What is OCD?

Obsessive Compulsive Disorder (OCD) can feel overwhelming and confusing, especially when someone is trying to determine whether what they're experiencing is normal, temporary, or a sign they need additional support. OCD is a debilitating disorder characterized by obsessions and compulsions. Obsessions typically consist of unwanted thoughts, images, urges, or beliefs. Compulsions can be carried out physically or mentally, and are usually aimed at reducing the anxiety caused by obsessions, but in reality, they tend to make things worse over time.

Obsessions are intrusive, unwanted thoughts, images, sensations, doubts or urges that trigger anxiety, disgust, uncertainty, or a feeling that something isn't "just right." They often go against a person's values, which is why they can feel so upsetting. Common themes include fears of contamination, accidentally harming someone, making a mistake, losing control, doubts about relationships, sexuality, religion, morality, or health, but OCD can attach itself to almost anything.

Compulsions are sometimes thought of as only physical behaviors. This isn't true because many compulsions are mental, meaning they aren't something we can visibly see. Mental compulsions can include reviewing memories, mentally checking, seeking certainty, searching for reassurance, avoidance, repeating phrases, praying in a ritualized way, mentally arguing with a thought, or trying to "figure it out." Because these happen internally, they're often overlooked, even by the person experiencing them.

Compulsions can also be understood as attempts to gain certainty or reduce distress. So, if an urge arises and a compulsion is performed (whether mental or physical), in order to feel resolved, certain or less threatening, it's likely functioning as a compulsion.

The problem with compulsions is that they're temporary. They train our brains into thinking they're helpful, when in reality they keep us stuck in the same repetitive loop and reinforce the obsessions.

OCD operates in a cycle. The cycle often looks like this:

• An intrusive thought or urge appearing.
• Anxiety or uncertainty related to that increases.
• A compulsion is performed to feel better or relieve the anxiety. This relief is temporary.
• The brain then learns the obsession must have been important, which actually makes it more likely to return.

Everyone experiences intrusive thoughts from time to time. The difference with OCD isn't necessarily the thoughts themselves, it's the meaning the brain assigns to them and the urge to eliminate uncertainty through compulsions.

If you're experiencing OCD symptoms, it's important to work with a therapist who not only understands OCD, but is also familiar with ERP (Exposure and Response Prevention). This is considered the most effective treatment for OCD and has the strongest research support. ERP helps people learn that they can tolerate uncertainty and anxiety without relying on compulsions. The goal of treatment isn't to stop having intrusive thoughts, it's to stop giving OCD control over how you respond to them. Some therapists also pair ERP with ACT (Acceptance and Commitment Therapy) and mindfulness. That said, ERP remains the most impactful piece of treatment.

OCD is highly treatable when it's properly recognized. Stay tuned for my next article, where I'll go more in-depth on OCD and address some common misconceptions surrounding the disorder.