Are obsessive thoughts and compulsive behaviors interfering with your daily life? Explore the symptoms, treatment, and self-help for OCD.
What is obsessive-compulsive disorder (OCD)?
It’s normal, on occasion, to go back and double-check that the iron is unplugged or worry that you might be contaminated by germs, or even have an occasional unpleasant, violent thought. But if you suffer from obsessive-compulsive disorder (OCD), obsessive thoughts and compulsive behaviors become so consuming they interfere with your daily life. OCD is an anxiety disorder characterized by uncontrollable, unwanted thoughts and ritualized, repetitive behaviors you feel compelled to perform. If you have OCD, you probably recognize that your obsessive thoughts and compulsive behaviors are irrational—but even so, you feel unable to resist them and break free.
Like a needle getting stuck on an old record, OCD causes the brain to get stuck on a particular thought or urge. For example, you may check the stove 20 times to make sure it’s really turned off because you’re terrified of burning down your house, or wash your hands until they’re scrubbed raw for fear of germs. While you don’t derive any sense of pleasure from performing these repetitive behaviors, they may offer some passing relief for the anxiety generated by the obsessive thoughts.
You may try to avoid situations that trigger or worsen your symptoms or self-medicate with alcohol or drugs. But while it can seem like there’s no escaping your obsessions and compulsions, there are plenty of things you can do to break free of unwanted thoughts and irrational urges and regain control of your thoughts and actions.
OCD obsessions and compulsions
Obsessions are involuntary thoughts, images, or impulses that occur over and over again in your mind. You don’t want to have these ideas, but you can’t stop them. Unfortunately, these obsessive thoughts are often disturbing and distracting.
Compulsions are behaviors or rituals that you feel driven to act out again and again. Usually, compulsions are performed in an attempt to make obsessions go away. For example, if you’re afraid of contamination, you might develop elaborate cleaning rituals. However, the relief never lasts. In fact, the obsessive thoughts usually come back stronger. And the compulsive rituals and behaviors often end up causing anxiety themselves as they become more demanding and time-consuming. This is the vicious cycle of OCD.
Most people with OCD fall into one of the following categories:
- Washers are afraid of contamination. They usually have cleaning or hand-washing compulsions.
- Checkers repeatedly check things (oven turned off, door locked, etc.) that they associate with harm or danger.
- Doubters and sinners are afraid that if everything isn’t perfect or done just right something terrible will happen, or they will be punished.
- Counters and arrangers are obsessed with order and symmetry. They may have superstitions about certain numbers, colors, or arrangements.
- Hoarders fear that something bad will happen if they throw anything away. They compulsively hoard things that they don’t need or use. They may also suffer from other disorders, such as depression, PTSD, compulsive buying, kleptomania, ADHD, skin picking, or tic disorders.
OCD signs and symptoms
Just because you have obsessive thoughts or perform compulsive behaviors does NOT mean that you have obsessive-compulsive disorder. With OCD, these thoughts and behaviors cause tremendous distress, take up a lot of time (at least one hour per day), and interfere with your daily life and relationships.
Most people with obsessive-compulsive disorder have both obsessions and compulsions, but some people experience just one or the other.
Common obsessive thoughts in OCD include:
- Fear of being contaminated by germs or dirt or contaminating others
- Fear of losing control and harming yourself or others
- Intrusive sexually explicit or violent thoughts and images
- Excessive focus on religious or moral ideas
- Fear of losing or not having things you might need
- Order and symmetry: the idea that everything must line up “just right”
- Superstitions; excessive attention to something considered lucky or unlucky
Common compulsive behaviors in OCD include:
- Excessive double-checking of things, such as locks, appliances, and switches
- Repeatedly checking in on loved ones to make sure they’re safe
- Counting, tapping, repeating certain words, or doing other senseless things to reduce anxiety
- Spending a lot of time washing or cleaning
- Ordering or arranging things “just so”
- Praying excessively or engaging in rituals triggered by religious fear
- Accumulating “junk” such as old newspapers or empty food containers
OCD symptoms in children
While the onset of obsessive-compulsive disorder usually occurs during adolescence or young adulthood, younger children sometimes have symptoms that look like OCD. However, the symptoms of other disorders, such as ADHD, autism, and Tourette’s syndrome, can also look like obsessive-compulsive disorder, so a thorough medical and psychological exam is essential before any diagnosis is made.
OCD self-help tip 1: Identify your triggers
The first step to managing your OCD symptoms is to recognize the triggers—the thoughts or situations—that bring on your obsessions and compulsions. Record a list of the triggers you experience each day and the obsessions they provoke. Rate the intensity of the fear or anxiety you experienced in each situation and then the compulsions or mental strategies you used to ease your anxiety. For example, if you have a fear of being contaminated by germs, touching a railing at the mall might generate a fear intensity of 3, whereas touching the restroom floor in the mall might generate a 10 and require 15 minutes of hand washing to ease your anxiety.
Keeping track of your triggers can help you anticipate your urges. And by anticipating your compulsive urges before they arise, you can help to ease them. For example, if your compulsive behavior involves checking that doors are locked, windows closed, or appliances turned off, try to lock the door or turn off the appliance with extra attention the first time.
- Create a solid mental picture and then make a mental note. Tell yourself, “The window is now closed,” or “I can see that the oven is turned off.”
- When the urge to check arises later, you will find it easier to re-label it as “just an obsessive thought.”
Identifying and recording your triggers also provides an important tool for learning to resist your OCD compulsions.
Tip 2: Learn to resist OCD compulsions
It might seem smart to avoid the situations that trigger your obsessive thoughts, but the more you avoid them, the scarier they feel. Conversely, by repeatedly exposing yourself to your OCD triggers, you can learn to resist the urge to complete your compulsive rituals. This is known as exposure and response prevention (ERP) and is a mainstay of professional therapy for OCD.
ERP requires you to repeatedly expose yourself to the source of your obsession—and then refrain from the compulsive behavior you’d usually perform to reduce your anxiety. If you are a compulsive hand washer, for example, that could mean touching the door handle in a public restroom and then not allowing yourself to wash your hands. As you sit with the anxiety, the urge to wash your hands will gradually begin to go away on its own. In this way, you’ll learn that you don’t need the ritual to get rid of your anxiety and that you have some control over your obsessive thoughts and compulsive behaviors.
Tackling your biggest fears straight off might be too extreme, so ERP exercises start with you confronting lesser fears and then working your way up the “fear ladder.” Confront those situations that generate a low fear intensity and once you’re able to tolerate the anxiety you can move on to the next, more difficult exposure challenge.
Building your fear ladder. Think about your end goal (to be able to use a public restroom without fear of contamination, for example, or to drive to work without stopping to check if you’ve hit something) and then break down the steps needed to reach that goal. Using the information you recorded in identifying your triggers, make a list of situations from the least scary to the most scary. The first step should make you slightly anxious, but not so frightened that you’re too intimidated to try it.