Explainer Link Copied 09.15.22

The Difference Between Obsessions and Compulsions

Plus, how to know if what you're experiencing falls into either category. ByKavin Senapathy

You’ve probably heard these terms before, but do you know what counts as an obsession vs. a compulsion? No worries, we’ll explain. We often associate being “obsessed” with things or people we love—like your favorite band, tacos, soccer, or knitting. And you might talk about being compelled  to act whenever you feel super strongly about something. But the obsessions and compulsions that plague people in the grips of OCD are anything but enjoyable. As someone diagnosed with OCD, or obsessive-compulsive disorder, I know firsthand that the condition can be dreadful without appropriate treatment. 

First, a quick primer on OCD for the unfamiliar: OCD is a chronic mental health condition that centers around uncontrollable thoughts (obsessions) and repetitive behaviors (compulsions) that someone feels like they have  to do in response to those intrusive thoughts. (You can read more about OCD here.) 

When most people think about what OCD “looks like” they’re probably thinking about the compulsive behaviors rather than the intrusive obsession behind it, says Jenny Yip, PsyD, a clinical psychologist who specializes in the condition and lives with it herself. Because you can only see  half the story of OCD, onlookers might wrongly assume it’s “not a big deal” and that people with the condition can simply “get control” over it, she says. But while compulsions are the tip of the OCD iceberg, visible on the outside, obsessions are the immense glacial mass concealed inside the mind. 

Here, we’ll take a closer look at these two main facets of OCD (obsession vs. compulsion) so you can better understand this complicated condition. 

Obsessions are intrusive thoughts that attack what you care about. 

Unlike being ~so obsessed with soccer~ obsessions in OCD include disturbing thoughts, images, and fears. The content of obsessive thoughts can vary widely, but they’re generally ego-dystonic, meaning they run totally counter to your actual values and sense of self, says OCD therapist Erin Nghe, LCSW. That’s part of what makes them so distressing. For example, you might have intrusive thoughts that involve harming other people or taboo topics around sex or morality. 

I had a slew of different obsessions during the worst of my OCD, but nearly all of them focused on harm coming to my family. One frequent obsession was the vivid image of leaving home with my baby and returning at the end of the day to find an intruder hiding inside, ready to jump out and hurt us. It’s worth noting here that everyone has nonsensical, sometimes unpleasant intrusive thoughts—not just people with OCD. The passing image of a home invasion—or contamination by sickening pathogens, violence, or any other unpleasant thought—might pop into anyone’s head on occasion. With OCD, these thoughts are persistent and, instead of passing through, they get stuck in the front of someone’s mind and feel impossible to ignore, kind of like a persistent “bully” making demands, explains Katia Moritz, PhD, a licensed psychologist who specializes in treating this condition. 

Once stuck, the scary, abhorrent, or disgusting thoughts, sensations, or images elicit extreme anxiety. As that extreme anxiety mounts, the urge to do something to release it builds. And that brings us to compulsions. 

Compulsions are actions that offer temporary relief from the obsession.  

An OCD compulsion is basically what someone with the disorder does in response to the obsession to temporarily relieve the anguish. For instance, one very young patient, around 4 years old, told Dr. Moritz that “his bones were telling him to do the compulsions” even though they didn’t make sense to him, she recalls. Compulsions are not an enactment of the obsessive thought itself but more like a “safety behavior,” Nghe explains. That sense of safety and false certainty that compulsions provide is short-lived, and before long, the terrible cycle repeats: the sticky and unwanted thought, the urge to do something, giving in and performing the compulsion, feeling temporary relief, the obsessive thought returning, and so on.

Like obsessions, what compulsions look like varies widely, from repetitive hand washing, to tapping and counting, to avoiding situations, to mentally counting to a specific number while blinking fast. Unlike obsessions that all happen in the mind, compulsions can be noticeable to others. In fact, people might even accommodate someone’s OCD compulsions without meaning to. For instance, the parent of a kid with OCD around contamination might purchase hand soap in bulk or help with excessive sanitizing of surfaces. While it might seem supportive and caring to participate in these rituals—after all, who doesn’t want someone they love to feel better when they’re upset—accommodating someone’s OCD can ultimately make it worse.

During the peak of my OCD, as I left my condo for the day, walking down two flights of stairs lugging my baby, diaper bag, and other essentials, my OCD would whisper, What if you forgot to lock your apartment door? As we approached the car to head out, the obsession would get louder. Picture the intruder lurking and pouncing when the two of you get home. He’ll take her and it will be your fault. Go back. Go now. 

The urge to go back and check the lock felt irresistible, so I would give in and do the compulsion my OCD demanded. I’d lug my baby and armsful of stuff back up two flights of stairs, set her car seat down, and begin to check the lock, not just once, and not just with my eyes. I jiggled the doorknob, tapping carefully five times to make sure it didn’t open. I then unlocked and relocked the door, repeating each step until my OCD was temporarily satisfied. This happened several times per week and, often, I would do my rigorous ritual and head back down the stairs only to go through the entire ordeal again. 

Like others with OCD, part of me knew that the whole thing was irrational. But having OCD makes it basically impossible to tolerate uncertainty. Nobody can be 100% sure that an intruder won’t break into their home, but people generally accept the fraction of a percent chance of something bad happening without much thought. In people with OCD, that tiny bit of uncertainty feels massive, and doing the compulsion offers a false sense of temporary certainty.

Therapy and medication can help people manage obsessions and compulsions. 

There is “no cookbook” that can possibly list all of the ingredients and manifestations of OCD nor is there “a one size fits all treatment,” says Dr. Moritz. But while OCD is thought to be a lifelong condition, treatment can dial it way down. The most effective way to tackle it is with daily medication, a kind of psychotherapy called Exposure and Response Prevention (ERP), or a combination of both, according to the International OCD Foundation (IOCDF). Before starting ERP, a therapist specially trained to treat OCD will educate the client about obsessions and compulsions, and work with them to rank these thoughts and behaviors by severity. 

The exposure part of ERP puts someone face-to-face with their obsessions, both in the therapist’s office and as homework to do between sessions. For instance, if someone struggles with thoughts of illness from contamination, structured exposures might include touching raw eggs or walking through the house with dirty shoes.

The response prevention part comes in when the anxiety starts ballooning—successful ERP requires a commitment to not responding to an obsession with a compulsion. So, instead of, say, cleaning the floor three times over while counting mop strokes, someone might sit in the room with a dirty floor or avoid cleaning it for several hours, tolerating the dreadful anxiety.

It’s hard work to face obsessions head-on without doing anything to assuage them, but it’s worth it. Over time, the anxiety associated with obsessions drops, and the thoughts become less sticky. For me, daily medication helped muffle my OCD, and starting ERP a couple of years later dialed it down far enough so that it no longer prevents me from pursuing my best life. Along with other realizations, the structured exposures and response prevention helped me understand, Oh, I can choose to not painstakingly re-check the locks, and my child is fine.   As someone progresses through this process, they can also do what Nghe calls “natural” exposure, which is basically asking yourself how you can “lean into” daily discomforts by taking healthy risks that align with your values and goals, even if they make you uncomfortable. 

Around 70% of people can get relief with traditional outpatient ERP and/or medication, according to the IOCDF. While there are still barriers to treatment, like the cost and availability of ERP, access to evidence-based help is growing steadily. 

The bottom line: If you’re obsessed with ’90s hip-hop or feel a compulsion to remove your makeup before bed even when you can barely keep your eyes open, but it doesn’t come with distressing, life-hindering anxiety, then congratulations—you have great taste in music and your skin thanks you. But if reading this made you realize that you or someone in your life may be dealing with true distressing obsessions paired with tedious compulsions, take a moment to process. As excruciating as the cycle of thoughts and rituals may be, OCD doesn’t need to control someone’s life forever. There are more resources than ever before to connect with others and start breaking free of obsessions and compulsions.

The post The Difference Between Obsessions and Compulsions appeared first on Wondermind.

Explainer Link Copied 09.15.22

Here’s What OCD Actually Is (and Isn’t)

Please stop saying you're "so OCD" about cleaning. ByKavin Senapathy

The bestie whose home looks like Marie Kondo’s dream, the cousin who takes pride in his meticulous grooming, and the coworker whose office is the most organized in the entire building all have one thing in common: Their quirks aren’t  OCD or obsessive-compulsive disorder. This idea that OCD is just “a quirky behavior” isn’t only inaccurate, it’s harmful, says Jenny Yip, PsyD, a clinical psychologist who specializes in the condition and lives with it herself. 

In reality, OCD involves so much more than wanting things to be “just right,” and it can be extremely distressing to live with. I know that distress all too well. I’ve lived with OCD for well over a decade and, while I’ve learned to manage it, my symptoms still flare up from time to time (like this fall when I have to send my oldest off to middle school…yikes). These flare-ups are no fun, but I’m thankful that OCD doesn’t control my life the way it did before treatment. Still, it’s hard to escape the stigma and stereotypes that still surround this condition. 

These stereotypes—like that it’s “so OCD” to want things arranged a certain way or to be super focused on cleanliness—can invalidate people’s experiences and may even make people less likely to get help for their own symptoms, explains Dr. Yip.  So, let’s talk about what OCD actually is, who it affects, and how to get help if you or a loved one is struggling with it. 

One quick thing before we dive into the details: Mental health is complex and everyone has a unique experience, so don’t go diagnosing yourself just because you read a few articles on the internet (though, we do appreciate you stopping by to learn a few things). If this resonates with you, consider it a jumping-off point in your journey to getting care. OK, let’s get into it…

What is OCD? 

OCD is a chronic mental health condition characterized by uncontrollable thoughts (obsessions) and repetitive behaviors (compulsions) that someone feels like they have  to do in response to those intrusive thoughts. All humans “have thoughts that are kind of weird and sometimes they’re scary,” says Erin Nghe, a licensed clinical social worker and OCD therapist. But that doesn’t mean that we’re all a little OCD. In people with the disorder, these thoughts are uncontrollable and get stuck in a person’s head. And while the compulsions offer temporary relief, they fuel a vicious cycle that can be so upsetting and time- and energy-consuming that they interfere with pretty much every aspect of your life. 

I would eventually learn that the scary, disgusting, and unwanted thoughts and images that once overwhelmed me were actually “obsessions,” which I previously thought was just a word we used to describe things we love and can’t get enough of (like favorite foods, sports, a new eyeshadow palette, dismantling the patriarchy, etc.). But, in OCD, obsessions are the opposite of pleasant. They’re persistent, unwelcome, and distressing and can take myriad forms—including thoughts of contamination, causing harm, being responsible for something terrible happening, taboo images, your partner not really being The One (hello, relationship OCD), and more. For instance, an obsession that once incessantly plagued me was the thought of being responsible for my home burning down with my loved ones inside in the middle of the night. So, yeah, not exactly the same as being obsessed with football. 

And then there are the compulsions, which are repetitive behaviors—including tapping, washing or cleaning, checking, counting, seeking excessive reassurance, or mental rituals—that someone feels a strong urge to perform to counter, calm, or shrink the unwanted thoughts. Often, there is an urge to repeat the compulsion in specific ways until it feels “just right.” During the worst of my OCD, obsessions about a house fire would elicit an irresistible urge to not only visually check that certain appliances or light switches were turned off, but to touch the switches to make sure. I couldn’t help but flip switches on, turn them back off, and tap them five times in a row to dampen the visions of my charred baby. Obsessions about fatal diseases and accidents claiming my loved ones compelled me to tap or knock on various items five times over and over again to dampen the upsetting thoughts. It didn’t matter that I’m a rational person. OCD can justify and compartmentalize the utterly absurd.

Anyone can develop OCD. 

With an estimated lifetime prevalence of 1-3% or more of the population, folks of all genders, ethnicities, and backgrounds can develop OCD, which tends to happen during adolescence or early adulthood. Research suggests that, on average, people might be dealing with symptoms up to 17 years before getting help. Those in certain marginalized groups face additional barriers, though more research is needed to tease out how to best serve different communities. 

OCD “is a brain-based” and “neurobiological condition,” says Katia Moritz, PhD, a licensed psychologist who specializes in treating this condition. Researchers are still figuring out how it develops, but they think it boils down in large part to genetic variations that affect certain neural pathways, or what Dr. Moritz calls “a glitch in the brain.” And, to varying degrees, other risk factors for those genetically predisposed to the condition include stressful or traumatic life events (which can influence the content and severity of someone’s symptoms) and environmental factors like observed behaviors, the onset of puberty, pregnancy and birth, and the effects of some infections and immune system disorders on the brain. Usually, these factors converge and lead to the gradual development of symptoms. Less common is a rapid onset of OCD in children following environmental triggers, like a streptococcal infection, that can happen seemingly overnight. 

How is OCD diagnosed? 

While there’s no blood test for OCD, diagnosis mainly comes down to identifying the obsessions and compulsions that take up a significant amount of time and interfere with your life. 

Dr. Yip explains that misconceptions abound, “even within mental health professionals.” Underdiagnosis and misdiagnosis are far too common, in part because OCD manifests in so many different ways. For instance, a study published in 2015 in The Journal of Clinical Psychiatry found that about half of physicians misidentified OCD when reading patient descriptions in an online survey. This can lead to tangible harm—like when a new parent shares thoughts of harming their baby, a physician who doesn’t grasp OCD may unnecessarily involve child protective services. 

Often, people with OCD are diagnosed with generalized anxiety disorder (GAD) instead. Children with OCD are often flagged as having ADHD instead because the conditions look outwardly similar—when a child is “ruminating over some horrific thing happening,” they may be “getting out of chairs” or “tapping” instead of focusing on whatever they’re supposed to be doing, says Dr. Yip. Even trickier, it’s not uncommon for someone with OCD to also have one or more other conditions, including GAD, ADHD, depression, and Autism Spectrum Disorders. To ensure that someone who is possibly experiencing OCD ends up in the right hands, it’s a good idea to use resources like the International OCD Foundation (IOCDF) to find vetted, qualified providers. 

What does treatment for OCD look like? 

While there’s no cure for OCD, that doesn’t mean that the condition has to dominate your life. Both therapy and medication (typically a class of drug called serotonin reuptake inhibitors) can be very effective for managing OCD. When it comes to therapy, a type of cognitive behavioral therapy (CBT) called exposure and response prevention (ERP) is known as the gold standard for OCD. Dr. Yip explains that in the exposure part of ERP, a trained therapist helps someone “purposely confront each of these intrusive obsessions” to train the brain to recognize that “even if it is horrible, I actually can tolerate it” without performing compulsions. In the response prevention half, the therapist helps the patient deal with the distress while doing something other than their compulsive behavior.  For many people, this helps reduce those upsetting thoughts, as well as the power they hold over you. 

Among a slew of other revelations, ERP helped me realize, Wait, I can choose to not check the stove over and over again and my home won’t catch fire. Don’t get me wrong, the first several times I had fire obsessions without doing my compulsions were extremely uncomfortable. It’s not a good feeling to stare a vivid image of your worst fears in the face without flicking them away, which is why starting this with a licensed mental health provider is key. But I’ll always count my lucky stars for the ERP that has empowered me to relegate OCD, which once ruled me, to the margins of my mind. 

Though access to treatment including trained ERP specialists is still sorely lacking, there are more resources and low-cost options now than ever before. And here’s some good news: Around 70% of people who receive traditional outpatient ERP and/or medication can expect to find relief, according to the IOCDF. 

The bottom line: If you have a gratifying obsession with caffeinated seltzer water, lifting weights, or whatever floats your boat, but don’t have incessantly disturbing obsessions, consider yourself fortunate. On the other hand, if reading this made you realize that you or a loved one might have OCD, take a deep breath. As weird or scary or revolting as someone’s thoughts may seem and no matter how irrational the rituals, there are millions and millions of people in a similar boat. While the road is far from easy, and advocates continue pushing for more recognition and resources for all people with OCD, it’s more feasible than ever to connect with others and start taking your life back. 

The post Here’s What OCD Actually Is (and Isn’t) appeared first on Wondermind.