Understanding OCD: Looking beyond the stereotype is critical to treatment

When people think of obsessive compulsive disorder (OCD), they often think of the observable compulsion, like checking locks or excessive washing. What goes unrealized is that this is just one dimension of the condition, and that the troublesome compulsion is associated with an equally troubling obsession. When someone with OCD engages in a compulsion (a behavior they feel little/no ability to resist), it is bound to an obsession (unrelenting thoughts that feel intrusive and uncontrollable). It is exhausting, frustrating, time consuming, and overwhelming. The (very reductive) line of thought for OCD is “I am having this horrible thought (obsession). If I do this (compulsion) it might be ok.”

OCD often centers on what is most valued, or generates the most fear. The unwanted thoughts frequently center on catastrophe (harm, disaster, loss), and the person feels that the compulsion will prevent it. One reason OCD often has its underpinnings in shame is the obsessions tend toward the scariest or most taboo subjects our society holds: common examples include harm to children, death, sexual preferences, stealing, lying etc. It’s important for those coping with OCD to know this is a normal component: The mere fact that a thought is upsetting is what makes it fertile ground for OCD. In no way does obsessing over these ideas mean there is something morally wrong with the individual.

Another reason OCD can generate shame is the disconnect between logic and feelings. A person might be engaging in compulsions they logically know are unrelated, unneeded, or excessive. However the feeling that it is completely related, needed, and appropriate is still present. It is confusing and difficult to explain to others.

OCD ranges from mild to severe with distinctions in severity of functional impairment. How much time is devoted to compulsions? Are they experiencing health issues from rubbing/washing? Do rituals or obsessions create a barrier to participating in daily life? Is it inhibiting your ability to go to work/school? Does reassurance seeking disrupt relationships? It isn’t unusual for an individual to outwardly appear “high functioning” but internally feel plagued. Any overwhelming symptoms are worth seeking professional assessment.

An interesting aspect of OCD is the diversity of presentations. These can include:

Hoarding - difficulty discarding acquired objects

Harm - intrusive thoughts about harming others/self

P(Pedophilia)- OCD - unwanted thoughts that one is sexually attracted to children

Responsibility - overly focused on how their actions could impact others

Somatic - obsessive thought around body sensations/movement

The most widely accepted treatment for OCD at this point is a combination of medication and therapy, most specifically Exposure Response Prevention.

A general resource around both treatment and information for OCD for Adults is NOCD ( ) and a resource for children is The Child Mind Institute ( ).

Dr. Gina Picchiotti is a Licensed Clinical Psychologist and is a therapist at Action Consulting & Therapy

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