An insight into Obsessive-Compulsive Disorder

OCD is characterized by obsessions and/or compulsions.

Obsessions refer to repetitive and intrusive thoughts, images, or impulses that cause distress. Compulsions refer to deliberate repetitive mental and physical behaviours such as cleaning, ruminating, checking, etc., which are performed as a response to the beliefs about the content or presence of the obsessional thoughts.

OCD sits in DSM-5 with other disorders hypothesized to be related to OCD such as hoarding, excoriation, trichotillomania etc. The most common forms of OCD are contamination fears and cleaning rituals, doubt and uncertainty in which people fear that something bad will happen if they do not perform certain acts the right amount of times or in the right way, and finally, thoughts that are considered inappropriate and immoral and often associated with the fear that the person will act objectionably  (APA; 2013).

Salkovskis (1985) suggested that intrusive thoughts occur to all humans. The difference between intrusive thoughts and obsessional thoughts lies in the idiosyncratic beliefs about thoughts. Salkovskis (1999) suggested that beliefs about responsibility lead people with OCD to believe that unless they act immediately to prevent negative thoughts from coming true, they will be responsible for causing harm or distress. People with OCD repeatedly misinterpret the significance of their intrusive thoughts and maintain these misinterpretations by engaging in several compulsive behaviours to resist, block or neutralize the obsessive thoughts (Wilhelm and Steketee, 2006).

Wells (1997) suggested that compulsive/neutralising behaviours are believed by the individual to prevent negative outcomes but also are intended to relieve distress. Freeston, Rheaume, and Ladouceur (1996) highlighted in addition to the significance of the responsibility, the importance of overestimation of threat, intolerance of uncertainty, and perfectionism.
CBT for OCD focuses on addressing the misinterpretations of intrusive thoughts and by challenging beliefs while dropping compulsive behaviours.

Behavioural experiments (BEs) in and out of therapy room are the main interventions while promoting change in beliefs. This can be an anxiety provoking process for individuals with OCD but they also learn duirng this process to manage anxiety in a more effective and functional way.

People supporting individuals with OCD should support them emotionally by empathising but not enabling their compulsions or rules as that only reaffirms their beliefs of danger and prevents them from discovering new ways of thinking.

References

American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders. Arlington: Va: American Psychiatric Publishing.

Freeston, M. R. (1996). Correcting faulty appraisals of obsessive thoughts. Behaviour Research and Therapy, 13, 459-70.

Salkovskis, P. (1985). Obsessive-compulsive problems: a cognitive behavioural analysis. Behaviour Research and Therapy, 23, 571-83.
 
Salkovskis, P. (1999). Undertsanding and treating obsessive-compulsive disorder. Behaviour Research and Therapy, 37, S29-S52.
 
Wells, A. (1997). Cognitive therapy of anxiety disorders: a practice manual and conseptual guide. Chichester: Wiley.
 
Wilhelm, S. a. (2006). Cognitive Therapy for Obsessive Compulsive Disorder: A Guide for Professionals. Oakland, CA: New Harbinger Publications.

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