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Simone Hoermann, Ph.D.Simone Hoermann, Ph.D.
A blog about the personality disorders (borderline, narcissistic, etc.) with a focus on research and therapy

Obsessive Compulsive Disorder

Simone Hoermann, Ph.D. Updated: Jan 14th 2010

Hands lathered in soap under a faucetLet me digress in this blog posting from my main topic of interest, the Personality Disorders.  A couple of months back, I started to facilitate a group for people who have Obsessive-Compulsive Disorder (OCD), so this is a topic that has recently been on my mind quite a bit.  I came across a blog entry on www.mentalhelp.net by Elisha Goldstein on using mindfulness skills in order to cope with some of the symptoms of OCD, which I thought was a really helpful idea.

            OCD is one of the Anxiety Disorders and is defined by the Diagnostic and Statistical Manual of Mental Disorders (DSM), as the name implies, by either obsessions, or compulsions.  What does that mean, you might ask. 

I like to explain this in a rather simplistic way: Obsessions are thoughts, images, or impulses that come into your head and they create anxiety and discomfort.  You are trying to push them out of your head, but can’t get rid of them, and there is a part of you that knows that the thoughts are unreasonable or excessive.  Examples of obsessions include a fear of being contaminated by germs, or doubts as to whether or not you turned off the oven or locked your door.  Other common examples of obsession include thoughts or fears that you may have run someone over while driving, when really nothing happened.  Some people report that they may be at a religious service and have the image of getting up and shouting something obscene, even though they would never do such a thing and are mortified by the idea.  The point is that these images, thoughts, and doubts create an enormous amount of anxiety and they take up a lot of time.  Typically, a person will try desperately to get rid of these unwanted and anxiety-provoking thoughts, but it’s like if I tell you: “Don’t think of a green polar bear!”  Of course, you can’t help but think of a green polar bear.  David Clark, the author of "Overcoming Obsessive Thoughts: How to Gain Control of Your OCD", points out that everyone has random thoughts coming into their head throughout the day, but the more you try to fight the thoughts, the more they tend to stay around. This is where I think mindfulness skills can come in handy when it comes to OCD -- just realizing, noticing and acknowledging that the thoughts are there and they cause anxiety, and then labelling this as something that is a function of OCD, as Jeffrey Schwartz describes,  can be helpful.

            Compulsions are behaviors or rituals that are intended to get rid of the anxiety.  Common compulsions include washing your hands over and over again, or going back to check your oven or door. Other examples include or driving back multiple times to make sure your didn’t run someone over or cause an accident, even though nothing happened, or going back to your doctor over and over and over to make sure you’re not sick, even though your health is fine.  Compulsions tend to make the anxiety caused by the obsessions go away, but they typically only offer relief that is very short-lived.

            So, extremely simply put, obsessions are (unreasonable) thoughts that make you very anxious and that you can’t get rid of, and compulsions are things you do to get rid of the anxiety. 

            Many people I work with are extremely embarrassed by their OCD symptoms and find it very hard to talk about them.  It can be very shameful to live with these fears and symptoms.  Therefore, unfortunately, many people don’t talk about the OCD, and I suspect many don’t seek help for it.  However, sometimes, I’ll explain that a certain symptom is part of the OCD, and people will find a lot of relief in realizing that.  The idea that what they are struggling with has a name and is something that other people struggle with, too, can be comforting.

That’s why I liked what Elisha Goldstein wrote about in his blog entry.  I think the refrain borrowed from Jeffrey Schwartz’s approach,  “It’s not me, it’s my OCD” , can be helpful in dealing with embarrassment and in not blaming or judging yourself.  It does require a bit of practice, though.  

 

Simone Hoermann, Ph.D.Simone Hoermann, Ph.D., is a Psychologist in private practice in New York City. She specializes in providing psychotherapy for Personality Disorders, Anxiety, and Depression. She is a faculty member of Columbia University, and facilitates psychotherapy and skills training groups at the Columbia East 60th Street Day Treatment Program.

    Reader Comments
    Discuss this issue below or in our forums.

    little quirks but compelling - john - Jul 25th 2010

    I have always been compelled to only fill my gas tank with 5 or 6.00 work at a time and sometimes 10.00. I always run the gas down to the last drop.

    i am always made fun of but I am still compelled to do this act. Does anyone have an answer for this. I know some would call it cheap but I think its to it. john 

    "Compulsive" Gambling - Lynne - Jan 29th 2010

    Pathological gambling is defined by the DSM IV as an impulse control disorder. Most people who admit they have a gambling problem call it Compulsive Gambling, as does Gamblers Anonymous. I just wonder whether it also is a form of OCD, because a pathological gambler definitely obsesses about the thought of gambling to the point that they are driven to gamble, much the same way someone else with OCD might obsess about germs and wash their hands repeatedly. I think the DSM IV fails to take the "obsesson" part into consideration, yet that is the driving force behind the act of gambling. It's not about money. I wish there were more studies about this. What do you think?

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