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Obsessions and Compulsions
What are obsessions?
- Persistent thoughts, impulses and images that cause marked distress (not simply excessive worries about life problems)
- Person attempts to ignore, suppress or neutralize the obsessions
- Person recognizes that obsessions are a product of his own mind (not paranoid delusions about others controlling his thoughts)
What are Compulsions?
- Repetitive behaviors (e.g., hand washing, checking) or mental acts (e.g., praying, counting) that a person feels driven to perform usually in response to an obsession – these acts are very time consuming
- These behaviors or mental acts are aimed at preventing some dreaded event – however, the acts are either not realistically connected with what they are intended to prevent, or are clearly excessive
What causes obsessions and/or compulsions?
We all experience disturbing thoughts occasionally – individuals suffering from obsessions or compulsions differ from most others in that they are unable dismiss and distract themselves from intrusive thoughts.
The question is why? What is the process responsible for life altering obsessions or compulsions?
Proposed chain of events associated with Obsessive Compulsive Disorder (OCD)
A trigger leads to a disturbing thought. A person prone to OCD will be unable to dismiss the thought or put a halt to related compulsions because:
- People with a predisposition to OCD believe that they are responsible for preventing disasters
- The intensity of their emotions (i.e. anxiety & depression) reduces their ability to dismiss their disturbing thought – for instance, during periods of depression the incidence of obsessions triples
- Compulsions bring temporary relief from persistent and distressing obsessions – the positive consequences of compulsions reinforces the ritualistic behaviors
How can therapy help for obsessions and compulsions?
- Psychoeducation Obsessions are described as beginning with thoughts which are quite common – but for OCD patients these thoughts trigger negative interpretations. OCD is explained as being related to an inflated sense of responsibility for preventing harm. This exaggerated feeling of responsibility intensifies the anxiety related to a disturbing thought. Attempts to suppress disturbing thoughts lead to a rebound effect that culminates in a vicious cycle (e.g., thought suppression to deal with increased anxiety only leads to more intense obsessions and anxiety – leading to more attempts at thought suppression – leading to more anxiety, etc…). Compulsions are described as anxiety-reducing tactics which result from an individual’s inability to cope with disturbing thoughts by simple dismissal or distraction.
- Exposure and Response Prevention (ERP): Approximately 66% of patients benefit from exposing themselves to their fear, reinterpreting their negative perceptions, and not performing their ritualistic behaviours/compulsions. When the feared catastrophes do not occur patients learn that their anxiety was exaggerated and that their compulsions are not needed.
- Schema-focused therapy: This is essentially a specialized type of therapy for severe or resistant OCD. The roots of obsessions and compulsions are examined. Understanding how experiences in early life (e.g., attachment with parents or negative events) are related to OCD symptoms can motivate a client to persist with ERP thus improving current symptoms and minimizing the possibility of relapse.
If you are suffering from obsessions and/or compulsions, a professional at the Montreal Clinic for Therapy Services can help.