OCD is an anxiety disorder with symptoms of obsessions (intrusive and persisting upsetting thoughts, ideas, images or impulses) and compulsions (behaviours and rituals designed to undo the anxiety caused by the obsession). Sometimes the rituals are behaviours you can see (e.g. checking, ordering, washing, cleaning, counting, asking for reassurance) and sometimes they are mental rituals (like counting, repeating special words, numbers or phrases silently, praying). At times the person with OCD will do these rituals on their own and try to hide them from you. At other times, they may try to involve your help (e.g. get you to do some checking too). The obsessions can be about anything and may include themes involving health, sexual behaviour and identity, safety, aggression and religion.
For example, someone may have the intrusive thought that they have germs on their hands, so they will feel compelled to wash their hands repetitively (sometimes a certain number of times, sometimes in a certain ritualised way). This may take up a considerable amount of time as they do not rely on their senses to decide when to stop or start washing. Instead, they rely on whether they “feel contaminated” or “feel better” rather than any visible signs of contamination. The washing ritual will reduce their anxiety in the short term, but keep the OCD going in the long term as it reinforces the belief that the way to deal with the germ obsessions is to wash in this way.
Thus, people with OCD get caught in vicious cycles of trying to reduce their anxiety by giving into obsessions with behaviours that only end up keeping their anxiety and obsessions going. Usually they are aware that the obsessions and compulsions are irrational or excessive, but they have not learned other ways of dealing with these distressing obsessions. I have a particular interest in OCD and find that once we take the time to understand an individual's OCD system, we can work out how they can take back control of their life.
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