are difficult to control. Common obsessions are about:

  • Forgetting to do something (e.g. locking the door or turning off the cooker)
  • Being contaminated by germs
  • Harming others (e.g. knocking someone over in the car or harming someone with a knife)
  • Performing socially unacceptable behaviours (e.g. swearing in church)
  • A need for orderliness (e.g. everything must be in its correct place).
These obsessions are naturally anxiety provoking and are often followed by time consuming rituals which attempt to neutralise the discomfort they cause. Rituals which are performed to provide relief from the distress caused by obsessions are sometimes referred to as compulsions. Examples of compulsions include:
  • Checking that you have performed tasks properly (e.g. locked the door)
  • Putting things into their 'correct place'
  • Washing yourself thoroughly
  • Cleaning the house
  • Counting items

People also often say silent prayers, picture happy images or repeat phrases over and over in their mind in order to minimise danger. Obsessions and compulsions usually occur together but they sometimes occur individually.

What causes obsessions and compulsions?

Thinking Styles:
Some people may have a thinking style that lends itself to developing obsessions and compulsions. For example, people who develop obsessions and compulsions appear more likely to overestimate the chances of something bad happening (e.g. their house being burgled). As such, they go to great lengths to avoid the possibility of this (e.g. check their door is locked a dozen times).
 
It is also believed that people who develop obsessions and compulsions are more likely to believe that they will be held responsible and blamed if something negative does happen. This too makes them want to engage in rituals to bring relief from this fear.
 
We also know that everyone has unwanted and unusual thoughts at times. However, people who develop obsessions and compulsions tend to view their unwanted thoughts as highly significant. For example, they may believe that having an unusual thought (e.g. of harming someone) makes it more likely that they will follow through with it, as opposed to seeing it as a random thought without meaning. People also sometimes believe that having an unpleasant thought (e.g. swearing in church) is just as bad as actually doing it.
 
Similarly, people often worry that that having unpleasant thoughts is a sign that they are unusual or that something is wrong with them. As a result of these interpretations, people can feel distressed, frightened, guilty or ashamed about their thoughts. This is why they often engage in rituals to try and reduce some of these difficult emotions.
Life Events:
Obsessions and compulsions commonly develop following a period of stress in someone's life (e.g. a bereavement, financial problems or work place stress). Someone's experiences throughout life can also have an impact. For example, if someone has grown up in a household where cleanliness was a high priority, they may develop a sensitivity towards hygiene issues themselves. If this is the case, they may be more likely to engage in time consuming rituals to make themselves and their surroundings feel clean.
Biological Reasons:
There is also some evidence that biological factors play a small role in the development of obsessions and compulsions. For example, if someone in your immediate family has experienced obsessions and compulsions, there is a higher, albeit small chance, that you may go on to experience them too.

In reality, it is possible that a combination of these factors play a role in the development of obsessions and compulsions. However, in some ways it is less important to know what causes them, and more important to know what stops us overcoming them.

What keeps our obsessions and compulsions going?

Relief Seeking Rituals:

Those who experience obsessions and compulsions become distressed when they have an unwanted thought (e.g. I'm contaminated and will spread germs). In attempt to neutralise this, they engage in rituals designed to bring relief from this distress (e.g. wash their hands). Although this is a very understandable way of coping with an unwanted thought, it is actually one of the main reasons that people find it hard to overcome them.

This is because, although rituals help people to feel better at first (e.g. checking the door is locked), this relief is normally short lived and the unwanted thought soon returns (e.g. did I check it properly). Because of this, people soon perform their relief seeking ritual again, as it is the only way that they know how to gain relief from their distress. Unfortunately this creates a pattern of behaviour where people repeatedly engage in rituals in the search for relief, to the point that the rituals themselves become very time consuming and distressing.

Furthermore, people sometimes believe that the only reason their fears have not come true (e.g. that they will become ill after touching a door handle) is because they have been consistently performing their rituals (e.g. thoroughly washing their hands afterwards). Because of this, they feel it is necessary to continue. However, by doing so, they do not give themselves the opportunity to learn that they would be highly unlikely to become ill, even if they had not bothered to wash their hands.

Avoidance:
Another factor that keeps people's obsessions and compulsions going is their tendency to avoid doing things that normally trigger unwanted thoughts. For example, someone may avoid going to church due to their fear of committing blasphemy. However by avoiding church, they don't give themselves the chance to prove that they would have behaved perfectly had they gone, and as a result their fear remains.

Similarly, someone may never take a turn of cooking in case they leave the hob on and cause a fire. This precaution would likely leave them thinking �if I had cooked, I could've caused a terrible fire� and again their fear remains intact.

Blocking Out Thoughts:
Just as people avoid situations and tasks that trigger unwanted thoughts (e.g. cooking or being the last person to leave the house), they also try to avoid their unwanted thoughts by pushing them to the back of their minds. For example, someone who has a thought that they might harm their loved one will try to block this from their mind as best as they can. Unfortunately we know that the harder someone tries not to think about something, the more likely they are to do so. As a result, this coping strategy actually just ensures that the problem continues.
Unhelpful Thoughts:
People's thinking styles play a role in keeping their obsessions and compulsions going. For example, people often overestimate the likelihood of a negative event occurring if they did not perform their rituals (e.g. had I not checked every plug in the house was off 3 times, I could've burned the house down). Because of this they find it difficult to refrain from engaging in time consuming rituals. Their fear of being held responsible for negative events like this has the same impact.

It is likely that a combination of all these factors play a role in keeping obsessions and compulsions going.

How can I overcome my obsessions and compulsions?

Fortunately, there are a number of strategies that we can use to reduce our obsessions and compulsions. These include:

  1. Learning how to gradually confront our unwanted thoughts (obsessions) without relying on relief seeking rituals.
  2. Tips to help us reduce our relief seeking rituals (compulsions).
  3. Learning how to challenge our unhelpful thoughts and see things in a more realistic light.