The Role of Obsessions in OCD

The Role of Obsessions in OCD OCD Print What Exactly Are Obsessions? OCD Obsessions Are More Than Everyday Worries By Owen Kelly, PhD Medically reviewed by Medically reviewed by Steven Gans, MD on August 05, 2016 Steven Gans, MD is board-certified in psychiatry and is an active supervisor, teacher, and mentor at Massachusetts General Hospital. Learn about our Medical Review Board Steven Gans, MD Updated on June 12, 2019 Caiaimage/Agnieszka Wozniak / Getty Images More in OCD Causes Symptoms and Diagnosis Treatment Types Living With OCD Related Conditions Obsessions are thoughts, images, or ideas that wont go away, are unwanted and cause extreme distress. Everyone has strange, unusual or even disturbing thoughts that pop up from time to time. Most people continue about their daily routine without giving these experiences a second thought, but if you have obsessive-compulsive disorder (OCD), these kinds of occurrences can become both distressing and debilitating. What Are Obsessions? There are many different types of obsessions, including: worrying constantly about catching a deadly disease and/or that you will contaminate others with your germsfears about contamination with environmental toxins such as lead or radioactivityan intense fear that something horrible will happen to a loved oneprofound worry that you will do something extremely embarrassing, like screaming out an obscenity at a funeralbelieving you may hit someone with your car or injure someone unknowinglyaggressive or disturbing ideas, such as thoughts of murdering your partner or childdisturbing sexual and/or religious imagery that might include sexual assault or inappropriate sexual actsa strong need to reorder things until they feel just righta fear of harming inanimate objects Obsessions are not simply worries about your everyday problems; they often feel impossible to control, even if you can recognize their irrationality. Often, the obsessions are so debilitating that you have difficulty keeping up at work or maintaining personal relationships. Obsessions can be so distressing that they cause you to try to get rid of them with other thoughts or actions, like compulsions. What Are Compulsions? Compulsions are behaviors that have to be done over and over again to relieve anxiety. Compulsions are often related to obsessions. For example, if you are obsessed with being contaminated, you may feel compelled to wash your hands or use hand sanitizer repeatedly. Common compulsions include cleaning, counting, checking, requesting or demanding reassurance and ensuring order and symmetry. As with obsessions, people with OCD usually (but not always) have insight into the irrationality of their compulsions. Obsessions and Thought Suppression Given that obsessions are at the core of OCD, it has been suggested that thought suppression may play a role in causing some of the symptoms of OCD. People with OCD may overreact to dangerous thoughts by trying to push them away, which only causes them to come back worse than before. Of course, this leads to more thought suppression, which leads to more distressing thoughts and it becomes a vicious cycle. For example, as part of a research study, people with OCD were asked to suppress their distressing thoughts some days while allowing themselves to have these thoughts on other days. At the end of each day, they were asked to record the number of intrusive thoughts they experienced in a diary. Not surprisingly, people with OCD recorded twice as many intrusive thoughts on the days they tried to suppress their thoughts than the days when they let their thoughts flow freely. Obsessions and OCD Spectrum Disorders There are a number of other disorders that, while not technically meeting the DSM diagnostic criteria for OCD, have very similar symptoms and fall within the so-called OCD spectrum. This spectrum captures different clusters of symptoms that are reminiscent of, but not exactly the same as, those of OCD. Often (but not always) the only difference between OCD and a given OCD spectrum disorder is the specific focus of the obsessions and/or compulsions. For example, body dysmorphic disorder  (BDD) is a form of mental illness in which the person has obsessive thoughts about a slight anomaly or imagined defect in their appearance. Like with OCD, BDD involves repetitive checking; however, the difference between the two is that people with OCD do not typically focus on how they look. Treating Obsessions Although the obsessions associated with OCD can be debilitating, there are a variety of treatment options that are safe and effective for many people. These include medications, psychotherapies, self-help techniques and in extreme cases, surgical procedures.