David Lechnyr, LCSW
We’ve all heard people describing themselves as being a little bit obsessive-compulsive, or OCD. However, this becomes a bona fide disorder when it compels us to think or act in ways which drastically interfere with our lives.
Obsessions are recurrent and persistent thoughts, urges, or images. They are often experienced as intrusive and unwanted, and cause anxiety or distress. We try to ignore or suppress these thoughts or images with little success.
Compulsions are repetitive rituals that are either external (easily noticed by others) or internal (mental thoughts). These rituals are often stereotypical, such as counting, excessive hand washing, and so on. Most often, compulsions are triggered by obsessions. We feel driven to do these rituals until we feel that the ritual is complete, such as having a feeling of certainty, a sense of completeness or things being “just right”, a reduction of anxiety, or feeling safe and secure.
In Cognitive-Behavioral Therapy (CBT), therapists view the development and maintenance of OCD as consisting of six cognitive, or mental, traits:
- Inflated Responsibility
- Over-Importance of Thoughts
- Overestimated Threat
- Need for Control over Thoughts
- Intolerance of Uncertainty
1. Inflated Responsibility
We mistakenly believe that we have the power to cause or prevent something disastrous from actually happening. For example, if you are concerned about germs and use excessive hand-washing, you might be concerned that if you don’t do this, you might make yourself or others sick.
2. Over-Importance of Thoughts
The mistaken belief that just having a thought means that the thought is likely to actually happen. When we have an intrusive thought, we feel the odds of the thought coming true is more likely than at other times. The reality is that having a thought does not increase the likelihood that something bad will happen. For example, if you have an intrusive thought that you might jump out of a second-story window, you might actually fear that this could happen. You then go out of your way to avoid being above the first floor or near any windows. You have mistakenly assumed that having this intrusive thought means that it’s likely to happen. Having the thought then becomes equivalent to the consequence we fear. The erroneous logic works like this: “Since I thought about driving off the road into traffic, I’m more likely to do it.”
3. Overestimation of Threat
We overestimate how likely it is that our thought will happen, or overestimate how much harm or consequence will befall us as a result. For example, when leaving the house, we might have the thought, “What if I really didn’t lock the front door? If so, then someone might break in and steal everything.” Or the fear of leaving a kitchen appliance plugged in might trigger the thought, “the house might burn down.”
4. Need for Control over Thoughts
We place excessive value on having complete control over our own intrusive thoughts, images, and impulses. We not only believe this is a good thing, but that it is actually possible. For example, a religious person might have intrusive thoughts that they consider to be immoral. They might fear that it shows that they are a bad or cursed person and that they are certainly going to hell. So they want to control their thoughts, because after all, “it must be possible to control my thoughts. After all, everyone else doesn’t have this problem.”
5. Intolerance of Uncertainty
Those struggling with OCD tend to believe that they must be certain in all things and have difficulty coping with uncertainty. For example, you might have the intrusive thought that you ran over someone when you turned the car and hit a bump on the side of the road. You mistakenly believe that you must find out if you actually ran over someone, so you drive up and down the road several times to make certain. You might call the local hospitals to see if there was a report of a hit and run.
This is the belief that there’s a perfect solution to every problem. That doing something perfectly is not only possible, but necessary. The interpretation that even small mistakes can have serious consequences. For example, having a fear of making a mistake at work might translate into reading and re-reading your emails before sending them off to your co-workers, in an attempt to eliminate any possibility of the slightest error.