Obsessive-compulsive disorder (OCD)
Obsessive-Compulsive Disorder is marked by recurring, unwanted thoughts, images or urges, followed by the urge to perform behaviours or mental rituals to relieve the distress they cause.
These cycles can take up a significant amount of time, interfere with everyday life, work and relationships, and are often highly distressing.
Obsessions
The unwanted thoughts, images or impulses, obsessions, arrive uninvited and feel difficult to control. Nobody chooses them, and they often bring intense anxiety, doubt, guilt or shame. Many people recognise their obsessions aren't realistic, and that awareness alone doesn't stop them returning.
The thoughts run against what a person actually values. That mismatch is part of what makes them so distressing, not a sign of what someone secretly wants.
Compulsions
What follows, compulsions, are repetitive behaviours or mental acts performed to reduce that anxiety: washing, checking, counting, reassurance-seeking, mental reviewing, ordering and arranging, or avoiding what triggers the obsession in the first place.
The relief is real but short-lived, and it reinforces the cycle over the longer term. Most people would prefer not to perform compulsions, and feel unable to stop.
Common subtypes
OCD tends to cluster around themes. These aren't separate conditions, and most people can relate to more than one. This isn't an exhaustive list, and the theme can change, but the cycle underneath stays the same.
- Contamination
- Fears of germs, dirt, illness or being "contaminated" by people, places or substances, often with washing, cleaning or avoidance.
- Checking
- Repeatedly checking locks, appliances, work or your own body to prevent harm or mistakes, without the doubt ever quite settling.
- Symmetry and order, or "not just right" experiences
- A need for things to be even, aligned or exactly right, and a strong sense of discomfort until they are.
- Harm
- Intrusive thoughts or images of harming yourself or others, or of something terrible happening, often with avoidance or mental checking.
- Relationship
- Persistent doubt about a relationship or partner: whether you love them enough, whether they're right for you, whether you're attracted enough.
- Scrupulosity
- Obsessions about morality, religion or being a good person, with fears of having sinned, offended or done wrong.
- Sexual orientation
- Intrusive doubt about your sexual orientation, and checking your reactions for evidence, in conflict with an otherwise clear sense of who you are.
- Perinatal and postpartum
- Intrusive thoughts about harm coming to the baby, during pregnancy or after birth. They are unwanted and distressing precisely because they run against a parent's love.
Treatment
OCD is highly treatable. The gold-standard approach is Cognitive Behavioural Therapy, particularly Exposure and Response Prevention, which involves gently facing feared situations while resisting compulsions, so the anxiety has room to settle on its own and the cycle loses its grip.
Medication, commonly SSRIs, can be used alongside therapy. This is determined and prescribed by a GP or psychiatrist. Acceptance and Commitment Therapy and Schema Therapy can be used as an adjunct alongside ERP, or where broader patterns are also part of the picture.
You don't need a diagnosis in hand, or certainty about which category fits, to bring any of this into a session.
Further support
Organisations with information, programs and support for families.
Talk to Sarsha
If you'd like to talk it through, you're welcome to get in touch, in person in Fremantle, or by telehealth from Perth or anywhere in Australia.
Enquire about an appointment