Repetitive, intrusive, unwanted and high intensity anxiety-triggering thoughts or images are at the root of obsessive compulsive disorder (OCD). These mental experiences are coupled with subsequent behaviors that are aimed at reducing the intensity of anxiety. So thoughts about being contaminated can quickly trigger the urge to wash and then prolonged or frequent washing. OCD is debilitating – it is time consuming and “mind” consuming – it requires substantial effort to avoid or manage the anxiety. People with OCD can appear distracted, distant and exhausted. The demands of combatting the anxiety-triggering thoughts with compulsions requires effort and energy. The costs can add up and be staggering – relationship strain and break up, job loss, poor academic performance, and loneliness and isolation.
The nature of “obsessive” thoughts can vary, but they can group around some particular themes: aggression, contamination, sexual thoughts, intense fears about losing items, religious concerns, symmetry or exactness, or needing to know or remember things exactly. These thoughts are accompanied by rapid increases in anxiety and/or disgust and a general intense discomfort.
The urges to fix, neutralize, eliminate or plan for consequences of the obsessive thoughts lead to carrying out a dizzying variety of coping behaviors. Over time, these coping behaviors can become compulsive. A coping strategy that may have been comforting and helpful at some point transitions into a compulsion when it becomes highly involved, time consuming, exhausting and repetitive. Compulsions can be overtly behavioral – like excessive handwashing or showering, asking for reassurance multiple times, or excessive checking. Compulsions can also be primarily internal behaviors like mental scanning, remembering, replaying an experience over and over, imagining a positive image to neutralize a negative image. At first these behaviors provide relief. Over time, they become a cause or exacerbator of anxiety if they are not performed. Thus the very responses that were helpful eventually become a central cause of disruption and anxiety in the long run.
Treatment options for OCD can be complex. The foundation of the treatment approach is exposure and response prevention (ERP), a behavior-focused strategy that helps individuals learn how to cope with intense anxiety without resorting to compulsive behaviors. ERP sounds conceptually straight forward, but can be quite challenging to implement. You should look for treatment providers that are very experienced in using it.