How to Define OCD: Three Areas That Are Helped By Counseling

The Diagnostic and Statistical Manual of Mental Disorders defines obsessive-compulsive disorder (OCD) as:

“…the presence of obsessions and /or compulsions. Obsessions are recurrent and persistent thoughts, urges, or images that are experienced as intrusive and unwanted, whereas compulsions are repetitive behaviors or mental acts that an individual feels driven to perform in response to an obsession or according to rules that must be applied rigidly” – American Psychiatric Association, 2022

Although concise, this definition can be made more understandable by breaking down different elements of this disorder. The two main components of this disorder are obsessions and compulsions.

Obsessions/Intrusive Thoughts

Obsessions are consistent thoughts, impulsive feelings or mental pictures that take place repeatedly in one’s mind. They take place without the person causing them and without the person wanting them to be there; this is where the term intrusive comes from. The thought, image, or urge intrudes on a person.

There are all sorts of obsessions that one might have, and they are as varied as people are. One person might experience an obsession as an intrusive thought that they have committed a sin, but that is only the beginning for someone with OCD. The thought of possibly committing a sin won’t leave their mind, and they find themself thinking about it over and over again, even when they don’t want to. This category would be called religious OCD or scrupulosity.

Another example of an obsession might be someone who feels an intrusive impulse (urge) to harm someone in some way and they are horrified by the realization. They continue to experience it over and over again, feeling more horror and more shame with each experience of it. This category is called harm OCD.

Yet another example might be someone who has intrusive mental images of sexual acts. This person does not want these images and is disgusted and horrified by them but cannot seem to get them out of their head. This would fall under the category of sexual OCD.

Because clinicians have noticed patterns among those who are diagnosed with OCD, obsessions have been grouped into particular categories, such as the ones used in the examples above. Other categories include but are not limited to hoarding/saving, symmetry/order, contamination, somatic (having to do with the body), and relationships.

Compulsions

It is often the case that both obsessions and compulsions are present in an individual who is diagnosed with OCD; however, only one of these needs to be present to meet the criteria for an OCD diagnosis.

The other component to a diagnosis of OCD is compulsions. Compulsions are physical or mental actions repeated over and over. These actions are characterized by an urge to complete them or by a particular and precise way of completing them. Compulsions are sometimes called “safety behaviors.” They are called this because one forms a belief that if they complete the behavior, they will be or feel safe.

For example, think of someone who has a contamination obsession. This person might obsess about the spread of germs. Their compulsion might be to clean everything that might have come in contact with germs. The compulsion might make them feel “safe” from germs, but only temporarily.

The trouble is that as the person uses the compulsion (cleaning) to temporarily feel safe, they are inadvertently training their mind that cleaning must happen to relieve the fear of germs spreading. The more one completes the compulsion, the stronger their belief that the compulsion will keep them safe from spreading germs.

You may see where this is going. The compulsions require more and more from the sufferer because it is not possible to be safe from all germs, and somewhere in their mind, they are aware of that. This awareness drives them to continue to try to fix the problem of germs being a danger. The solution to this is not to be or feel entirely safe from the effects of germs, as this is impossible. However, the OCD sufferer believes that this is the solution.

The Goal of OCD Treatment

In reality, the solution to symptoms of OCD is to build up the capacity to tolerate the discomfort and fear that comes with the thought of germs. The more this tolerance is built up, the less the compulsion will feel needed.

The same is true for any category of OCD: the OCD sufferer has convinced himself that the compulsion brings safety, but the reality is that it does not bring safety but demands continued engagement in the compulsions and mounting fear that drives the obsession. There are specific fears behind every obsession, and the goal for treatment of OCD is to build up a tolerance and a capacity to live with those fears.

Ways That Counseling Can Help

Sharing Obsessions and Intrusive Thoughts

Many people with OCD find the intrusive thoughts, obsessions, and compulsions they experience as frightening or shameful. This often leads to suffering in silence and fear, without knowing these are symptoms of OCD and without knowing that there are people who can offer help and support.

In particular, those who suffer from harm and sexual OCD symptoms often believe that they are bad people for having these unwanted and intrusive thoughts or compulsions. The word intrusive means that the thought is unwanted, uninvited, and unexpected. As you may be able to imagine, having sexual images suddenly come into your mind or unexpectedly thinking about harming another person would be quite disturbing!

This is common in those who suffer from OCD. The truth is that all people experience thoughts that are unwanted. Those who do not have OCD move past these thoughts without forming any judgments about themselves or the thoughts. Those with OCD have thoughts about these thoughts, which often lead to compulsions to get rid of these disturbances.

Meeting with a counselor and sharing these thoughts, obsessions, or compulsions with them can offer great relief from shame. Counseling can offer a place where someone can share these things that disturb them, and they will not be met with judgment but with compassion and help.

This is an important step for those who suffer from OCD. Being able to share this part of their life with another person who does not believe that they are “bad” for any of these things can bring a profound sense of relief and a starting point for continued treatment of OCD.

Tolerating Discomfort and Fear with Support

Once a person has been able to share these disturbing obsessions and compulsions with a caring counselor who does not respond with judgment, support and treatment can be discussed. The most common and efficacious treatment for OCD is called Exposure Response Prevention (ERP).

The first step is exposing the person to the fear behind the obsession. There are many ways to do this. Some people can use real-world exposures, and some can use imagining different scenarios as an exposure. This is done in the presence of a counselor, and the individual will share their emotional experience with the counselor.

It is important to note that the process of exposure causes great anxiety and fear to emerge in the individual. The purpose of this is to reform the brain processes to allow the person to not engage in a compulsion when they normally would and to teach themself that they do have the ability to tolerate the fear and discomfort they are attempting to avoid.

Response prevention involves the individual refraining from engaging in the compulsion or safety behavior, whatever that might look like. The point of refraining from the safety behavior is to train the brain and body to tolerate the discomfort of the fear or anxiety experienced when not engaging in the compulsion.

Eventually, the intensity of discomfort will subside, and the exposure will be over. This can be an overwhelming and scary experience, and this is why it is important to do it with a trained and caring counselor. The goal is for the individual to grow skilled at doing this so that they can practice it outside of their treatment with a counselor and eventually be able to do it on their own.

Identifying Unhelpful Thinking Patterns

An important part of treatment for OCD is identifying different thinking patterns that are not helpful. All of us experience what we might call automatic thoughts. These are generally based on different beliefs that we have about the world or ourselves.

For example, one person might experience an urge to floor the gas pedal as they are stopped in rush hour traffic. An automatic thought from someone who does not suffer from OCD might be “Wow, that’s a weird urge to have” or “That’s kind of funny that urge just showed up in my mind.” Someone who suffers from OCD might have the thought of “I’m a terrible person who cannot be trusted to operate a vehicle!”

The automatic thought of the person who suffers from OCD could bring up feelings of guilt, fear, shame, etc. If one can identify this automatic thought, one can then decide if they truly believe that thought. More often than not, these automatic thoughts contain errors in logic.

In this example, one of the errors in logic might be that the person is confusing feelings with facts. The person feels terrible for having that image come into their head, but that doesn’t mean that they are terrible for having that image come into their head. Slowly, with time and support from a trained counselor, these automatic thoughts can be identified and examined for alignment with the truth.

In summary, obsessions and/or compulsions are the components that are the diagnostic makeup of obsessive-compulsive disorder. As with all mental disorders, for one to be diagnosed, the symptoms must cause significant difficulty in functioning. In other words, the mere presence of obsessions or compulsions in one’s life does not mean that one meets the criteria for an OCD diagnosis. It is when it gets in the way of functioning that it becomes a mental disorder.

There are three significant ways that counseling can help one who suffers from OCD: sharing obsessions, intrusive thoughts, or compulsions with a non-judgmental and skilled counselor; engaging in ERP treatment; and learning to identify and slowly change unhelpful thought patterns.

There are many other ways that counseling can help those who suffer from OCD; this list is not exhaustive. Those with OCD need not suffer in silence nor continue to be bound by OCD; there is hope and people who want to support you in healing!