Recently I posted a series of blogs about the most common anxiety disorders that can disrupt your living.
The truth is all of us experience anxiety, and that anxiety can be different for each person. But when your anxious thoughts and behaviors begin to interfere with your work, your relationships, or your overall joy of life, you may be struggling with an anxiety disorder.
One of these blogs looked at panic attacks and panic disorder. We explored specific phobias and social anxiety disorder. Finally, we considered generalized anxiety disorder. In this blog, we will consider Obsessive-Compulsive Disorder (OCD). Several years ago, the Diagnostic and Statistical Manual of Mental Disorder (DSM-5), which lists the criteria for psychiatric diagnoses, moved OCD out of the category of “Anxiety Disorders” into its own unique category. However, because it is a significant component, let’s look at the role that anxiety plays in OCD.
It is a good thing to be organized. There is nothing wrong with being neat and orderly. Following rules can give direction to your life. And yet, any of these behaviors can be carried to the extreme, to the point where it seems to take over a person’s life. When this happens, you can struggle with OCD.
The first component of OCD is obsessions.
Obsessions are thoughts, impulses and images that are so persistent they create intense anxiety. These thoughts and images feel intrusive, like they are happening despite all your efforts to resist them. You may realize that these thoughts and images are unreasonable, but you still can’t keep them from happening. You may experience full-blown panic attacks because these thoughts and images are so distressing.
Here are some of the most common obsessions:
· Thoughts you might harm yourself or others
· Violent images
· Fear of acting on unwanted or forbidden impulses
· Sexual images or urges
· Concern with right and wrong or morality
· Fear of saying things that might become true
· Concern about dirt, germs, bodily waste or secretions (urine, feces, saliva)
· Concern with contaminants
· Fear of being responsible for something terrible happening
You will notice that some of these obsessions can be grounded in legitimate concerns. For example, there is nothing wrong with being concerned about knowing what’s right or wrong; there is nothing wrong with an internal moral code. But when those concerns become so scrupulous that you become deeply anxious about almost any decision or action, it can get in the way of meaningful living.
The second component of OCD is compulsions.
These are repeated ritualistic behaviors (for example, checking and hand washing) or mental acts (counting or repeating a phrase). These behaviors have a specific purpose—to reduce the distressing anxiety that comes with the obsessive thoughts and images. This happens so frequently and intensely that it sets up a closed feedback loop. You have an obsessive thought or image. You feel the anxiety. You perform a compulsive behavior to alleviate the anxiety.
Here are some of the more common compulsions:
· Excessive or ritualized cleaning (hand washing, bathing, grooming)
· Cleaning household items and other objects
· Checking locks or appliances
· Checking that you didn’t make a mistake
· Needing to repeat routine activities (going in or out a door or up and down from a chair)
· Collecting or not being able to get rid of useless objects (junk mail, newspapers, wrappers)
· Excessive making of lists
· Superstitious behaviors
Again, the key here is that these behaviors are so excessive they interfere with your ability to enjoy a meaningful life.
You may realize that these obsessions and compulsions are excessive; however, they may have been a part of your life for so long, they may not seem unreasonable. Still, there are times when have tried to ignore them or stop them, but when you do that only increases the anxiety. One of the difficult things about OCD is that all of these rituals seem to reduce the anxiety. But that only happens for a short period of time and the anxiety returns. So some part of your mind thinks that these rituals are working, even while the joy in life continues to be missing.
Acceptance and Commitment Therapy (ACT) is the approach that I use to treat OCD.
ACT is based on the idea that the more you try to get rid of unwanted thoughts, feelings, and urges, the more they persist. When this happens, it seems like the only option is to exert more control over them. Instead of getting caught up in unwanted thoughts and feelings or trying to push them away, with ACT you will learn a variety of mindfulness practices that allow you to be gently accepting of the thoughts and feelings. This mindful acceptance gives you the psychological flexibility to choose actions that are an expression of what you value.
My anxiety treatment page will give you more information about ACT and how it might be helping with your Obsessive-Compulsive Disorder.