You may have heard people say, “Don’t mind me, I'm just so OCD”, as they clean their house or organize their books. In wider society, describing oneself or someone else as “OCD” is a way to convey that they like things to be organized and neat, or they will feel somewhat distressed. The label “OCD” has been co-opted by common language, but clinically, it describes a very distressing series of intrusive thoughts and compulsions that can take up a large portion of an individual’s time and energy.
OCD, or Obsessive Compulsive Disorder, is defined as a cycle of obsessions and compulsions that are so extreme that it consumes at least an hour of the individual’s time every day and causes intensive distress or disrupts the completion of daily living tasks or important activities that the person values.
We all have things that we consider ourselves to be “obsessed” with, like certain musical artists, TV shows, or books. In OCD, obsessions take a different and more intrusive shape in the mind. Obsessions are images, thoughts, or impulses that return to an individual repeatedly and feel uncontrollable. The nature of these obsessions is often disturbing to the person, and in most cases the person knows that they are illogical or don’t make sense.
Some common obsessions and their symptoms are:
- Fears of germs and contamination, leading to worries about touching objects others have touched or being in unclean spaces.
- Fears of forgetting or losing something, resulting in doubts that you know where you have left your items.
- Fears of being unable to control their behavior, including intrusive images of engaging in risky or unsafe behaviors.
- Having aggressive thoughts towards themselves or other people, including intrusive images of engaging in self-harm or violent behavior, even when they would never do so.
- Unwanted or taboo thoughts related to sex, like experiencing unpleasant sexual images or thoughts that do not reflect desires.
- Unwanted or taboo thoughts related to religion, like a fear of going to hell or being struck down by God.
- A desire to have things perfectly symmetrical or in order, a need to have things “just right.”
Most of the time OCD involves unwelcome obsessive thoughts that are often followed by compulsions. Compulsions are repetitive behaviors that a person feels the urge to do to suppress the anxiety induced by obsessive thoughts or to control the outcome of the thoughts, even if it is unrealistic. By engaging in compulsions, a person with OCD is easing their stress and temporarily can put the intrusive thoughts at bay, but ultimately, they will keep coming back.
There are some kids who may be diagnosed with obsession-only type OCD or compulsion-only type OCD. Someone with obsession-only type OCD, may experience uninvited, intrusive thoughts but they do not engage in compulsions that function to soothe their anxiety following the thought. It is also possible that they are engaging in mental compulsions that they do not have awareness around, and this can be explored and assessed throughout treatment. For a kid with compulsion-only type OCD, they might not have the awareness of their thoughts to be able to know that their compulsive behaviors are tied to neutralizing an anxious thought or worry. Younger kids often present with compulsion only type OCD, and they often don’t know how to understand why they’re engaging in compulsions, but only that they feel strongly that they need to do something to feel better or “just right.”
Some common compulsions are:
- Washing and cleaning, like hand-washing skin until it becomes raw in response to contamination or germ obsessions.
- Checking for items, lights being turned off, doors are locked, or the stove is turned off in response to fears of forgetting or losing things.
- Needing to count in a certain way or complete a pattern to keep a thought at bay.
- Arranging items so they are completely in order in response to intrusive thoughts.
These compulsions do not always match or fix the concern that is embedded in the intrusive thought. For example, a kid can experience an unwanted thought about sex and need to complete a pattern of tasks or behaviors at home to assuage the anxiety induced by the thought.
Overall, people with OCD are experiencing distress from the content of their intrusive thoughts and they do not get any pleasure from engaging with compulsions. Compulsive behaviors only serve to provide temporary relief, before the vicious cycle of OCD starts up again. Many adults with OCD can rationalize that their intrusive thoughts are not logical, but for kids, they may genuinely fear that something terrible might happen if they don’t follow through with their compulsions. Since this cycle is so distressing, many people end up trying to avoid situations where their intrusive thoughts may be triggered. This avoidance can limit an individual's ability to engage with day-to-day life, and actually can lead to more distressing thoughts. This is a result of the ineffective effort to suppress feelings without changing actual contingencies in the environment.
Want to learn more?
- Watch our FREE OCD webinar
- Read Treating OCD: Effective Approaches for Kids and Teens
- Read Client Spotlight - Exposure and Response Prevention: Thinking about Knives
- Contact us