OCD is usually defined as a chronic/long-lasting anxiety disorder in which a person has uncontrollable and reoccurring thoughts (obsessions) and behaviors (compulsions) that the person feels the urge to repeat over and over again.
Furthermore, what characterizes these thoughts and behaviors is that they are:
- Unwanted – the individual does not want them present, and resists against their occurrence.
- Irrational – one part of the individual knows that the thoughts and behaviors are irrational, but still feels he must obey their commands.
- Time consuming – the individual spends a considerable amount of time focusing on the obsessions and compulsion.
- Not causing happiness – but rather anxiety and depression.
- Causing social problems and isolation, which affects family life and their professional life.
The cause of OCD.
Why a person develops OCD and not some other anxiety disorder depends on many factors, including: biology (brain chemistry), genetics, personality, environmental factors (diet, pollutants), and upbringing.
OCD is labelled as an anxiety disorder, although it has many links with the autism spectrum, and the reason it is labelled as an anxiety disorder is because it is assumed that the obsessions and compulsions are being used by the psyche as a defense mechanism against unconscious feelings and interpersonal conflict.
OCD tendencies often starts in childhood as a symptom of unconscious or repressed feelings, but over the course of time the symptoms itself becomes the problem given their all-encompassing nature.
“The fear” or the obsession is not considered the cause of the condition. Rather it is believed that it is unconscious feelings and interpersonal conflicts that have triggered the condition, and that the individual rather than facing and handling uncomfortable and mixed feelings towards attachment figures has developed obsessions or compulsion as a way to regulate the anxiety associated with these feelings.
The Triangle of Conflict illustrates this point clearly and visually shows the difference between the three processes that goes on in the mind; the feeling, the anxiety response, and the defense mechanisms.
Figure: the ToC
As such, OCD is by many psychologists considered defense mechanisms gone haywire and now having a “life or their own”. Often times these OCD symptoms becomes so extreme and debilitating that they impede normal functioning. Many people that struggle with strong OCD spend their day isolated and shameful.
The thoughts and behaviors can become so invasive and all-encompassing that they often influence the entire existence of a person and severely affect his quality of life including relationships, work and career, and self-esteem.
The 4 main areas of OCD.
- Intrusive thoughts – such as harming people or oneself, health issues, numbers and order, doing something on doesn’t want to do (e.g. doing something violent), etc.
- Compulsions – such as touching, checking, seeking reassurance, cleaning, washing, etc.
- Controlling behavior – in essence controlling other people and using OCD to make other people comply (i.e. by using guilt to control others). The secondary gain.
- Strategies to cover up the OCD – actions designed to keep the OCD a secret to others. These strategies can evolve to become quite elaborate. Often they develop to become just as stressful as the obsessions and compulsions themselves. Most OCD’ers are shameful about their condition, but their shame and strategies to hide the OCD only make the condition worse.
Just because the thought is in your head doesn’t mean that it was you that made the thought or that the thought means anything. You are not the inventor of your thoughts, but merely the observer of them. This can be proven by trying to stop thinking completely. You will pretty soon see that this is not possible. However, if you were the inventor of your thoughts you should also be able to turn them off completely. Since you can’t turn off the thoughts completely it means that you did not invent them, you are merely hearing them in your head as they pass by.
Even though you are thinking a thought this doesn’t mean that the thought is true. You can think the thought: “What if I wake up tomorrow ten feet tall?”, but even though you have entertained that thought in your mind doesn’t mean it is true or that the likelihood of the thought becoming true has increased. However, many OCD’ers believe that the thought they are having in their mind is true because the body is emotional or anxious simultaneously. But the thought; “Did I remember to turn off the stove?” is not true just because you are anxious at the same time. One of the major tasks of OCD’ers is to learn to separate between thoughts and feelings in order to overcome OCD. Because as long as their thoughts and feelings go hand in hand and are intertwined OCD’ers will continue to frighten themselves with their thoughts and they will also continue to interpret anxiety as meaning fear, which it doesn’t mean.
Everyone has unsolicited thoughts, but OCD’ers have more of them and the subjective experience of them is more intense. They more often have thoughts about violence, sex, disease, and death. Either that they hurt someone or themselves, or that their property will burn and harm someone etc. What if: cancer, danger. Thoughts about being and staying safe. The reptilian brain in hyperdrive. With repetition and failure to accept the consequence, thoughts become more and more real and scary.
What characterizes OCD’ers is that they resist their thoughts and try to fight against them, but this practice only leads to the thoughts reoccurring. Trying to prevent thoughts leads to their return, as if the ego is trying to get you to accept whatever thought that is present in your mind. Practicing surrendering, letting go, and accepting thoughts rather than fighting against them is another important part of overcoming OCD.
Compulsions usually have no real meaning or relevance, they are just actions that were made up by the ego in order to regulate your anxiety and distract you from your feelings, even though many will try to rationalize their compulsions as having a significant meaning.
For instance, the compulsion to wash your hands doesn’t mean that you in your childhood experienced disease or death as a result of poor hygiene in your family. Rather, the ego will latch onto any behavior (and worry/fear) that functions as a distraction from the body’s anxiety. When the body is anxious, the compulsions actually help with reducing and regulating anxiety because they provide a distraction from what is uncomfortable inside.
Focusing on just the compulsion without addressing the underlying anxiety will just cause the compulsion to shift to something else. For instance, if a person has managed to overcome the compulsion of double-checking the stove and other electrical appliances at home before going to work in the morning without addressing potential feelings and conflicts towards coworkers, bosses, clients, the job itself and its meaning to him, etc., then it usually is just a matter of time before another compulsion, such as the need to wash your hands before going to work, arises.
Often it is the same phenomenon that happens when trying to cure a person’s phobia. Say a person manages to cure his spider phobia with exposure therapy but without focusing on interpersonal feelings and conflicts, then often one can observe that a few weeks later that person has developed a new phobia, such as fear of snakes, ghosts, etc.
Often a compulsive need is continued until emotional conflicts are resolved. In psychotherapy, this process focuses on completely different topics than the content of the compulsion.
The range of compulsions is endless and only the imagination sets the limit for what the ego can come up with as a ritual or behavior that “must” be performed. Most common ones are however related to: cleanliness, health worries and rituals designed to prevent injuries or disease, counting and numbers, order and symmetry, death, violence, and hurting others (e.g. doing something irrational without wanting to such as jumping off the stairs or driving into traffic.), superstitions (e.g. ghosts), religious rituals not common and excessive in their frequency, and sexual compulsions.
OCD and secondary gain.
Since OCD often becomes all-encompassing it has been speculated that the role of OCD is to stop a person from having to face reality. This is because while a person is occupied in his mind with his obsessions or busy performing his compulsion and rituals, life passes by day after day and year after year while the OCD’er avoids normal relationship and/or professional activities or responsibilities. Many with OCD are isolated and struggle with long-term relationships, and many pass up on promotions or work opportunities because it would mean more responsibility or exposure. Many with OCD are therefore self-employed or work in a field where they can call the shots or be left alone.
ODC usually has secondary gains that often maintains the disorder. For instance will the OCD often be used as an excuse to control the family, and be angry, unreasonable, or act inappropriately without anyone being able to speak back unless they will be guilt-tripped in return.
OCD also becomes an excuse for not succeeding, and therefore it protects a persons self-esteem (i.e. “If not for my OCD I could have been popular with the ladies.”).
If you are struggling with OCD, set aside some time to become aware of any secondary gain that the OCD provides you. Ask yourself if you are willing to let go of these gains in order to achieve something more constructive and loving.
Acceptance vs. Cover-Up Strategies.
Trying to keep the OCD a secret and design strategies to avoid giving others a view into how you are doing just makes the OCD worse. When you can accept the OCD as it is and not try to resist its symptoms you will notice that the OCD symptoms subside significantly. Many people experience full recovery just by doing this, that is, accepting their condition fully and not trying to hide it!
Often these strategies are based on the assumption that people around us will view us negatively and judge us as less worthy if they get to know the OCD symptoms. However, this assumption pre-judges people around them as non-loving and non-accepting people, and that only makes you stiff and paranoid around them.
People often take cue from you on how to react towards you. If you can view your OCD with humor, acceptance, and light-heartedness, then so will others. However, if you are ashamed and defensive regarding the OCD then others will not act naturally and loving around you either for fear of offending you. That will only drive other people away and create a divide between you and others.
Become aware of your own strategies and become aware of what aspects of the OCD that you try to keep hidden. Ask yourself if it is possible to accept the OCD as it is and embrace it rather than resist it.
Treatment of OCD.
Is OCD a problem/cause or a symptom? Different schools of psychology are not in agreement on this, but for the sake of practically trying to overcome it it’s most constructive to assume that it is both. That means focusing both on addressing the obsessions and compulsions themselves, but also addressing underlying factors that contribute to the anxiety such as interpersonal conflict and unconscious feelings. Often people focus entirely on stopping the behavior or the thoughts, and they don’t address the underlying causal factors.
Psychodynamic therapists believe that anxiety is the primary condition and needs to be addressed first, and that the OCD is the secondary condition which will be easier to change and manage once the anxiety is dealt with. They view OCD as a defense mechanisms that covers up unconscious feelings, and that the OCD symptoms give temporary anxiety relief when the action or thought is in process. The idea is that thoughts, obsessions, rituals, habits, and compulsions provide temporary respite or distraction from the overwhelming anxiety and feelings.
Many researchers also believe that OCD is due to chemical imbalances in the brain. Often OCD’ers get put on anti-depressants, with mixed results. Some with heavy OCD symptoms sometimes get relief with anti-psychotic medicine.
Some have found relief through functional medicine. Firstly by getting a check-up on how the state of the chemical balance in their brain actually is, and secondly by changing their diet to eating less processed food and more natural food (e.g. avoid meat that is factory raised and pumped full of antibiotics, and start eating meat raised organically and naturally). By consuming a diet that reduces inflammation (e.g. avoiding plants and grains containing lectins), people often experience increased mental well-being and a reduction in their anxiety symptoms.
How do I stop the obsessive thoughts?
This is the first question OCD’ers ask when they enter therapy, but the answer to that is that you can’t stop certain thoughts from entering your mind. You can’t control what thoughts enter your mind, but you can to a great extent control what to do with them after they have entered.
However, many OCD’ers have stopping thoughts as their primary goal and are therefore stuck in their OCD loop. That is because by trying not to think about a thought you are actually making yourself think about it more (e.g. The “Do not think of a pink helicopter” exercise).
Even though you can’t control what thoughts enter your head, you can learn to become comfortable with the feeling or anxiety that accompany the thoughts. The feeling or the anxiety is often so uncomfortable that for the psyche it is easier dealing with the OCD symptoms than dealing with the feelings and anxiety. Learning how to regulate and reduce the anxiety/feelings in the body is of great importance for breaking the OCD-loop. The TBO-exercise is an effective anxiety regulation technique that focuses on the Tempo in the body, your Breathing, and Observing the anxiety and challenging it.
The main trick to handling the obsessive thoughts is to do nothing about them and accept them as they are. Imagine yourself letting them pass like clouds in the sky rather than resisting them. Don’t give them any meaning, don’t buy them as true or as facts, don’t act on them or do anything about them while you are obsessive, don’t push them away or become frustrated by them, and don’t try to replace them by forcing yourself to think of something else.
Let the thoughts be in your head without giving them attention and you will notice that the mind gets done with a thought and replaces it with a new thought continuously without you having to force anything. Learn to sit with the feelings in the body and do nothing while the thoughts come and go.
You are not your thoughts.
Many OCD’ers are highly identified with their thoughts and equate their thoughts with themselves. To learn that you are not the inventor of your thoughts but merely the observer is key to creating distance between yourself and your thought so that they don’t freak you out. When you believe that you are the inventor of your thoughts you become identified with them and then you either take credit for them or blame yourself for having them. Then you start to fight the thoughts in your head, trying not to have them there in the first place. However, even though the thought are in you, they are not you. You are the observer of them.
The train-metaphor is often used when describing our thoughts. If you imagine yourself at a train station you can view your thoughts as trains that enter the station and then leave again when it’s their time to leave. You decide whether to board the train or whether to let the train pass, just as you decide whether to give a thought any attention or letting it pass. Even though you get on a train you can choose to get off again, just as you can give attention to a thought and then decide to let it go and focus on the next thought when it comes. Or you can simply decide to stay on the platform and observe trains all day without getting onboard any, just as you can let thoughts come and go all day without thinking too much about them.
Another trick when listening to your thoughts is to exaggerate them or to give them another voice in your head in order to further separate between you and your thoughts. One reason that you believe that the thoughts are you is because they sound like you, but by giving them another voice or dialect, or by exaggerating the consequence or the obsession, it becomes easier to get a distance to the obsession and not get involved with it.
Experience feelings without acting on them (habituation).
Learning anxiety regulation so that you can be more comfortable when feelings arise is key to overcoming OCD. Obsessions and their accompanying compulsions goes away when the body is calm and anxiety is not present. Compulsions are like defense mechanisms that people do in order to bring down their distress level.
Often it is the response/action/compulsion that becomes the biggest problem and not the thoughts per se. Cognitive psychologists have created a procedure called Exposure and Response Prevention (ERP) in order to habituate a person to his feelings.
In essence, the procedure encourages the person to deliberately do the feared thing and then to take it one step further while focusing on regulating anxiety throughout the task.
A bacteria obsession and a washing compulsion is a good example. Here you will in step one touch something that you normally would avoid, and then you would take it one step further by, instead of acting on the compulsion and washing your hand, then place the unwashed hand on your cheek.
Repeated deliberate exposures while focusing on regulating the anxiety has shown to be an effective method for treating compulsions.
The ERP method includes making a hierarchy of your fears, and grade them in order of difficulty. Also, ERP focuses on becoming aware of the level and intensity of both your obsessions and compulsions so that you can map any changes throughout the gradual deliberate exposure procedures. This includes observing yourself and noticing how you respond when anxiety comes. What are your strategies for dealing both with your obsessions and with your compulsions?
Resistance towards the compulsions upholds them. Stop trying to stop the compulsions and become frustrated by them. Try to have a total acceptance of your compulsions while at the same time deliberately exposing yourself in order to tolerate greater feeling and discomfort without having to act upon them.
OCD: Doubt vs. Certainty.
A typical character trait of OCD’ers is their unwillingness to accept uncertainty. They “need” to be absolutely 110 % certain, not only in regards to their OCD symptoms, but also in regards to their relationships and professional life.
However, the paradox is that in order to overcome OCD and achieve that level of certainty, OCD’ers need to become more comfortable with their feelings because it is our feelings that give us our sense of certainty. What gives us our gut-feeling, intuition, and certainty is given to us by our senses. It is our sense; our vision, hearing, smell, taste, and touch that is the basis for our sense of certainty. Our certainty doesn’t come from our thinking
But OCD’ers have a problem in this regard since they don’t trust their senses. They believe that it is (magic) thinking that keeps them safe, and not their senses. Many have during their upbringing learned not to trust their senses and this has made them uncertain in many regards regarding both themselves and the world around them. OCD and (self-)doubt therefore goes hand in hand.
In order to break out of the vicious cycle and overcome their affliction, OCD’ers need to redevelop trust in their senses and their ability to handle situations spontaneously. They need to accept that life is uncertain and that it is unrealistic to demand 100 % certainty in every situation in life. Also they need to learn to accept uncertainty and to take calculated risks based on their level of discernment, because an unwillingness to take risks ultimately leads to a loveless life.