Obsessive Compulsive Disorder (OCD) is an anxiety disorder that causes recurrent and persistent thoughts, urges, or images that are intrusive and unwanted, known as obsessions.
These obsessions might include a strong fixation with dirt or germs, worry that something is incomplete or something bad will happen, thoughts about violence or hurting someone, or extreme concern with order, symmetry, or precision.
A person with OCD tries to manage these unwanted thoughts through rituals or repetitive behaviors, known as compulsions.
Common compulsions include repeatedly checking locks, alarm systems, ovens, or light switches; excessive or ritualized hand washing/cleaning; ordering or arranging things in a particular way; or rituals related to numbers, such as counting, repeating, excessively referencing, or avoiding certain numbers.
While completing a ritual temporarily relieves the anxiety, it keeps a person stuck in a vicious cycle because it reinforces obsessive thinking.
Not performing these compulsive behaviors can cause great anxiety, often attached to a specific fear of serious consequences if the behaviors are not completed.
Is OCD Curable?
OCD can be treated and managed to reduce its significant impact on one’s daily functioning through medication, therapy, mindfulness, or a combination of treatments.
Rather than being a victim of your thoughts, feelings, and sensations, you can change your relationship with them through various treatments.
People with OCD who receive appropriate treatment typically experience an increased quality of life and improved functioning. Depending on the severity of OCD, some people may need longer-term or more intensive treatment.
Why Compulsions Make Your Intrusive Thoughts Worse
Compulsions, or rituals, are behaviors that people with OCD perform in response to an obsession or intrusive thought. People perform these compulsions to suppress their anxiety and neutralize their fears.
They also carry them out to keep things safe, ensure that the thoughts do not come true, and ensure that something bad does not happen.
However, while compulsions might “help” in the short term, they only make the intrusive thoughts worse and serve to keep the OCD cycle going long-term.
Every time one engages in a compulsion related to the obsession, the thoughts will only become stronger in a powerful and debilitating loop.
Compulsions will never make the intrusive thoughts go away; they will only reduce your anxiety and give you a short-term reprieve from your thoughts. If your brain has a pattern of carrying out a compulsion each time you get an intrusive thought, you will never have the opportunity to learn that these intrusive thoughts are harmless.
There is a critical focus on compulsions in treating OCD because they are normally the most concrete and accessible way to target the disorder. While we can’t always control our thoughts and feelings, we can control our behavior and response.
A person with OCD should accept their thoughts and understand that the distressing thoughts they experience are not necessarily something that they have (or can have) control over. While you may be unable to control whether an intrusive thought pops into your head, you can control how you respond.
Finding a way to discontinue compulsions is how you can decondition your anxiety and learn to have less frequent and intense obsessions.
The following section will discuss how to deal with these meddling thoughts and how you can learn to cope with them.
What to Do Instead: How to Deal with OCD Intrusive Thoughts
Don’t try to prevent your thoughts
You can be aware of an intrusive thought without trying to stop it. Sometimes instructing yourself not to think about a thought only brings more attention to it.
Instead, start by recognizing the thought and then letting it go. Trying to control the thought is counterproductive and adds fuel to the fire.
Instead, maybe start by simply taking a pause when the thought arises rather than immediately reacting to it.
Thoughts need energy to survive, so they will fade if you do not give time or energy to the thought. Instead, label it and move on. Over time, defusing your obsessive thoughts will help you feel more in control.
This process is challenging and takes a lot of practice, so try not to get discouraged if you initially struggle to resist your urges. Practicing mindfulness meditation is a good way to learn how to let go of thoughts and feelings.
Separate your thoughts from your identity
You are not your thoughts! Thoughts are just a string of words and are not inherently dangerous.
Thinking about something disturbing is not the moral equivalent to carrying out the act. Just because your brain generated a thought does not mean you are obligated to take responsibility for it.
The intrusive thoughts you experience do not necessarily reflect who you are and do not say anything about you.
Remember that intrusive thoughts do not always align with your core values, beliefs, and morals. Learn to appreciate yourself for who and how you are and practice leaning in, embracing, and celebrating your unwanted thoughts, feelings, and sensations.
Let go of perfectionism
Perfectionism tends to be a fundamental feature of OCD. Excessive perfectionism involves holding standards that are impossible to attain and feeling anxiety or depression when these impossibly high standards are not met.
While stopping perfectionistic behaviors will likely increase anxiety in the short term, over time, this anxiety will decrease, despite the fact that something has been done imperfectly.
As you gain more experience with letting things remain imperfect, future encounters with imperfection will become easier and easier.
To begin thinking outside the “perfectionist” box, try testing your perfectionistic predictions, put your perfection into perspective, define ‘perfect,’ and try a different point of view.
Try not to seek reassurance
While seeking reassurance occasionally is not bad, people with OCD tend to seek reassurance in excess.
Whether you are asking if someone is mad at you, checking things repeatedly, or researching to ensure you are safe and healthy, getting reassurance can perpetuate a harmful cycle where you constantly need even more reassurance to feel better.
Reassurance can be considered a type of compulsion in OCD, and while reassurance might provide temporary relief, it will likely worsen OCD symptoms in the long run.
Remember that uncertainty is a part of life – do not judge yourself or feel ashamed, but try to notice when you’re seeking reassurance and not act on the urge.
Handling guilt and shame
People with OCD tend to feel overwhelming guilt, fear, shame, and self-hatred about their intrusive thoughts.
It is important to give yourself grace and be patient. Remember that everyone sometimes experiences intrusive thoughts, and you are not a “bad” person because of it.
You are not expected to be in control of these thoughts, nor are you meant to identify with them.
What if OCD is Not Treated?
OCD can be considered disruptive to one’s daily living if left untreated. OCD can be debilitating. It could take a mental and physical toll on behalf of the person affected, leading to physical illnesses, anxiety, and depression.
Untreated mental health conditions are also a significant source of drug and alcohol addiction as people turn to these substances to cope with the distress of the disorder.
OCD compulsions can also take up a substantial amount of one’s time. People might miss school or work, and their personal and professional relationships can suffer under the weight of an untreated mental health condition.
Individuals might isolate themselves from friends and family because people with OCD tend to avoid certain situations or places that can trigger an obsession.
Additionally, the pressure and exhaustion a person might experience after performing compulsions can lead them to isolate themselves socially.
The anxiety, pressure, and exhaustion can also lead to various physical health issues, causing their personal and professional life to suffer even more.
Family Involvement
If you have OCD, the attitudes and behaviors of family members can impact your symptoms and decisions about treatment. Even though psychological treatments like exposure therapy are effective for OCD, many people don’t seek help.
Family and friends often shape our views about our mental health difficulties and whether we should pursue treatment.
Family members who criticize you or your symptoms may unintentionally be making your OCD worse. Criticism is linked to more severe OCD symptoms.
Critical family members often think you have more control over your obsessions and compulsions than you do. They may believe you could stop the OCD if you tried harder. This could lead them to have more negative attitudes about you seeking treatment.
It’s also common for family members to accommodate your OCD symptoms, like participating in compulsions or modifying family routines. They may do this to reduce your distress or their own anxiety. However, high levels of accommodation can increase family stress. Family members who accommodate a lot may think exposure therapy will be too hard for you. The high stress may also motivate them to encourage you to get treatment.
The critical and accommodating behaviors that family members show, while often well-intentioned, can fuel OCD and create concerns about treatment.
If you choose to include family in your treatment, it will be important to address these behaviors and treatment worries early on. This can create a more supportive environment and improve your treatment success.
Seeking Professional Help
Cognitive Behavioral Therapy (CBT)
Cognitive behavioral therapy is a type of therapy that is effective for treating OCD. The goal of cognitive behavior therapy in the context of OCD is to uncover the underlying fear driving the intrusive thoughts (often can’t be articulated without probing) and get the patient to tolerate – not relieve – this anxiety.
The person will engage in the obsession, feeling anxiety to peak, but resisting the urge to perform the compulsion.
People with OCD are often treated using a form of CBT called exposure and response prevention (ERP) therapy. In ERP, patients are exposed to feared situations or objects that are meant to set off their compulsions.
This form of therapy is meant to purposely invoke more anxiety in attempts to disrupt the neural circuit between the processing and action parts of the brain. Over time, patients learn to resist the urge to perform compulsive behaviors and manage their OCD thoughts or actions.
By staying in a feared situation without anything terrible happening, patients learn that their fearful thoughts are just thoughts and nothing else. ERP takes time, effort, and practice, but patients learn to cope with their thoughts without relying on their compulsions.
The compulsion to avoid anxiety is a powerful driver of OCD, but ERP is one of the most powerful tools available for treating OCD because it directs the patient to live with the anxiety and see that nothing bad will happen as a result.
Medication
Certain psychiatric medications, specifically selective serotonin reuptake inhibitors (SSRIs), can help control the obsessions and compulsions of OCD.
There are several different SSRIs that have been approved by the U.S. Food and Drug Administration (FDA) to treat OCD, including Clomipramine (Anafranil), Fluoxetine (Prozac), Paroxetine (Paxil, Pexeva), Escitalopram (Lexapro), and Sertraline (Zoloft).
Patients who do not respond to one SSRI medication can sometimes respond to another. Effective treatment of OCD can be a combination of CBT and SSRIs, especially if OCD symptoms are severe.
Mindfulness
Mindfulness techniques, specifically meditation, can effectively manage OCD thoughts or urges and the distress that comes with them. Meditation can help you relax, slow your busy thoughts, and be fully present in the moment.
It can take your mind away from what it is fixated on and help you push out your obsessive thoughts and compulsive tendencies. Instead, you can focus on your breath, a mantra, or specific imagery.
Other treatments
In rare circumstances when therapy and medication are not effective enough to control OCD symptoms, other (more invasive) options might be offered.
First, intensive outpatient and residential treatment programs emphasize ERP therapy principles, which might be helpful for people with extreme OCD who struggle to function because of the severity of their symptoms.
Deep brain stimulation (DBS) is another possible option for adults aged 18 years and older who don’t respond to traditional treatment approaches.
This procedure uses electrodes implanted in your head that may help regulate abnormal impulses.
Lastly, transcranial magnetic stimulation (TMS) is a noninvasive procedure that uses magnetic fields to stimulate nerve cells in the brain to improve symptoms of OCD.
What is family involvement in the treatment of OCD?
Family members, with the best intentions at heart, might sometimes engage in behaviors that inadvertently support or accommodate the compulsive rituals of the person with OCD.
These accommodations can range from participating in the rituals, offering repeated reassurances, or avoiding certain triggers that might cause distress to the affected individual.
For instance, if a person with OCD fears contamination, family members might start to clean the house excessively, avoid bringing in certain items, or even participate in washing rituals to prevent distress or appease the individual.
While these accommodations might provide short-term relief to the person with OCD, they can be counterproductive in the long run. They can reinforce the belief in the validity of the obsessive fears and can make the compulsive behaviors more entrenched.
During treatment, therapists need to work with families to identify these accommodations. Once recognized, strategies can be developed to reduce and eventually eliminate them gradually.
This reduction aids in the exposure-based treatment strategies, allowing individuals with OCD to confront and manage their fears without the safety nets these accommodations provide.
Involving the family in this process is crucial, ensuring everyone is on the same page and working collaboratively towards recovery.
It also helps the family understand the difference between supporting the individual versus unintentionally supporting the OCD.
FAQs
Why is OCD worse at night time?
Bedtime is the loneliest part of the day, and OCD attacks us when we are most vulnerable. When you are alone with your obsessions, this can make them feel more real and powerful.
At night when your mind is meant to be at its quietest, anxious thoughts are most likely to linger and grab control of your mind. Obsessive thoughts can keep victims of OCD up all night, and one compulsion can disrupt an entire night’s sleep.
Additionally, research has shown a link between OCD and insomnia – people with OCD are likelier to have insomnia than the rest of the population.
Why does OCD make you tired all the time?
OCD can be exhausting. The near-constant disturbing thoughts are mentally draining, and carrying out compulsions – which can take hours a day – can be physically draining too.
People with OCD often feel depleted at the end of the day, as the symptoms of OCD can be taxing. This can be a dangerous cycle, too, as an exhausted brain can cause OCD symptoms to feel much worse.
| DON’T | Do |
|---|---|
| Don’t try to eliminate anxiety | Do eliminate compulsions |
| Don’t judge, invalidate or make assumptions about someone’s identity based on their OCD theme | Do show acceptance, compassion, empathy, and kindness. Themes often attach to what someone values the most |
| Don’t automatically react to anxiety | Do voluntarily face fear: be willing to risk that our brain is throwing out false signals. We need to teach the brain that it’s wrong over and over again |
| Don’t rationalize OCD thoughts | Do respond differently to thoughts |
| Don’t compare one person’s OCD journey to that of another | Do understand that each OCD journey is as unique as a fingerprint. Different factors, e.g. resources, income, support system, influence recovery |
| Don’t rely on problem-solving. This fuels rumination | Do practice uncertainty and model this with as many things as reasonably possible |
| Don’t reassure using phrases like: “It’s fine” “Calm down” “That’s not going to happen” or “You’d never do that” | Do support using phrases like: “I hear you…but trying to find the answer isn’t going to help” or “That could happen, but let’s be uncertain” and “Are you seeking reassurance? I’m unsure, but we’ll face it together”. |
Sources
- https://www.verywellmind.com/how-can-i-stop-ocd-thoughts-251049
- https://www.psychiatry.org/patients-families/obsessive-compulsive-disorder/what-is-obsessive-compulsive-disorder
- https://www.mayoclinic.org/diseases-conditions/obsessive-compulsive-disorder/diagnosis-treatment/drc-20354438
- https://www.webmd.com/mental-health/features/meditation-for-ocd
- https://beyondocd.org/expert-perspectives/articles/the-search-for-imperfection-strategies-for-coping-with-the-need-to-be-perfe
- https://ocdspecialists.com/compulsions-in-ocd/
- Obsessive Compulsive Disorder: A Self-Help Book (Karina Lovell and Lina Gega)
- Merritt, O. A., Rowa, K., & Purdon, C. L. (2023). Criticism and accommodation are associated with treatment concerns in close others to those with anxiety. British Journal of Clinical Psychology, 62(1), 146-157.
- Breaking the OCD cycle using exposure and response prevention
