What is OCD?
What is Obsessive Compulsive Disorder?
OCD has three main symptoms, obsessions, emotional distress, and compulsions, followed by temporary relief. OCD has many sub-types, with many people experiencing a wide array of symptoms at any one time, leading to confusion, exhaustion, and disarray. Most people with OCD symptoms also report having low self-esteem, a confused sense of self, and feelings of hopelessness.
For OCD to exist, the person must care about the subjects that their triggers have latched on to, which can make OCD feel all the more desperate. There are also several cognitive distortions that people with OCD often believe, which perpetuates feelings of anxiety, shame, and despair even further. But, no matter how long you have experienced OCD or how severe your symptoms are, we are here to show you that there is hope.
Learning to understand your OCD can often be the first step to starting your journey to successfully managing your condition. We hope that the information on this page proves a useful starting point to understanding yourself and your OCD better.
The OCD Cycle
Here is a step-by-step guide to the OCD cycle and what happens for someone with OCD.
The core belief is particularly important for people with OCD, as this is encompasses the core drivers behind almost all obsessive compulsive symptoms. It is important that for true management and recovery from OCD, a person’s core belief is both identified correctly, as well as effectively challenged.
Obsessions are reoccurring thoughts, images, impulses or worries that come into your head, which seem to intensify the more you try to push them away. These obsessions tend to only exist around areas that the sufferer cares about, which in turn make the person begin to feel extremely anxious and out of control. For example, “I really love my partner, but I am worried that I cheated on them last night” or “I would never want to harm my children, but I am worried that I may want to, or could do by accident”.
Obsessions can exist around almost anything, although common traits include those centred around feeling overly responsible for something or others, desperately wanting certainty around a particular subject or generally feeling distressed by the content that comes into person head. To control these obsessive intrusions, the sufferer begins actively performing behaviours to rid themselves of such thoughts, giving those very thoughts more meaning than if they learnt to simply ignore them.
Compulsions can be anything that the person partakes to neutralise or take away the unwanted feeling that originates form the obsession and unwanted emotion. Common examples include repeatedly checking, seeking reassurance from loved ones, self-soothing and reassuring through mental checking, washing, rumination and avoidance.
Compulsions can be broken down into two different types of compulsions, those that we can see that take place outside of the body (overt), and those that happen solely inside of the head (covert), known as rumination or mental problem solving. Compulsions give the person a false sense of control, making them feel like if they only perform the compulsion perfectly or one more time, then they will be relieved of the anxiety. However, in the longer term this only sets the person up to fail and in turn experience such intense unwanted emotions more regularly.
The emotional response for someone with OCD is a key contributing factor within the OCD cycle. Without intrusive thoughts being compounding by such overwhelming emotions, it is likely ignoring the thoughts would be considerably easier. One of the key brain areas that becomes activated during the emotional response is the amygdala, a part of the brain that becomes active when we are in danger. Although in everyday life this is an extremely helpful part of the brain, for those with OCD the amygdala begins to fire to perceived threats, rather than real ones. Due to the intensity of emotions such as anxiety, dread, guilt and shame this becomes an increasingly alarming, scary and overwhelming experience. Due to such high levels of distress, the person begins performing ‘compulsions’ or ‘rituals’ to reduce the unwanted emotions.
The OCD sub-types can be a good way of making sense of your experience. It is common to experience two or more such themes, with many people experiencing significantly more.
Responsibility or Harm OCDIf you have OCD, you may have an overinflated sense of responsibility. This means that you believe you have the power to either cause or prevent bad events that are personally important to you. ‘Magical’ thinking, which is the act of performing specific actions to prevent something from happening (an extreme form of superstitious thinking), is closely related. It makes you feel more comfortable if you have more influence and control over what happens. With responsibility for OCD, the sufferer places great importance on what they do, their actions, thoughts, and decisions; most elements in their life become a challenge, as they often feel that they will end up with catastrophic consequences. Things feel like life and death like it does for any OCD.
Contamination OCDContamination OCD refers to the fear of becoming personally contaminated through one’s actions, being contaminated by others, infecting others, or different combinations of any of these. Obsessions can also include mental contamination. Common triggers include viruses, bacteria, bodily waste or secretions, people who appear ill or unclean, poisons, radiation, or toxic chemicals. Often this can lead to a person displaying behavioural compulsions such as handwashing, although this is but the tip of the iceberg. Other behaviours can include avoiding certain places where they ‘feel’ contaminated, mentally ruminating about events or neutralizing, washing the entire body repeatedly, and asking others for reassurance.
Checking and CountingChecking rituals can result from all types of obsessions, including fears of harming accidentally, fears of harming impulsively, or sexual obsessions. Compulsive checking aims to reduce the distress associated with uncertainty or doubt over feared consequences for oneself or others. For example, a person who worries about causing harm by not being careful enough may think that if they check that the door is locked, they will be assured that no one will break-in.
Whereas specific situations cue some checking, such as leaving the house or turning off plug sockets, many compulsions are performed in response to random thoughts that pop into the mind and are considered dangerous. People with these types of obsessions may believe that it is more likely to happen if they think of a bad event. For example, counting rituals is often a compulsion for many suffering from OCD. This is also closely related to the feeling that everything needs to be symmetrical, counting a certain number of times until it feels right, or the inability to walk through a door threshold until it feels safe.
Religion and Spirituality OCDThose suffering from Scrupulosity OCD hold strict religious, moral, and ethical perfection standards. For example, if read in a black and white view, specific passages in the Bible and other religious texts may carry intense burdens of condemnation. In holding a strict view of these holy verses, the Scrupulosity sufferer experiences not just extreme guilt but also anxiety about the threat of eternal punishment for having violated religious precepts. Without having chosen to experience these obsessions (OCD thoughts being both intrusive and unwanted), the individual experiencing Scrupulosity feels an overwhelming urge to take whatever compulsive action offers the promise of relief and reduce the feeling that they may have sinned.
PerfectionismPerfectionism is one of the most common personality traits in OCD. Indeed, some researchers have described obsessive-compulsives as the ultimate perfectionists. There is an element of perfectionism that runs throughout almost any sub-type of OCD. Perfection doesn't exist. However, this doesn't stop many people from striving for what they believe is perfect. Occasionally, individuals may feel that trying to do everything ideally is the main driver behind their OCD experience. This would be classed as 'perfectionist' OCD and, in some cases, can be a standalone subtype. The areas of a person's life that often become negatively impacted include academia, work, relationships, cleaning, and other day-to-day tasks. Strictly speaking, a perfectionist can latch onto anything the person values.
Magical ThinkingThis form of OCD can manifest from an irrational belief that one has the power to control and prevent dangerous situations or events in their life from happening by performing particular safety-seeking behaviours. Magical thinking OCD is based on superstition, a trait that lives within all of us. However, for someone with OCD, magical thinking is often compared to the analogy of ‘superstition going mad.’ Dangerous events will often include those closest to us, including parents, children, and friends.
False Memory OCDThe imagination can play a significant role in this sub-type of OCD. The person may have a fearful image or imaginary story pop into their mind, and they become worried that these events may have happened in real life. They struggle to separate imagination from reality and, over time, lose confidence in their ability to know the difference between their imagination and their memories. Someone with this form of OCD can become increasingly confused about what is real and what is not. A person’s sense of self-identity can also become very weak in some circumstances.
Purely Obsessional OCD (Pure O)Pure O, first coined by Prof. Steven Philipson, is driven by the need to find the correct answer or neutralize a thought until it feels right. 'Pure O' tends to manifest as a question followed by the need for certainty that leads to compulsive mental rumination and problem-solving. Like any compulsion, rumination can take up many hours of an individual's day. However, this type of OCD differs because compulsions are purely nonobservable, meaning that they all take place within the mind, with all compulsions taking place internally. As a result, many clients who experience 'Pure O' describe feeling exhausted almost all the time. Although 'Pure O' can latch onto any subject the person cares about, often obsessions in these cases will refer to existential questions such as the meaning of life or why things are a certain way.
Symmetry and OrderlinessSome people with OCD have obsessions surrounding the way objects are arranged or organized. These people may feel very uncomfortable when confronted with situations where things are misaligned or in disarray. On a related note, some people may be uncomfortable when something does not appear perfect. For example, they may not be able to tolerate having written something where the letters may be shaped imperfectly or if the display on their phone doesn't feel right. Finally, individuals with obsessions about symmetry and exactness may have magical thinking associated with their concerns. For example, they may worry that their mother will have an accident unless things are in the right place. In other cases, symmetry may refer to a more generic need for something to "feel just right."
Health related OCDA common form of OCD relates to obsessions around health anxiety and fear that physical pains may mean something more sinister or indicate more health severe implications. The sufferer cannot find the reassurance they so desire and obsess they may have a life-threatening illness. No matter how much reassurance they have, they always doubt it. Common compulsions can include researching, seeking reassurance from loved ones, and repeatedly visiting the doctor or hospital for tests and check-ups.
Paedophilia OCD (POCD)This type of OCD relates to obsessions around intrusive thoughts that are sexually attracted to children or have or may sexually harm a child. It is not uncommon for people with this type of OCD to feel depressed due to the appalling nature of their obsessive thinking. Although these thoughts mean nothing about the individual, the very existence of such intrusions makes the person feel like there must be some deeper meaning to them, as if they are no longer the moral person they once thought they were. As a result, those with POCD often begin spending lots of time in their head trying to work out the validity of their thoughts and avoid spending time around children. In addition, such triggers can often cause individuals to doubt their behaviour around other vulnerable members of society, including those with a disability or the elderly.
Sexual Orientation OCDOften overlapping with relationship OCD, the person becomes bombarded with intrusive thoughts that they may be gay. Although the person may have some clarity of their sexual orientation, they doubt that they really know and therefore often spend hours online researching, seeking reassurance from others, and ending their current relationship. Other thoughts may centre around a vague sense of self, with many individuals saying that they feel confused about who they are anymore. It is also common for the person to experience guilt, as they think that there is nothing wrong with being gay but can’t help but be afraid of the idea regardless. Such thoughts can then lead to feelings of low mood, depressive symptoms, and increased cynicism.
Somatic OCDThis is a common but less known type of OCD whereby the individual becomes overly focussed on normal bodily functions such as blinking, swallowing, and breathing in themselves and others. They can also become hyper focussed on their peripheral vision and sight. Over time, the person feels that what was once automatic bodily sensations now have a manual quality to them. The person experiences anxiety upon either becoming aware or unaware of such feelings and can often fear they may become unable to function or lead a normal life again.
Cognitive Distortions are biased perspectives that you may hold about other people, yourself, and the world around you. Although some may be subtle, others can have a very negative impact on your quality of life. It is common to experience multiple cognitive distortions if you experience OCD.
All or Nothing Thinking
All or nothing thinking will stop you from seeing all of the grey areas in a situation. You are likely to perceive a situation as perfect or utterly awful based on perfectionism, with very little in between.
Overgeneralization means that you are likely to come to a general conclusion based on a single incident or a single piece of evidence. For example, if something terrible happens just once, you expect it to happen repeatedly. Although this is not reality, it feels this way to you.
If you engage in filtering (or ‘mental filtering’), you will take the negative details of a situation and magnify them while filtering out all positive aspects.
Blaming and Poor Personal Responsibility
If you engage in blaming, you hold other people responsible for your emotional pain. But, unfortunately, you may take the opposite tack and blame yourself for every problem — even those clearly outside your control.
Heavens Reward (the cosmic scorekeeper)
Heaven’s reward is a false belief that a person’s sacrifice and self-denial will eventually pay off as if some global force is keeping score, sometimes compared to the concept of Karma. If you work hard and don’t experience the expected payoff will usually feel bitter when the reward doesn’t come. Heaven’s reward works both ways, and it can be upsetting for you if ‘bad’ people get away with things, as it means the world is unfair.
If you engage in catastrophizing, you expect disaster to strike, no matter what. This is also called magnifying and can also come out in its opposite behaviour, minimizing. When catastrophizing, you may hear about a problem and use what-if questions such as “What if tragedy strikes?” or “What if it happens to me?” and imagine the absolute worst occurring.
Should Statements and Demands
Should statements (“I should pick up after myself more…”) appear as a list of ironclad rules about you or how other people should behave. People who break the rules make a person following these ‘should’ statements angry. You may also feel guilty when you violate your laws.
Thought-Action Fusion, or Thought-Event Fusion
If you experience this distortion, you may feel confused about what is real and what is your imagination. Often, you are likely to become less trusting of your mind due to increased rumination or checking behaviors, leading to growing feelings of uncertainty and emotional distress. In addition, if the thought is about memories, you are likely to think the events through and question your actions, sometimes called ‘False Memory’ OCD.
Emotional reasoning is where you take your feelings at face value. Simply put, you believe that ‘because I feel this way, it must be true.’ This can be highly problematic if you have OCD, as your emotions are not regulating correctly, which means you will believe things simply because of what you are feeling rather than staying with facts.
Personalization is when you take things too personally. For example, if you have OCD, you will be a sensitive person. Such heightened emotions can make you feel like you have offended others, disliked, or somehow embarrassed yourself, even though you may not be sure how these things have come about.
Neuroplasticity and forming new, healthier habits
You may have heard of the saying that our brain is made of plastic or malleable. This refers to the brain’s ability to physically change to adapt to new situations and implement newly learned skills. Our brain has the fantastic ability to learn throughout our lifetime, whereby through changing our behaviour, we can essentially reprogram the way our brain works biologically. The brain can break and reformulate new, healthier pathways, creating more consistent changes with a less anxious life consistent with newer, healthier habits.
The exact causes of OCD are unknown, including the precise neuroscience of OCD. However, we use these findings to educate clients about forming healthier lifestyle changes and habits that can support the successful management of OCD in someone’s life.
Evidence suggests that intensive therapy lends itself to the successful treatment of OCD compared to standard weekly sessions.
Dr. Saxena concluded: "Our study reinforced the efficacy of the treatment, and now we've shown how it works in the brain."
We have BEEN THERE. We have RECOVERED. We can SHOW YOU HOW.
All of our treatment programs have been created by qualified therapists with a combined 35 years of experience in what it is like to live with OCD. Although we appreciate our professional training, we believe that there is no replacement for the first-hand experience of living with the disorder.
We use the most proven, evidence-based treatments for OCD to help you regain control over your life and your suffering. Every treatment program includes:
- Cognitive Behavioural Therapy (CBT)
- Exposure Response Prevention Therapy (ERP)
- Rational Emotive Behavioural Therapy (REBT)
- Acceptance and Commitment Therapy (ACT)
- Mindfulness-Based Stress Reduction (MBSR)
- Compassion Focussed-Therapy (CFT)
- A relapse prevention program to take home
- Premium reading materials
- Follow up support
- All are tailored to suit your specific needs, even when attending our group treatment.
All are delivered to you in a safe, private and comfortable environment. We also provide options for online therapy and can even send an OCD expert to work with you in your own home.
Check out our range of free eguides, including a more in depth look at Understanding Obsessive Compulsive Disorder (OCD)