What is OCD?

Counting and checking rituals are performed with the hope of preventing obsessive and fearful thoughts or making them go away. Counting can be associated both with the need to avoid danger and the obsession with symmetry and evenness.

Checking rituals often involve an impulse to check items such as door locks, light switches, faucets, and stoves. Checking may also occur mentally, such as by reviewing and analyzing memories to ensure that one did not make a mistake or cause harm. These rituals may be geared to preventing an error that could seriously impact another’s well-being. People with checking compulsions are plagued by feelings of irresponsibility, carelessness, and constant doubt about whether or not they completed the task.

Intrusive thoughts are unwanted thoughts, impulses or "mental images." These thoughts may surround the fear of committing an act a person considers to be harmful (physically or sexually), violent, immoral, or sacrilegious. There is no intent to act on these thoughts (although your OCD may attempt to persuade you that you will/otherwise) and these thoughts bring no pleasure, causing extreme distress.

Examples of intrusive thoughts:

• Intrusive thoughts or mental images of harming/killing loved ones or self
• Repeatedly worrying that one has or will physically assault another person
• Repetitive thoughts that one has said or written something inappropriate
• Mental images or thoughts that one considers sacrilegious or blasphemous

Sexual intrusive thoughts (SIT) consist of unwanted sexual thoughts. This may include fears that one is incorrect about or will experience a change in their sexual orientation. SITs can also contain intrusive, unwanted mental imagery of sexual behaviors or actions that the individual does not desire, the fear of committing a harmful sexual act or being sexually aggressive. This is not the same as having a sexual fantasy or being homophobic.

Examples of sexual intrusive thoughts:

• Recurrent fear of molesting a child despite finding such thoughts repulsive and unwanted
• Recurrent fears that one might be wrong about their sexual orientation (e.g., fears that a straight person might be gay, or fears that a gay person might be straight) when in fact he/she is not

Fear of contamination is one of the more "known/publicized" OCD categories and often surrounds fear of disease and germs. Some people do not have a specific fear but rather are "disgusted" by different things. Contamination OCD can result in the fear of touching items, being around certain people, and being touched by people. Related compulsions include excessive and repeated hand washing, showering, bathing, and house cleaning. Individuals with contamination OCD frequently avoid people, and public places, change clothes, and throw out any items they believe to be contaminated.

Individuals may also experience concerns related to “mental contamination,” or the fear that certain ideas and concepts will become contaminated. Related compulsions often include avoidance and mental rituals designed to protect these thoughts.

Scrupulosity is characterized by obsessions that have religious or moral content. What distinguishes these beliefs from healthy religious/spirituality and morality is that the pattern of beliefs and behaviors are related to excessive distress about having committed a sin or performing immoral acts. Additionally, these patterns usually represent a departure from what is considered normative in one’s religious or spiritual community. Individuals' angst may focus on thoughts or actions already taken (such as offending a religious deity or committing a moral offense against another person) or the possibility of committing improper acts in the future.

Individuals with perfectionism or "just right" OCD often experience an overpowering internal sense that the balance, order, place, frequency or position of something is disturbed and must be corrected. It can be the spoken or written word, touch, feel, sound or smell of something that is not "just right." The individual with "just right" OCD often performs endless repetitions of ordinary tasks out of frustration that they are not "perfect" or "just right." Touching and tapping, symmetry, ordering and arranging, perfectionism and counting can all be part of the rituals related to "just right" OCD.

Magical thinking is an illogical thought pattern characterized by the linking of unrelated actions or events. Individuals may become preoccupied with lucky or unlucky numbers, colors, words, actions, sayings or superstitions and link them to catastrophe or "bad things" that might happen. The individual with "magical thinking" OCD truly believes and lives by these rules and consequences, often with the belief that the mere act of thinking results in the occurrence of a feared event.

It is important to note that avoidance can be just as detrimental as rituals when it comes to giving the OCD power and contributing to the OCD cycle. Although there may be many places and situations, which you avoid due to your OCD, with proper treatment you can engage, return to and resume activities (thoughts, people, places or things) you have previously been avoiding. When engaging in cognitive-behavioral therapy with exposure and response prevention it is important that you work to eliminate avoidance behaviors (both avoidance of exposure situations as well as avoidance of touching/cross-contaminating certain things) in order to make optimal progress in your treatment.

About five to six percent of first-time mothers experience obsessive-compulsive symptoms following childbirth. Those that have OCD may have a worsening of symptoms. Individuals with postpartum OCD are often overcome by unwanted intrusive thoughts focusing on their baby. These intrusive thoughts include fear of harming their baby or causing some type of harm to come to the baby. These thoughts cause significant distress and rituals surrounding these intrusive thoughts may include checking behaviors (checking that the baby is okay) and reassurance seeking (seeking reassurance that the baby is okay and no harm was done to the baby).