The Straight, the Narrow: What is Obsessive-Compulsive Disorder?

Obsessive-Compulsive Disorder (OCD) is one of the most common mental illnesses in children, and it’s the reportedly one of most common psychiatric diagnosis overall. Due to the stigma and shame that often accompany OCD many people often realize their thoughts and actions are illogical but feel like they can’t stop.

The International OCD Foundation explains that, “Obsessive Compulsive Disorder is a mental health disorder that affects people of all ages and walks of life, and occurs when a person gets caught in a cycle of obsessions and compulsions. Obsessions are unwanted, intrusive thoughts, images or urges that trigger intensely distressing feelings. Compulsions are behaviors an individual engages in to attempt to get rid of the obsessions and/or decrease his or her distress.”

Common Obsessions may include:

Contamination, unwanted sexual thoughts, religious (scrupulosity), losing control, harm, superstitious thinking (or “magic thinking”) and perfectionism.

Compulsions may include:

Checking and Checking (such as making sure a door is locked many times before leaving the house, replaying the memory, ect) counting (sometimes in a specific sequence), reassurance seeking (from self or others), and hoarding type behaviors, among others. Compulsions are often senseless and repetitive.

Obsessive thinking is more unrealistic and sometimes has a perceived magical quality. Some examples include: a student with OCD might believe that she has to set up items on her desk in certain order and count a specific number to keep from failing a test. Or, a parent with OCD might believe that he needs to say (or think) a particular phrase throughout the day to keep his children safe

Someone with OCD who worries about forgetting to turn the oven off, for example, may not be able to check it just once. They will likely have to go back repeatedly, which can take minutes to hours until the anxiety reduces enough that the person can move on to their next activity. If the cycle continues, anxiety about the oven can take so much time that a person is late for work or decides not to leave the house at all (in fear of it burning down). When OCD behaviors start to interfere with regular life—it’s time to consider beginning treatment.

The difference between OCD and GAD:

While people with Generalized Anxiety Disorder (GAD) tend to worry a lot, they don’t typically engage in compulsive, ritualistic behaviors to cope with their anxiety. Those with GAD usually know their thoughts are illogical, and can use evidence to reframe their thoughts.

The treatments for GAD and OCD overlap as well. Many medications are helpful for both problems (SSRI’s). However, for OCD, a focused type of cognitive behavioral treatment called exposure and response prevention (ERP) has been shown to be “the gold standard” for treatment. This is where, with exposure techniques, the individual begins to habituate to the anxiety. This includes exposure to both the thought and the compulsions (not the feared outcome).

For examples, let’s take the young man who is afraid his house is going to catch fire. He continually “checks” to see if the oven is off to satisfy his obsession (“worry”). Since anxiety grows (it will not stay constant) he may eventually have to check the oven 10 to 15 times to lower his anxiety and overall distress (because these checking behaviors are reinforcing).  Exposure’s he may approach with his therapist might be decreasing and/or delaying the checking compulsions and thus, having exposure with his distressing thoughts (for longer periods of time) to allow habituation.

If you know anyone who struggles with OCD or think you may have OCD yourself, here are some reminders and next steps to take:

  1. Know that you are not crazy – OCD is treatable!
  2. Find a qualified therapist (make sure they have experience in treating OCD)
  3. Consider talking with your doctor about medications to help alleviate symptoms

OCD is often accompanied by shame and fear. This makes it harder for those to seek treatment when research shows how affective and life changing this can be. Everyone deserves to live their fullest life.

“You don’t have to control your thoughts. You just have to let them stop controlling you” -Dan Millman


If you need help, please don’t hesitate to ask. Counselors and therapists are ready to be your support and guide.