About OCD
There is a lot of inaccurate information about OCD in our culture. OCD is not a curious personality trait and is not limited to individuals with concerns about germs. OCD is a painful disorder that can touch every part of your life and leave you feeling overwhelmed and exhausted by your own thoughts. Individuals with OCD experience repeated obsessions and compulsions that feel out of control, disrupt their ability to function in the world and make them doubt the very person they are.
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What are obsessions?
Obsessions are unwanted thoughts, images or urges that enter someone's mind without the individuals control. Obsessions in OCD are disturbing and cause a high degree of distress. While the content of the obsessions can be varied, OCD obsessions are never pleasant or enjoyable.
What are compulsions?
Compulsions are things the individual feels they must do to try to decrease the distress they experience from the obsessions. OCD compulsions may include physical actions, thoughts strategies or avoidance of people places or things. OCD compulsions can be identified by their focus on ensuring that a feared event, situation or circumstance can be controlled or avoided.
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Everyone has worries or thoughts that come into their mind without their control. When these are about things that are unlikely to occur, are illogical or inconsistent with who they are, they will dismiss the thoughts without further reflection. For individuals with OCD, while they may recognize that a situation is unlikely, or that a thought is inconsistent with their values, they may begin to ruminate on why they are having the thought or trying to do whatever they can to guarantee their safety and the safety of others from the feared situation. This pattern of experiencing distressing thoughts, images or urges (obsessions), followed by a deep need to take action in response to those, makes up the core of OCD.
OCD can take a multitude of forms. Some forms of OCD include obsessions that are repugnant or feel embarrassing to share. Individual may know the content of their obsessions is unusual or unlikely to occur, but their drive to respond to it regardless may make them feel out of control of their own behavior. While OCD can take any form, there are some themes of OCD that are more common than others. Most often, individuals will find they have many "flavors" of OCD and that these may change over time. It is also important to say that this is not an inclusive list of how OCD can present.
Responsibility - Fear of being responsible for harm coming to another. This may be fear that what you say may be misinterpreted, or a piece of trash on the street you don't pick up could cause another to trip. It may be feeling you jinxed another with a word you used or that if you do not take a particular action you that another wont be safe.
Contamination - Fear of becoming contaminated or that you can contaminate other people or things. People may fear contamination from things such as germs, bugs, radiation, food additives, dirt, etc. Individuals may also fear being contaminated by another persons behaviors, actions, thoughts or personality. Others may fear that a general sense of "badness" or "immorality" may rub off on them.
Harm - Images of harm coming to others or urges to harm others or themselves when this is not something they want. Individuals may worry they may kill themselves or that they will act violently against others. They may have repeated violent images in their mind that they can't stop. Individuals have images that are sexual in nature or may fear they may harm another sexually.
Just Right or Perfectionism - A sense of how something "should be" and distress or fear something awful may happen if things aren't that way. placed or don't occur in a particular way. Individuals may feel they need to lock a door, sit down or even breath in a "right" way and may repeat these actions until they feel they were done "right." They may want household items places in particular places or exactly aligned with furniture edges. They may have fear about forgetting something or not doing something correctly.
Identity- Individuals may fear that they may have a different gender identity than they are living, or that they may have a different sexual orientation. Individuals may fear who they are is not who they think they are.
Moral/Scrupulosity - Concern about estrangement from your faith, that you may accidentally offend your God or engage in blasphemy. Individuals may have excessive concerns if they make the right of wrong choices or if they are a moral of "good" person.
Unanswerable/existential questions - Fear about things that can't be known with certainty. This may include if their partner is happy with them, if they chose the right career or what may happen after they die. Individuals may fear that the world could come to an end or that they may someday die from a disease.
What to expect during treatment
Developing a plan & Shifting behavior
As we get to know your OCD, we will make a list of your obsession and your compulsions (this is called a hierarchy). We will identify which of these obsessions or compulsions interfere the most with what is meaningful for you and will identify which areas of your life you want to reclaim, even if it takes hard work to do so. In session we will experiment with small risks and new behaviors. Between sessions you will be asked to continue to practice new ways of doing things that may feel scary or awkward.
The important part of this work is deeply understanding why you want to get better and being willing to try new behaviors. I never ask you to do more than you are willing and you need to be ready to challenge yourself. We move one step at a time and at the pace you are comfortable and you wont do it alone. My role is to make sure the work you put in pays off and help you find the most effective path to recovery.
Working with uncertainty and living your values
As care progresses we will learn how to pay less attention to OCD thoughts and to stop engaging with them directly. This overtime, takes their strength and allows you to learn for yourself if the things that OCD threatens you with are as powerful as they pretend to be. At this stage people find that they begin living their life by their choices rather than trying to determine which choice is least likely to cause OCD symptoms. and we begin to learn to life life on life's terms, with all the uncertainties that we cant deny.
Understanding how OCD works and how it works in your life
OCD grows due to behavioral patterns and learning over time. Understanding the factors that cause OCD to take root and grow is critical when we are making a plan to uproot it. (Yes, be ready for more plant metaphors). Early in therapy we will talk about how OCD gains strength over time and what it needs to grow. We will also look at where in the cycle of OCD we can intervene so it loses strength. Knowing clearly how crtain behaviors help or hinder OCD, makes future hard work doable.
We will also look at how OCD looks in YOUR life. Every person experiences OCD a bit differently. because of this, we will spend time understanding your unique OCD. This is similar to needing to know where the root source is to a vine that is taking over the yard. If you only cut back the vine you can easily see, you will never keep that vine from re-growing. The hardest part at this stage is being honest regarding what you are experiencing. We live in a world that tells us we are what we think and with OCD nothing could be farther from the truth. Individuals with OCD may feel they are going crazy, they are irrational or that or others would judge or persecute them if they knew their thoughts.
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