Obsessive-Compulsive Disorder (OCD)

Individuals with OCD are bothered by intrusive, anxiety-laden thoughts (obsessions). They respond to these thoughts with behaviors or ritualized thoughts (compulsions) which act to temporarily reduce their anxiety, but which are often problematic in themselves. For example, an individual with OCD might experience intrusive thoughts about his home being burglarized because of an unlocked door, and then respond to these thoughts by either checking the lock repeatedly (behavior) or mentally reviewing the process of locking and checking the lock (ritual thought). Other common obsessions include fears of contamination, fears of making mistakes, and fears of harming others. Common compulsions include excessive washing or cleaning, checking or seeking reassurance, and silently repeating phrases or numbers. While many individuals with OCD recognize their obsessions as irrational, and regard their compulsions as excessive or unreasonable, some do not.

Clinically significant OCD occurs in about 2.5% of the population. While it tends to be chronic, the severity of symptoms tends to fluctuate over time. According to the DSM-IV, you may meet the criteria for OCD if you:

  1. Experience either obsessions or compulsions.
  2. At some point have recognized these as excessive or unreasonable.
  3. The obsessions and compulsions cause marked distress, are time consuming, or interfere with the rest of your life.
  4. The content of the obsessions or compulsions are not limited to the symptoms of another disorder (like obsession with food in an eating disorder).

An obsession can be thought of as a meaningless message broadcast by the alarm centers of your brain. While the fight-or-flight response is activated, there is no real threat associated with the alarm. In this way, having OCD is like having a smoke alarm in your home that goes off every time you use you toaster. Responding to your obsessions by engaging in rituals is like calling 9-1-1 every time you make toast. At some point, it is helpful to recognize that even though the alarm is going off, it is not necessary to respond to it.

Each time a person responds to an obsessive thought by engaging in a compulsive behavior, the association between the obsession and the compulsion is strengthened, and the OCD gets worse. To change this, both cognitive-behavioral therapy (CBT) and acceptance and commitment therapy (ACT) emphasize exposure to the obsessive thought or impulse and prevention of the compulsive response. ACT emphasizes that an obsession is, by definition, a thought that the individual is unwilling to have. The goal of acceptance is to experience the thought and attendant anxiety in a new context of willingness, thereby changing the nature of the thought from an obsession to a thought that one is willing to have. This changes the experience of the thought. Since it is no longer necessary to get rid of the thought, it is not necessary to engage in the compulsive behavior.

ACT also emphasizes the importance of clarifying your values to strengthen your commitment to acting in ways that are consistent with those values. For example, the person with OCD might be encouraged to ask "which do I value more: having perfectly ironed linens or enjoying time with my loved ones?" Being clear about what it is that you value most can provide answers to the question of why you would want to accept uncomfortable feelings. The acceptance allows you to live the life you truly want to live. A step-by-step approach to increasing your acceptance of disturbing thoughts and feelings of anxiety, as well as increasing your ability to focus on and commit to choices that are consistent with your values is presented in The Worry Trap.