Areas of Focus

COD

“Some people with OCD are compelled to pick up pieces of broken glass from the street. They worry that, if they don’t, then someone else might cut themselves on the glass. If the person with OCD fails to prevent that happening, they think, well I may as well have walked up to the stranger and deliberately hurt them.”
— DAVID ADAM

OCD involves senseless and unwanted thoughts and images that intrude into the mind. These mental intrusions, referred to as obsessions, are often triggered by an external factor. They provoke intense discomfort or anxiety, along with fear and uncertainty regarding potentially negative or harmful consequences.

In turn, these experiences trigger the urge to reduce the obsessional anxiety by means of actions (these can be mental or physical). Rituals, referred to as compulsions, are used to fight off obsessional thoughts, reduce anxiety, and restore a sense of certainty and safety. Avoidance strategies also assist to reduce anxiety.

Although compulsions and avoidance behaviours reduce obsessive anxiety in the short-term, they quickly fail. They fail due to the inevitable return of the obsessive thoughts and their associated anxiety. In turn, this requires endless repetitions of the required rituals and avoidance behaviours. Over time, these patterns intensify to the extent that important areas of life are disrupted.

The following five subtypes of OCD have been identified:

  • Contamination Obsessions with washing/cleaning compulsions.

  • Harm Obsessions with checking compulsions.

  • Symmetry Obsessions with ordering, arranging, and counting compulsions.

  • Obsessions without visible compulsions (mental rituals).

  • Hoarding.

Cognitive behavioural therapy with exposure and response prevention is the first line psychological treatment for OCD. Simply speaking, this involves the deliberate exposure to situations that trigger obsessive thoughts without enacting the associated compulsion. In addition, psychodynamic therapy may be useful to better understand the symptoms and their broader impact.

References

Abramowitz, J., Taylor, S., & McKay, D. (2008). Obsessive-compulsive disorder. The Lancet, 374, 491–499.

Shedler, J. (2012). The efficacy of psychodynamic psychotherapy. In R. A. Levy, J. S. Ablon, & H. Kächele (Eds.), Psychodynamic psychotherapy research: Evidence-based practice and practice-based evidence (p. 9–25). New York: Humana Press.