Wondering if you have symptoms of obsessive compulsive disorder?

Here are links to a couple of assessments on OCD that can be completed on one’s own:

​Yale Brown Obsessive Compulsive Scale​

​OCI​

“Obsessive Compulsive Disorder” (OCD) refers to a disorder in which anxiety over unwanted thoughts leads to repetitive behaviors meant to decrease anxiety associated with the intrusive thoughts. Sometimes these behaviors are not actions per se, but mental compulsions, or things we tell ourselves or think about to try to reduce our anxiety or reassure ourselves out of it. 

While obsessions or compulsions can be extremely painful symptoms to have, they are also highly treatable. 

In my practice, I have seen a number of different types of obsessive or compulsive symptoms as well as approaches for coping with them that clients have found helpful. One common type of obsession has to do with worrying about what other people will think of you. You might be overly concerned with how you look or how you perform. As an example, this kind of obsession may lead to compulsive dieting or exercise behaviors, or a compulsive need to check your work over and over again to make sure you don’t make any mistakes. Or, you might be compulsively nice all the time to everyone and have trouble standing up for your own needs. Everyone’s obsessions/compulsions are different. You may even be perfectionist about certain things but pretty relaxed about other things. Obsessions and compulsions may be a large part of your identity and personality, or they may be isolated intrusions that come up when you’re feeling particularly anxious or when triggered for whatever reason.

Here are a couple of examples: Your obsessions might be triggered by interpersonal conflict, such as a fear that someone is angry with you; you may start to worry excessively about whether you did something wrong or whether the other person will stop liking you. You might feel like you need to call this person over and over again to make sure that everything is still “okay” between you. For someone else, however, a trigger for obsessive thoughts might be work-related; a fear of making a mistake on the job and being criticized or causing harm to someone. The difficulty is that the thoughts and/or behaviors seem to be repetitive and fixating. It’s hard to be flexible in the face of them, and feels more like a broken record that won’t stop playing the same thing over and over again. Much of this experience may be described as a type of “rigidity”- a rigidity in your thinking or relating to yourself, to others, to a fear, or to an external situation.

In the above cases, the root of the anxiety and obsessive compulsive symptoms may be a need for approval from others or an underlying self-esteem problem. The OCD could also be due to a history of trauma and a belief deep down that you are “bad” and “unlovable” and that that is why bad things have happened to you (for example, a germ phobia might represent a feeling of being “blemished” deep down). Another possibility is that your obsessive thoughts and rituals are a way of punishing and tormenting yourself for feelings that you have (perhaps out of your awareness) which you feel guilty about or that make you feel out of control, such as angry or greedy feelings. This also may be a way of punishing yourself for pleasure, as obsession compulsive experiences take the fun out of everything!

Other ritualized types of thinking and behaving don’t have much to do with other people and wanting approval from them or other relational dynamics, but may be more about wanting a sense of “control” over your own life or environment. If you have this type of OCD experience, you might feel a strong need for certain “things” in your life to be in a certain “order” or to go a certain way. For example, you might feel like you constantly need things to be more “even” or “neat” or “clean”. You might rearrange things many times a day or wash your hands again and again to prevent “germs”. Sometimes this can have to do with not feeling enough “control” in other areas of your life or not having had enough control in an earlier traumatic situation. Controlling the things around you, things that you cancontrol, makes you feel like at least there is “something” that you are in charge of all on your own, or that you can prevent upsetting things from happening to you in the future. This may also be a way of avoiding unpredictability and uncertainty by keeping some things under tight wraps and focusing on those things to the exclusion of life experiences that involve risk, discovery, and the unknown. (This can get rather boring after a while, although the sense of safety it offers is hard to give up!)

Sometimes OCD can lead to a need to “control” things to an extent that it makes it hard for others to live with you. You may even want to stop needing to control so much but find that you are actually controlled by the need for control. For example, if you are a mother who is obsessed with avoiding germs and you have a two-year old who likes to play outside in the dirt all the time, this can lead to conflict; either you will allow your child to play in the dirt (which may be healthy for your child at his stage of development), and feel anxious as well as maybe even angry with your child for doing something which increases your anxiety, or you might excessively control your child and restrict his play in a way that will be constraining to him.

Most people with OCD know that the thoughts they have and things they do don’t make a lot of sense (or at the very least, are not flexible enough to be put aside at times when the use of them is counterproductive or unnecessary), but feel like they cannot help their thoughts or behaviors anyway. If this is the case for you, you may have shame about this or perhaps feel out of control by your symptoms. You may even try to hide them from others and they may even become part of a secret world that puts up a painful wall between you and other people in your life. Or, you may feel fine as long as you can manage to “control” everything you feel the need to control in order to manage your anxiety, but you still might be driving everyone around you crazy, leading to interpersonal conflict! There are also some times that a person with OCD may actually not know if his repetitive thoughts and actions make sense or not; this can lead to a feeling of craziness if others around you are telling you something different from what you believe inside.

Among the different types of help for obsessive compulsive disorder are medications which decrease anxiety; cognitive techniques which help a person learn to think differently (for example, challenging the idea that germs are really so dangerous); behavioral techniques which help a person act differently (such as ignoring obsessive thoughts and not repeating compulsive behaviors over and over again, or exposing oneself to the feared situation- such as germs- until you get used to it and no longer fear it), and even ​EMDR​ may be helpful at times. My favorite approach is a psychodynamic one in which we might try to uncover whether there are meanings to the content of the obsessions or compulsions that are not immediately obvious (for example, a belief that you are “dirty” leading to compulsive cleaning actually being about feelings of being “dirty” due to a forbidden desire), or whether there is a hidden function for the self of the obsessing/ritualized behaviors such as emotion regulation, self-punishment, an indirect communication to others around you, or a way of organizing your identity. However, I also feel strongly that exposure and response prevention and cognitive therapy are necessary in addition to really get symptom relief. I use a combination approach in my practice. 

While it may take a trial of several approaches until you find the one that works for you, it is usually a good idea to see if you feel comfortable with the therapist you see and with the approach that the therapist uses. Don’t be shy to ask about that in your initial consultation and to “shop around” for the person who will be just right to help you with your individual types of symptoms. Remember, the “label” OCD describes a set of thoughts, feelings, and behaviors that you are having trouble with, but doesn’t really say that much about the cause of your symptoms, their meaning, or what will help you manage or eliminate them!