Obsessive-compulsive disorder (OCD) is a mental health condition characterised by, as its name suggests, obsessions and compulsions. It should, however, be noted that official psychiatric diagnosis differentiates if from obsessive-compulsive personality disorder (OCPD), which regardless of its name is not characterised by actual obsessions and compulsions. OCD is anxiety based condition, which can be successfully attended to in psychotherapy or counselling. When faced with OCD in a therapy room, the condition itself is not hard to diagnose and differentiate from other conditions, however, people presenting with OCD will sometimes tend to hide their symptoms from the therapist due to the sense of shame.
What are obsessions and compulsions?
There are different views and definitions of obsessions and compulsions, however, they are more or less overlapping. Maybe, since Diagnostic and Statistical Manual of Mental Disorders (DSM) is also the diagnostic tool for the disorder, the best ones to explain obsessive-compulsive disorder (OCD) are the ones used there.
According to Diagnostic and Statistical Manual of Mental Disorders (DSM), obsessions are defined as “recurrent persistent thoughts, urges, or images that are experienced”…”as intrusive”…”and that in most individuals cause marked anxiety or distress”. “The individual attempts to ignore or suppress”…”them with some other thought or action”. This action is referred to as compulsion.
Diagnostic and Statistical Manual of Mental Disorders (DSM) defines compulsions as “repetitive behaviors (e.g., hand washing, ordering, checking) or mental acts (e.g., praying, counting, repeating words silently) that the individual feels driven to perform in response to an obsession…”. “The behaviors or mental acts are aimed at preventing or reducing anxiety or distress, or preventing some dreaded event or situation…”.
Symptoms of obsessive-compulsive disorder (OCD)
As mentioned, obsessive-compulsive disorder (OCD) is characterised by obsessions that the individual with OCD is suffering from and compulsions that they are performing in order to relive himself or herself of anxiety and distress caused by obsessions.
Obsessions can be in the form of frequent thoughts or images that seem intrusive and have violent or sexual content. They can also be in the form of urges—again sexual or violent or any other urge that may seem destructive or damaging. Obsessions are experienced as coming from somewhere outside—something the individual doesn’t relate to and is scared of. Commonly there is fear of doing something that would be perceived as outrageous, violent, sexual, shameful, crazy—something that the individual cannot consciously identify with. This is also why obsessions have the nature of provoking fear and anxiety and want to be avoided and repressed. This is in fact quite ironical, given that the obsessions themselves are in most cases repressed and unconscious content rising into awareness.
Compulsions are repetitive acts that an individual suffering from obsessions will perform in order to neutralise the anxiety that obsessions cause. Compulsions will usually be experienced as acts of cleaning, checking, multiple repetitions of different tasks and rituals in the attempt to prevent the catastrophe from occurring and hence soothe the anxiety associated with obsessions.
Individuals suffering from OCD—especially when OCD is not in fact diagnosed as a disorder but rather as a personality trait (i.e. when all diagnostic criteria according to DSM-5 are not met)—will usually have a sense of compulsions being irrational behaviour, however, they will still preform it due to its apparent anxiety relief characteristics.
OCD and panic attacks
Panic attacks are also not uncommon with people suffering from obsessive-compulsive disorder (OCD). If obsessions are prevalent and considerable, panic attacks of potential loss of control can occur. This will especially be the case when obsessions are nature that the individual will harm themselves, others or go crazy or that something catastrophic will happen to them.
Similar to generalised anxiety or social anxiety, the nature of panic attacks associated with obsessive-compulsive disorder (OCD) is also in repressed content penetrating into the awareness—an aspect that someone presenting with OCD does not identify themselves with. It is important to be ware of that in therapy and also to acknowledge that bringing these aspects into awareness, acknowledging and reframing them is essentially how we will end up dealing with OCD in psychotherapy or counselling.
OCD from developmental perspective
Developmentally, it appears that obsessive-compulsive disorder (OCD) is strongly associated with homes where children did not learn to soothe their anxiety through relationship with their parents and hence do not really know how to soothe it later on in their lives. Homes of these children were usually such that the parents—predominantly the mother—was herself to anxious to soothe the child and make sense of their anxiety. Such homes are usually described as chaotic—places where aggression, violence and abuse occurred repeatedly and where such occurrences were sporadic and something that the child could not really expect.
Children that grew up in such environment get the perception of the need to be perfect and do things perfectly in order for the environment to remain calm and controlled. However, this is a delusion, which later on manifests itself thinking that control over others and the world can be gained by following compulsions.
OCD, guilt, responsibility and certainty
Also, what is prevalent with individuals presenting with obsessive-compulsive disorder (OCD) is the sense of guilt and, related to that, the sense of responsibility and the need for certainty. This can be evident to such extent that a person will feel responsible for things that are completely and often times knowingly out of their hands and clearly not their responsibility or fault. In order to minimise the potential for things to go wrong—to gain perceived certainty—and hence to minimise the chance for them to feel guilty, the person will try to control the environment from a very omnipotent point of view.
Because of the lack of relationship in their childhood, people presenting with obsessive-compulsive disorder (OCD) will develop a relationship with their own compulsions—and they are the ones that take over the role of soothing the anxiety. They will also stick animate characteristics to inanimate objects—usually this will create a substitute for authentic relationship.
Transactional analysis (TA) psychotherapy is a potent way to deal with obsessive-compulsive disorder, because it will deal with all aspects of the underlying cause of the disorder—ranging predominantly from intrapsychic causes, which are in fact causing the disorder, but also the cognitive behavioural element of the disorder.