• Are you stuck in the cycle of intrusive thoughts, repetitive habits, and rumination?
• Do you often feel anxious thinking and worrying about things that you know aren’t real or logical?
• Do you get stuck doubting basic things and worrying about “what if”s?
• Do you repeat seemingly random or arbitrary habits to reassure yourself that your fears won’t come true?
• Do you spend a lot of time and energy thinking and making sure everything is OK – only to have to repeat the pattern again? (and again?)

If you or someone you know relates to any of these questions, Obsessive Compulsive Disorder (OCD) may be an explanation. OCD is often thought of as simply just extreme cleanliness and perfectionism. Some like to jokingly use OCD as an adjective, with comments like “I’m really OCD about organizing my room, “ or “my boyfriend is so OCD about his hair.”

However, in reality, OCD is a crippling mental health condition that can take over someone’s life if not treated effectively. It can take on any number of forms, irrational fears, compulsions, and repetitive habits. OCD sufferers may also experience one or multiple types of it at any given time, or various forms at different times.

What are really meant by “obsessions” in OCD?

“Obsessions” in OCD simply mean unwanted, intrusive thoughts or images based in doubt, fear, and worry. They do not refer to romantic infatuation, positive fixations, or just strongly held interests. Common examples could include:

• Harm OCD – worries that you might harm yourself and/or others in some violent, impulsive or wreckless way. Pedophilic and Perinatal obsessions are even more specific subtypes of this.

• Contamination OCD – excessive worries about being exposed to germs that could lead to illness, vomit, death, spreading to others, or intolerable disgust.

• Scrupulosity (moral or religious) – rigid worries about doing something wrong, immoral, or sinful, or unintentionally becoming a bad person destined for hell, rejection by a higher power, or intolerable guilt.

• Health/Illness Anxiety (Hypochondriasis) – exaggerated worries about terminal or chronic illness. Sufferers often fixate on common and normal physical sensations, and/or seek reassurance about their health from multiple medical professionals and online searches.
• Existential OCD – repetitive and circular worries about philosophical matters, life meaning, and/or life after death.
• Relationship OCD – anxious thoughts that you should leave your partner or spouse and are meant to be in a relationship with someone else.

• Real event OCD (sometimes referred to as “False Memory” OCD – doubting your memory and repeated questioning of some past event or conversation in which you fear you have done something deserving guilt or regret.

• Sensorimotor or Somatic OCD – continuous thoughts fixated on a basic bodily function (e.g. staring, blinking, breathing, chewing, etc.) being irregular, a sign of more serious illness, or a target for social embarrassment.
• Perfectionism or “Just Right” OCD – repeated discomfort about something being, looking, or feeling “not quite right,” imperfect, misaligned, or asymmetrical, with efforts to make them feel “right.”
• Sexual Orientation OCD – anxious doubts and rumination about one’s sexual orientation without any clear basis.

What are really meant by “compulsions” in OCD?

The term “compulsion” is often used loosely and mistakenly to describe any repeated habit or action, including addictions (e.g. “compulsive” gambling), body-focused repetitive behaviors (e.g. “compulsive” hair-pulling or nail-biting), or deviant behavior (e.g. “he is a compulsive liar”).

When it comes to OCD however, “compulsions” are merely thoughts or habits that people repeat in order to reduce the anxiety caused by obsessions. Unfortunately, performing compulsions or rituals actually only serves to make OCD worse, as they become increasingly hard to stop. With more repetition, compulsions can wear down one’s ability to trust their own logic, senses, and experience. Examples of compulsions can include:

• Excessive washing or disinfecting – contamination obsessions frequently lead sufferers to wash their hands to the point of dry, cracked, or bleeding skin, or spend hours disinfecting door knobs and household surfaces.
• Reassurance seeking – parents, friends, professionals and internet searches may be sought out repeatedly to confirm a sufferer’s safety, moral uprightness, or accurate memory about past events.
• Checking (and re-checking) – sufferers may perform multiple checks on house and car locks, alarms, stove switches, text messages, and emails, etc. These checking routines can become more and more elaborate and time consuming.
• Ruminating and “reasoning” – it can seem helpful to try and “think through” or “figure out” a way to disprove obsessions. However, such efforts are often not helpful and actually just play into OCD’s trap.
• Praying, reading religious texts, or performing liturgy in a rigid way – for many Scrupulosity sufferers, repeated religious practices can feel like a way to relieve guilt or doubt in one’s moral standing.

In addition to repetitive compulsions and thoughts, OCD sufferers may tend to avoid certain activities, places, images, or reminders of their obsessions. Depending on the type of obsession, sufferers may try to avoid bridges, knives, children, movies, household surfaces, or even their own thoughts.

OCD can be devastating to your mental health (and your loved ones)

OCD is estimated to affect 2.3% of our entire population at some point in life, as per a Harvard Medical School study [1]. The average age of initial onset for sufferers is 19 years of age [2].

In addition to the anxiety caused by the obsessions, most sufferers report feeling incredibly frustrated. You may know that the thoughts are fake or illogical – yet you just can’t stop worrying “what if” they are true? It can be so confusing and disorienting when the space between what is real and what is imaginary becomes so blurred.

If you’re in a relationship with an OCD sufferer, or a parent of a child or teen with OCD, you desperately want to help reduce their suffering. Yet you may also be tired, frustrated, and confused as to why your efforts to comfort them have not stopped them from asking you repeatedly for reassurance. The strain of this alone, despite much supportive and good intentions, can create much stress on relationships and families.

But what caused my OCD?

The fact that OCD thoughts can seem so confusing and ridiculous  naturally leads one to be curious as to the reason or origin of those thoughts. It can also seem natural to believe that some past trauma must have caused these thoughts. Research does not support the idea that significant trauma is necessary to cause OCD, though someone can definitely suffer from OCD in addition to the after effects of trauma.

While there are not entirely clear answers as to why some people develop OCD and others do not, we do know that experiencing severe stress of any kind can make us more vulnerable to having the kind of anxious reaction to intrusive thoughts that can set OCD in motion.

More importantly, another thing we do know is that we have effective treatments for OCD – which is great news. It is often said that you don’t necessarily need to find the match that started a fire in order to put the fire out.

Finding the right treatment for OCD can be confusing

While there are medications shown to be helpful for OCD, most people say they prefer not to rely on them for treatment and recovery. Even more may have found that general talk therapy can be helpful for certain issues, but is not necessarily effective for OCD.

In fact, open ended general talk therapy or therapy that focuses on childhood trauma are not shown by research to be helpful. Generally speaking, approaches that are more directive and skill-based (typically under the Cognitive Behavior Therapy umbrella) are known to be more effective. Even more specifically, most skilled and effective OCD therapy should be grounded in Exposure with Response Prevention (ERP) or Inference-based Cognitive Behavior Therapy (ICBT), which are treatments that have been developed and researched to apply specifically to the unique features and challenges typical of OCD.

“I’ve had general talk therapy. How will therapy for OCD at your practice be different?”

Our practice specializes in providing evidence-based, tailored skills, tools, and education for minimizing the distress caused by OCD on your life. We know very clearly from years of experience that just creating a “safe space” in therapy to discuss intrusive thoughts and compulsive rumination is not sufficient to be of help.

Recovery from OCD requires specialized education, guidance, and direction, as well as practice in between therapy sessions to master new coping skills. As previously mentioned, the most established treatments for OCD are ERP and ICBT, which is what we apply with our clients.

Exposure with Response Prevention (ERP) has historically been the most widely studied and utilized approach to treating OCD. It involves coaching sufferers to gradually confront avoided triggers, thoughts, or images to reduce anxiety, while also helping reduce compulsions, rituals, and rumination.

Inference-Based Cognitive Behavior Therapy (ICBT) is a specific type of CBT for treating OCD with a different emphasis than ERP. It helps sufferers identify their obsessional doubts and understand the unique intricacies of OCD in a way that can help them keep from getting sucked into the intrusive thought patterns altogether.

Either approach, or elements of both, may be more useful for any given OCD sufferer, and our team is skilled in evaluating and educating our clients about these treatment options. Either way, there is hope!

How many therapy sessions are necessary to overcome OCD?

This question comes up all the time because our clients are in distress and desperately want relief, though are unclear how long it will be before they start to feel better. If you’re suffering from OCD, you’re eager to get better.

The best answer we can give is that successful courses of treatment can range greatly in duration. Some clients report really having a better understanding of OCD and how to cope with intrusive thoughts within just a few sessions, which already is a great relief. With others, it can certainly be a longer process over time, most notably if someone is also dealing with ongoing health or relationship stressors, substance abuse, or posttraumatic stress.

Either way, we plan to use every illustration, tool, strategy, and treatment intervention necessary from the best of established therapies to help you or your loved one feel better and shake off the pain of OCD.

Get started with an expert OCD therapist

CBT SoCal’s long tradition of expertise in OCD therapy stems from our founder, Dr. Rodney Boone, a well respected OCD specialist in Los Angeles from 1980 until his retirement in 2022. Our staff have helped hundreds of people over the years to confront OCD and limit its devastating emotional, professional, and financial impact. We have also trained, consulted, and supervised mental health professionals in other practices and clinical settings to treat OCD effectively. If you or your loved one suffers from Obsessive Compulsive Disorder, contact us to schedule a free phone evaluation to see how we can best help.

Sources:

[1] Harvard Medical Review https://www.hcp.med.harvard.edu/ncs/ftpdir/table_ncsr_LTprevgenderxage.pdf

[2] Mol Psychiatry https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2797569/