The nature of obsessions and compulsions – Got Anxiety?

Approximately 3 to 4 percent of the population is diagnosed with Obsessive-Compulsive Disorder. These individuals have great difficulty dismissing intrusive thoughts and images as being unimportant, resulting in the tendency to ruminate on these intrusions, worry excessively about their meaning, and spend a great deal of time attempting to control or resist them.

As a result, they find themselves engaging in repetitive behavioral or mental rituals, all of which serve the function of attempting to alleviate anxiety, and to prevent the occurrence of harm, associated with specific obsessions.

Below, is a brief overview concerning the nature of Obsessions and Compulsions.

OBSESSIONS

Obsessions are unwanted, unacceptable intrusive and repetitive thoughts, images, or impulses that are associated with subjective resistance, are difficult to control, and generally produce a great deal of anxiety, even though the person having such obsessions may recognize their senselessness.

The content of obsessions generally revolves around themes concerning contamination, harm/aggression, horrific sexual acts, symmetry, precision, pathological doubt, and/or blasphemy — all of which are entirely at variance with one’s values and usual manner of behaving.

Note that obsessions are not limited to simply thoughts; they may also include sudden visual images or urges that are typically triggered by certain environmental situations or objects (e.g., seeing what is believed to be a contaminated object).

However, there are also times when obsessions seem to occur “out of the blue,” void of any specific identifiable “trigger.”

Due to the extensive variety of obsessional themes, the content of the obsessive thoughts is quite idiosyncratic in nature. Indeed, research suggests that there may be as many as 34,000 different forms of obsessions.

However, the 4 most common categories would include: doubting/harming, contamination, symmetry/exactness and scrupulosity.

Regardless of the theme, all forms of obsessions contain 4 defining features: (1) Intrusiveness: The thought, image, or impulse repeatedly enters consciousness in an unintended manner, against the persons will; (2) Unacceptability: The emotional response associated with the obsession typically results in feelings of anxiety, guilt, or disgust, due to the unacceptable content of the obsession; (3) Resistance: There is a strong urge to resist or prevent the obsession from entering consciousness either through avoidance of specific environmental cues and/or the performance of rituals; (4) Ego-Dystonic: The content of the obsession is entirely inconsistent with the manner in which one views him/herself.

COMPULSIONS

Unlike obsessions, compulsions (better referred to as rituals) are repetitive, stereotypic overt behaviors or mental (covert) acts that are performed with the intent to “neutralize” or “undo” the particular thought, image or impulse.

These rituals are accompanied by a very specific set of self-imposed rules, and are performed for the purpose of serving two primary functions:

Temporary relief of emotional distress triggered by the obsession.

Preventing harm from occurring to the person him/herself, a loved one, or a perfect stranger, due to a sense of over responsibility.

A ritual is typically accompanied by a diminished sense of voluntary control over the ritual itself. Subjective resistance is often present, but the person eventually gives in to the overpowering urge to perform the ritual.

Overt (behavioral) rituals such as washing, checking, repeating specific behaviors, ordering (e.g., rearranging objects to restore balance or symmetry), hoarding, and covert (mental) rituals such as repeating certain words or phrases, counting, visualizing particular colors, etc. are the most common forms seen across a variety of obsessional themes (aggression, symmetry, contamination, etc.).

Although mental rituals are quite common among the OCD population, they are oftentimes not reported by the individual.

It should also be noted that stated within the Diagnostic and Statistical Manual, 5th Ed., published by the American Psychiatric Association (2014), a diagnosis of OCD does not require the presence of both obsessions and compulsions, which is why the formal diagnosis of OCD includes the words AND/OR when referring to these symptoms.

However, current research indicates that obsessions and compulsions do in fact co-occur in the majority, if not all, cases of OCD.

The reported lack of specific rituals is usually the result of the individual’s unawareness of the ritual itself, when performed in a covet manner; as opposed to observable rituals of a behavioral nature (e.g., excessive hand-washing).

In addition, it is not unusual that oftentimes individuals have difficulty understanding the difference between compulsions related to OCD, and other types of disorders such as compulsive gambling, compulsive eating, compulsive shopping and compulsive sexual behaviors.

The distinctive features of compulsions, with respect to the diagnosis of Obsessive-Compulsive Disorder, as well as clinical examples of obsessions and their corresponding rituals, will be outlined in part 3 of this series.

Barry C. Barmann, Ph.D., is a Licensed Clinical Psychologist in Nevada and California. His wife, Mary B. Barmann, MFT, is a licensed Marriage and Family Therapist in California. Visit anxietytreatmentinclinevillage.com to learn more.