About Obsessions & Compulsions
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“Obsessions” are intrusive (unwanted) thoughts, images or impulses that recur and persist despite attempts to get rid of them, and which cause significant anxiety. Obsessive thoughts are experienced as inappropriate intrusions, unreasonable, and unlike ordinary worries about more realistic problems. They often relate to concerns about being responsible for causing harm, either by doing something or failing to do something. Examples of typical obsessions include thoughts about being contaminated by germs, doubts about having switched off appliances or locked doors, or urges to engage in violent acts or shout out obscenities. Sufferers try, usually unsuccessfully, to ignore, suppress, or neutralise these intrusive ideas.
“Compulsions” are behaviours, either physical or mental, that the sufferer feels driven to engage in repetitively or ritualistically. They are used either to control obsessions, prevent some feared event, or reduce anxiety or as part of following some rigid personal rule. Examples of physical compulsions include hand washing, ordering, checking, etc. Examples of mental compulsions include praying, counting, repeating words silently, reassuring yourself, etc. According to the definition used in psychology and therapy, compulsions either do not realistically prevent the dreaded event they’re used to counter or they are ways of coping that are being used excessively.
When particularly chronic and severe, obsessions and/or compulsions can lead to the diagnosis of “Obsessive-Compulsive Disorder” (OCD). Research suggests that about 2.3% of the population have suffered from diagnosable OCD in their lifetime (NCS-R). (If you board a double-decker bus full of passengers, at least one of them should have a history of OCD, on average.) However, only 34% of sufferers have discussed their symptoms with a medical practitioner (Roth & Fonagy, 2005, p. 199). Behaviour therapy (called “exposure and response prevention” or ERP) is traditionally the most evidence-based treatment for OCD, with average success rates of 86% across studies for those who complete the course of treatment (Roth & Fonagy, 2005, p. 204). More recently, cognitive-behavioural therapy (CBT) has been developed for OCD, which may be more suitable for some clients as it attempts to directly challenge underlying beliefs that may contribute to the symptoms.
Diagnosis of OCD requires that obsessions and/or compulsions take up at least an hour per day or otherwise significantly impair your ability to function in life, and that they cause pronounced anxiety. If another psychological problem is present and the obsessions are confined to it then OCD is not normally diagnosed. OCD is one of the most diverse anxiety disorders and the content of obsessions and form of compulsions vary considerably from one person to another. However, some common examples are provided in the table below:
|Common Obsessions||Associated Compulsions|
|Fear of contamination||Excessive or repeated washing and cleaning|
|Doubts (e.g., gas jets off, doors locked)||Repeated checking-behaviours, reassurance-seeking|
|Need for symmetry, precise arranging||Ordering, aligning, arranging, balancing, or straightening objects until “just right”|
|Unwanted sexual or aggressive thoughts or images||Checking, praying, “undoing” actions, asking for reassurance|
|Concerns about throwing away something valuable||Hoarding|
The International Council on OCD developed the following set of rough screening questions. If you answer “yes” to one or more of these questions, and the behaviour causes you significant distress or interferes with your ability to function in certain areas of life, that doesn’t necessarily mean you have OCD but it’s possible you might and so probably worth obtaining further information.
- Do you wash or clean a lot?
- Do you check things a lot?
- Is there any thought that keeps bothering you that you would like to get rid of but can’t?
- Do your activities take a long time to finish?
- Are you concerned with orderliness or symmetry?
Overcoming Obsessive-Compulsive Disorder (OCD)
by David Veale and Rob Wilson
This is probably the best self-help CBT book about obsessions and compulsions. It’s written by a leading expert on OCD and based on a relatively modern treatment approach. Because OCD takes many forms, the authors emphasise that some of the examples are bound to appear irrelevant to some readers but if you have OCD there will also probably be many examples of problems similar to your own, and the underlying structure of different obsessions and compulsions is believed to be very similar despite apparent differences in their content.
Blog Articles About Obsessions & Compulsions
- What’s the point checking things? August 22, 2012What’s the point checking things? Copyright © Donald Robertson, 2012. All rights reserved. One of the most common problems people report in relation to anxiety is the compulsion to check things excessively, e.g., checking that lights are turned off, emails … Continue reading →The post What’s the point checking things? appeared first on Cognitive-Behavioural […]Solutions: London Cognitive-Behavioural Therapy (CBT)
- Initial Assessment Questions: Obsessive-Compulsive Disorder (OCD) May 17, 2012This article contains a series of questions about obsessive-compulsive disorder (OCD) symptoms designed to help you describe your problem for assessment in cognitive-behavioural therapy (CBT).The post Initial Assessment Questions: Obsessive-Compulsive Disorder (OCD) appeared first on Cognitive-Behavioural Therapy in London. […]Solutions: London Cognitive-Behavioural Therapy (CBT)
- Appraisal of Obsessions & Compulsions May 14, 2012This article provides examples of questions potentially used in Metacognitive Therapy to help understand (conceptualise) obsessive-compulsive disorder (OCD).The post Appraisal of Obsessions & Compulsions appeared first on Cognitive-Behavioural Therapy in London. […]Solutions: London Cognitive-Behavioural Therapy (CBT)
- Adaptive Checking in Metacognitive Therapy May 10, 2012This short article describes the strategy of "adaptive checking", a form of Exposure and Response Commission (ERC), in Metacognitive Therapy for obsessive-compulsive symptoms.The post Adaptive Checking in Metacognitive Therapy appeared first on Cognitive-Behavioural Therapy in London. […]Solutions: London Cognitive-Behavioural Therapy (CBT)
- NHS Video: Obsessive-Compulsive Disorder (OCD) April 11, 2012Two NHS video clips about cognitive-behavioural therapy (CBT) for obsessive-compulsive disorder (OCD) and a two-part ITV documentary.The post NHS Video: Obsessive-Compulsive Disorder (OCD) appeared first on Cognitive-Behavioural Therapy in London. […]Solutions: London Cognitive-Behavioural Therapy (CBT)
- Key Beliefs in Obsessive-Compulsive Disorder (OCD) July 27, 2011This article briefly summarises and provides quick self-rating questions for six key attitudes found in Obsessive-Compulsive Disorder (OCD).The post Key Beliefs in Obsessive-Compulsive Disorder (OCD) appeared first on Cognitive-Behavioural Therapy in London. […]Solutions: London Cognitive-Behavioural Therapy (CBT)