Obsessions

Obsessions are involuntary thoughts, images or impulses. Common obsessions include, but are not limited to, fears about dirt, germs and contamination; fears of acting out violent or aggressive thoughts or impulses; unreasonable fears of harming others, especially loved ones; abhorrent, blasphemous or sexual thoughts; inordinate concern with order, arrangement or symmetry; inability to discard useless or worn out possessions; and fears that things are not safe, e.g. household appliances. The main features of obsessions are that they are automatic, frequent, upsetting or distressing, and difficult to control or get rid of.

Compulsions

Just as with obsessions, there are many types of compulsions. It is common for people to carry out a compulsion in order to reduce the anxiety they feel from an obsession. Common compulsions include excessive washing and cleaning; checking; repetitive actions such as touching, counting, arranging and ordering; hoarding; ritualistic behaviours that lessen the chances of provoking an obsession (e.g., putting all sharp objects out of sight); and acts which reduce obsessional fears (e.g., wearing only certain colours). Compulsions can be observable actions, for example washing, but they can also be mental rituals such as repeating words or phrases, counting, or saying a prayer. Again, not all types of compulsion are listed here. The main features of compulsions are they are repetitive and stereotyped actions that the person feels forced to perform. People can have compulsions without having obsessional thoughts but, very often, these two occur together. Carrying out a compulsion reduces the person's anxiety and makes the urge to perform the compulsion again stronger each time.

A person can have some or all of these symptoms. Almost everybody experiences the type of thoughts that people with OCD have (e.g., wanting to double-check the front door or the gas). However, most people are able to dismiss these thoughts. People with OCD cannot ignore unpleasant thoughts and pay undue attention to them. This means that the thoughts become more frequent and distressing and, over time, they can affect all areas of a person's life, often their job and their family and social life. A person with OCD can, however, appear to function perfectly normally despite being greatly distressed. This often makes it possible for people with OCD to hide their OCD (because of this, OCD has often been called the 'secretive disorder'). It is important to remember that severity of OCD differs markedly between people but each person's distress is very real. People with OCD are not 'mad' or dangerous and do not carry out their unpleasant thoughts. Most people with OCD know that their thoughts are excessive or irrational but the anxiety they feel makes the thoughts difficult to ignore.

A Case Study, Paul

Paul knew he was a bit of a perfectionist and yes completing a task could take a long time, but didn’t everyone check five times whether the car was securely locked? When it took Paul 1 hour to move away from the car and start the weekly supermarket shopping, his wife insisted he visit a doctor. He was diagnosed with Obsessive Compulsive Disorder.

Early Life Experiences

Paul can’t mention anything special about his childhood. His parents were OK (although his father was a very careful man and hammered home the importance of doing things correctly) and his two brothers and one sister were fine. He gets along with them quite well. If anything, he was very protected in his childhood. He can’t remember anything upsetting before the age of 23, when his first girlfriend ended their relationship.

Beliefs

"Things have to feel right otherwise I’d better not do them"
"I should feel OK"
"If I am not sure, I’d better not do it!"

Unhealthy Negative Feelings

Anxiety

Self-Defeating Behaviours

Many OCD behaviours (for example constantly checking whether he has done something).

What triggers the problems now?

The slightest doubt over whether he has done something or not.