Counselling and Personal Development Service

Obsessive – Compulsive Behaviours

Classification:

Obsessions are recurrent and persistent ideas, thoughts, impulses or images that are experienced, at least initially, as intrusive and senseless.

Compulsions are repetitive, purposeful and intentional behaviours that are performed in response to an obsession, or according to certain rules or in a stereotyped fashion. The behaviour is designed to neutralise or to prevent discomfort or some dreaded event of situation. The activity, however, is not connected in a realistic way to what it is geared to prevent or neutralise nor it is clearly excessive.

Both the obsessions and the compulsions can cause marked distress and can be time consuming. They can interfere with the person's normal routine, occupation, relationships and general social activity.

Demographic Aspects

Obsessive-compulsive Disorder (OCD) affects 1 to 2 people in 100. Like most anxiety disorders and minor depressions, OCD usually starts in adolescence and young adult life. More males experience OCD at a younger age that females, but there does not seem to be any differences in gender.

The Most Common Types of OCD

•  Obsessions of contamination / Hand washing

Washers and cleaners are consumed with obsessions about contamination by certain objects or situations e.g. germs, disease and chemicals. To eliminate contamination they create rituals e.g. washing hands repeatedly and excessively, or cleaning their houses for hours and hours.

•  Pathological doubt (obsession) / Checking compulsion

They check excessively in order to prevent a certain “catastrophe” from occurring. Common concerns are checking electrical appliances to prevent fire and checking doors and windows to prevent burglary.

•  Repetitive thought / Counting compulsions

Thinkers and counters usually enlist repetitive thoughts or images, called thinking compulsions in order to counteract their anxiety provoking thoughts or images – the obsessions. They will try to recall events in detail or repeat a mental list as a way to ensure safety.

•  Obsessional need for Precision

Orderers require that things around them be arranged in certain rigid ways, including symmetrical patterns, often becoming upset if someone else rearranges their possessions. Usually they do not fear impending doom but rather feel compelled to engage in the ritualistic action when things are not presented “perfectly”.

•  Worriers and Pure Obsessionals

These experience repetitious negative thoughts that are uncontrollable and quite upsetting. However unlike those with any of the above forms of OCD, they do not engage in repetitious behaviours such as hand washing or checking locked doors, not to they have compulsions such as praying or counting.

•  Hoarders

Collect trivial objects and find it impossible to rid themselves of these possessions. A hoarder might walk the street collecting bits of paper and store them at home in case they may need them in the future.

Characteristics of OCD

•  Persistent distress that accompanies an obsession often reflects a fear of harm for that person.

•  Most worriers and people affected by this disorder would agree their obsessions are senseless.

•  Compulsive rituals provide temporary relief from the distress being experienced. This relief provided by the compulsive behaviours motivate use of the rituals again and again, but they never provide a lasting solution.

•  The rituals usually involve specific sequences or patterns. To end the distress of obsessions, the compulsions must be performed in a certain ritualistic manner e.g. washing each finger separately a specific number of times.

•  Some enlist the help of others in their rituals e.g. washers may ask their families to wash excessively as well.

Causes of OCD

There are several ideas about the causes of obsessive-compulsive behaviour. One idea is that it is a ‘learned' behaviour, in which the person comes to recognise that performance of rituals is accompanied by relief from their obsessional thoughts and this reinforces the ritual.

Another idea suggests a biological basis. This indicates that abnormalities in certain neurotransmitters may be involved. Neurotransmitters, particularly serotonin, regulates, among other things, mood, aggression and impulsivity. Altered levels of serotonin are thought to be an important factor in people with OCD.

No research has proven that OCD runs in families, i.e. that it is hereditary. However, it has been found that relatives of OC's are more likely than the average person to have other anxiety related problems.

There is also a strong link between OCD and depression. It is believed that two thirds of people with OCD will experience depression at some point in their lives.

A people's psychological make up can also influence the onset and persistence of this behaviours disorder. Low self-esteem can also play a role. If a person's self-esteem is low, s/he is more likely to become devastated by their own mistakes and therefore put more pressure on themselves to get things right. It is this kind of thinking that can lead to obsessional thought.

Treatment of OCD

OCD can be treated through relaxation techniques, counselling or drug treatment, or by a combination of all three. Some sufferers find relaxation exercises and guided imagery cassettes useful in reducing anxiety that causes obsessional thinking. Work on self-esteem may also be of benefit.

Cognitive behavioural therapy that uses specific techniques to help people get rid of their unwanted images, thoughts and beliefs as well as alleviating their compulsions is a common approach used with OCD sufferers. Within this therapy, individuals learn to identify their specific distressing thoughts and learn how to replace them with more supportive ones.

Various types of drug treatment have proven helpful in treating and alleviating symptoms of OCD.

Further Reading

Dumont , R. (1996). The Sky is falling: understanding and coping with phobias, panic and obsessive-compulsive disorders. New York : W.W Norton & Company. Highly Recommended.

Foa, E.B., & Wilson , R. (1991). Stop Obsessing. New York : Bantam Books.

Rapoprt, J.L., (1989). The boy who couldn't stop washing. New York : Dutton.

Complied and edited by Catherine Bolger (TCD Counselling Service) and Vicky Panoutsakopoulou (DCU Counselling Service).