>> Obsessive Compulsive Behaviors
OBSESSIVE COMPULSIVE BEHAVIORS AND DISORDERS
Obsessive-Compulsive Disorder (OCD) is characterized
by recurrent, unwanted thoughts (obsessions) and/or
repetitive behaviors (compulsions). Repetitive behaviors
are often performed with the hope of preventing obsessive
thoughts or making them go away. Performing these
so-called "rituals," however, provides only
What is an obsessive-compulsive disorder?
Obsessive-compulsive disorder (OCD) is an anxiety
disorder characterized by recurrent, unwanted, disturbing
thoughts (obsessions) and/or repetitive, ritualized
behaviors that a person feels driven to perform (compulsions).
Like a needle getting stuck on an old LP, OCD causes
the brain to get stuck on a particular thought or
action that it just can’t let go. People with
OCD often say the symptoms feel like a case of mental
hiccups that won’t go away.
The Obsessive Compulsive Foundation reports that 1
in 50 adults in the United States currently experiences
OCD, and twice as many have experienced it at some
point in their lives. Symptoms of OCD occur in people
of all ages and may change in severity over time.
Most people with OCD have both obsessions and compulsions,
but a minority have obsessions alone (about 20 percent)
or compulsions alone (about 10 percent). Compulsions
generally accompany obsessions as a result of the
brain’s attempt to dismiss or neutralize the
What are obsessions?
involuntary, seemingly uncontrollable thoughts, images,
or impulses that occur over and over again in a person’s
mind. The person does not want to have these ideas,
finds them disturbing and intrusive, and usually recognizes
that they don’t really make sense. They commonly
crop up when someone is trying to focus on an intentional
thought or activity.
People with OCD may worry excessively about dirt and
germs and be obsessed with the idea that they are
contaminated or may contaminate others. Or they may
have obsessive fears of having inadvertently harmed
someone else (perhaps while pulling the car out of
the driveway), even though they usually know this
is not realistic. Obsessions are accompanied by uncomfortable
feelings, such as fear, disgust, doubt, or a sensation
that things have to be done in a particular way.
Some common obsessions include:
What are compulsions?
- Fear of being contaminated by germs
- Fear of causing harm to oneself or others
- Intrusive sexually explicit or violent
thoughts and images
- Excessive focus on religious or moral
- Fear of losing or not having things
you might need
- Order and symmetry: the idea that everything
must line up “just right.”
- Superstitions: excessive attention to
something considered lucky or unlucky
is a repetitive behavior – a ritual –
that a person feels driven to do and cannot seem to
stop doing. Compulsions represent an attempt to manage
an obsession by doing something to resolve it. For
example, if someone is obsessed with being contaminated,
that person might develop elaborate hand-washing rituals.
If an obsessive worry is whether or not the door was
locked, then a compulsive response might be to check
the lock a certain number of times before leaving
the house or going to bed.
The ritual is meant to bring relief from the anxiety
caused by the obsession, though the ritual itself
can cause anxiety if it becomes too demanding or time-consuming.
Even if the ritual eases the discomfort caused by
the obsession, it will probably return, and the person
with OCD feels compelled to repeat the behaviors over
and over again.
Some common compulsions include:
SIGNS AND SYMPTOMS OF OBSESSIVE-COMPULSIVE
What are the signs and symptoms of obsessive-compulsive
- excessive double-checking
- hand washing
Most people, from time to time,
go back and double-check that the iron is unplugged
or the door is locked before leaving the house. That’s
normal, but when someone worries constantly that the
door is unlocked and makes a ritual out of checking
the lock 40 times before being able to get in the
car, that’s an indication that the person’s
thoughts and behaviors have risen to the degree of
obsessive-compulsive disorder (OCD). The adult with
OCD recognizes his or her repetitive thoughts and
behaviors as irrational but feels unable to break
free from them.
OCD may be diagnosed when compulsive behaviors take
up excessive time (an hour or more a day), begin to
interfere with your normal activities, or cause great
anxiety because they’re so demanding.
While the onset of obsessive compulsive disorder usually
occurs during adolescence or young adulthood, younger
children can manifest symptoms of OCD by showing the
same behaviors adults with OCD exhibit.
It’s often misdiagnosed in youngsters
and adults as another condition
such as autism
or is overlooked because it occurs with other disorders,
such as depression, eating disorders, attention deficit
disorders or Tourette’s syndrome. In addition,
OCD is often underdiagnosed because people with OCD
may feel embarrassed by their thoughts and behaviors
and try (often successfully) to hide the signature
behaviors of their condition or because they lack
access to effective health care. On average, people
with OCD see three to four doctors and spend over
nine years seeking treatment before they receive a
correct diagnosis. Studies have also found that it
takes an average of seventeen years from the time
OCD begins for people to obtain appropriate treatment.
TREATMENT AND HELP FOR OBSESSIVE-COMPULSIVE
What treatment is available for OCD?
OCD is not usually curable, but it is highly treatable,
in that effective treatment can greatly reduce the
occurrence of obsessive thoughts and compulsive rituals.
A combination of behavior therapy and medication seems
to offer the best long-term improvement.
Exposure Treatment and Response Prevention
A type of behavioral therapy called exposure and response
prevention is generally the first line of treatment
for OCD. In this treatment, you are repeatedly exposed
to the source of your obsession. Then you are prevented
from engaging in whatever compulsive ritual you use
to reduce the anxiety brought about by your obsession.
For example, if you are a compulsive hand washer,
you might be asked to touch the door handle in a public
restroom and then be prevented from washing up. As
you sit with the anxiety, the urge to wash your hands
will gradually begin to go away on its own. In this
way, you learn that you don’t need the ritual
to get rid of your anxiety.
Exposure treatment and response prevention is carefully
planned out and controlled, with your therapist at
your side to provide support. You will begin with
a situation that provokes only a low level of anxiety.
Once you’ve been exposed to this situation and
have waited out the anxiety without engaging in your
compulsion, you will move on to a more challenging
situation. Continuing with the previous example, you
might progress from touching the bathroom door handle
to touching the toilet flush lever or even the toilet
seat itself. With each successful exposure and response
prevention, you’ll feel a greater sense of control
over your obsessions and compulsions. Studies show
that exposure and response prevention can actually
“retrain” the brain to function differently,
permanently reducing the occurrence of OCD symptoms.
This type of behavioral therapy can even extinguish
compulsive behaviors entirely.
A cognitive component is often combined with the behavioral
approach of exposure and response prevention. Cognitive
therapy targets the OCD sufferer’s catastrophic
thoughts and exaggerated sense of responsibility.
According to OCD Action, “Cognitive therapy
suggests that OCD results when an individual misinterprets
intrusive thoughts or urges as a sign that not only
will harm occur, but that they may be responsible
for it through what they do or what they fail to do.”
Therefore, a central task of therapy is to address
these irrational thoughts and challenge them.
COPING WITH OBSESSIVE-COMPULSIVE
What self-help tips can help me cope with
If you have OCD, you can help yourself
in many ways. Educating yourself about the disorder
is a vital first step. It’s also important to
practice the cognitive-behavioral techniques you’ve
learned from therapy on your own. Renowned OCD researcher
Jeffrey Schwartz emphasizes the importance of self-treatment
on a day-to-day basis.
HELPING A LOVED ONE WITH OBSESSIVE-COMPULSIVE
How can I help a friend or family member with
|Self-Help Strategies for
||Learn everything you can about OCD. Read books
on the disorder and talk to your therapist and
doctor. The more you know, the better able you
will be to manage your symptoms. You can find
many books about OCD at local or online bookstores.
|Practice the skills you’ve learned
||Using the skills you’ve learned in therapy,
actively work toward eliminating your obsessions
and compulsive behaviors. This is a challenge
that requires commitment and daily practice.
|Stay connected to family and friends
||Obsessions and compulsions can consume your
life to the point of social isolation. In turn,
social isolation can aggravate your OCD. It’s
important to have a network of family and friends
you can turn to for help and support. Involving
others in your treatment can help guard against
setbacks and keep you motivated.
|Practice relaxation techniques
||Meditation, yoga, deep breathing, and other
stress relief techniques may help reduce the
symptoms of anxiety brought on by OCD. A form
of meditation known as mindfulness
may be particularly helpful to OCD sufferers.
Read Helpguide's Stress
Relief: Yoga, Meditation, and Other Relaxation
Techniques to learn more.
|Join a support group
||You’re not alone in your struggle with
OCD, and participating in a support group is
an effective reminder of that. In a support
group, you can share your experience and learn
from others who are going through the same thing
you are. Visit Search
for a Support Group to locate OCD support
groups in your area.
If your friend or family member has
OCD, your most important job is to educate yourself
about the disorder. Learn everything you can about
the disorder and make sure your loved one has access
to information about it as well. Share what you’ve
learned with your friend or family member and let
them know there is help available. Simply knowing
the condition is treatable may provide enough motivation
to get them into a therapist’s office.
The way you react to your loved one’s OCD symptoms
also has a big impact. Negative comments or criticism
can make OCD worse, while a calm, supportive environment
can help improve the outcome of treatment. There’s
no point in scolding someone with OCD or telling the
person to stop performing rituals. They can’t
comply, and the pressure to stop will only make the
behaviors worse. The best way to help a loved one
cope with OCD is to be as kind and patient as possible.
Praise any successful attempt to resist OCD, and focus
attention on positive elements in the person’s
The Mayo Clinic suggests the following tips if you
live with someone with OCD:
- Bring relevant books, tapes and
other literature into your home.
Encourage your loved one to read or listen
to these presentations about obsessive-compulsive
disorder. Often, your loved one already
knows his or her behavior is irrational.
- Be patient about the pace of
progress. The severity of obsessive-compulsive
disorder varies, as do recovery times.
- Praise small successes.
At first, decreasing hand washing time by
10 minutes a day may seem insignificant
to some, but it may be a giant first step
for a person with obsessive-compulsive disorder.
- Refuse to participate in the
person's rituals. Explain that
doing so would only make the condition worse.
- Don't become a baby sitter.
Your loved one needs to know you trust him
or her to be left alone at times —
to not always be under your watchful eye.
Ellen Jaffe-Gill, M.A. created this article with contributions
from Jeanne Segal, Ph.D. Last modified on 10/16/06.
Reprinted with permission from http://www.helpguide.org/.
C 2008 Helpguide.org. All rights reserved.
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