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OCD treatment: The obsessive-compulsive condition

OCD is an abbreviation of the term Obsessive-Compulsive Disorder. OCD is regarded as an anxiety disorder in ICD-10 and occurs in about 1.6% of the population.

What are obsessions?

Obsessions are unwanted and recurring thoughts that disturb the ordinary thought process. The actual content of these thoughts is often unpleasant or disaster-oriented and can be very difficult to brush off or ignore. But a clear resistance against these thoughts will always be present.

What are compulsions?

Compulsions and rituals are repeated actions, the purpose of which is to force the obsessions, or an inner unrest, to go away. Compulsions are in no way connected with desire or enjoyment and often seem exaggerated or irritatingly time-consuming.

Even so, the compulsions must be performed until an inner peace or ”the good feeling” is achieved. Compulsions can be overt actions or hidden mental (intellectual) actions; the latter might consist of “magic verses” which must be recited inwardly in order to make the obsessions go away (be neutralized).

The overt compulsions may have the purpose of preventing or hindering the obsessions from happening in real life. If there is a fear that the stove has not been turned off “correctly”, the compulsion could be to repeatedly check the stove before it is possible to leave the home. Many people who have checking rituals for the main door, the stove, electrical installations, water faucets, windows, heaters, etc. will end up arriving late for appointments because they “got stuck” in time-consuming checking rituals.

Basic symptoms of OCD

OCD is an illness with many types of obsessions and compulsions, so the pathological picture will also vary a great deal from person to person. However, there are many common elements which may be categorized as follows:

A lack of acceptance of uncertainty. That is to say, there is an inescapable need to be 100% sure that no harm will come to one’s self or to others.
Perfectionism, which can show itself in many ways. Some want to be 100% correct in their behavior towards other people, while others try to live 100% “optimally”, which may involve a great fear of making the wrong decision or “missing out on something better”.
Pathological doubt. A feeling of great doubt is particularly evident in connection with checking rituals.
Indecision. Difficulty in making decisions, even about the smallest things. This basic symptom can be closely connected to perfectionism and a desire for what is optimal.
An exaggerated sense of responsibility for events/the environment/other persons, when it is clear that these things lie beyond the person’s control or responsibility.
Slowness. Often arrives late.
Avoidance behavior in situations that could bring on obsessions or compulsions.
Misinterpretation of danger signals – which, like avoidance behavior, is seen in all anxiety disorders.

The most frequent types of OCD

Most people with OCD have both obsessions and compulsions. A small group will, however, only experience either obsessions or compulsions.

Below is a list of some of the most frequent types of OCD. The number of items on the list that are present in a given person with OCD is entirely individual.

A fear of harming one’s self or others. It must be stressed that even in cases of so-called “violent” obsessions, a person with OCD will never act on them in real life – even if there is a great fear of doing so.

Some people may fear that even a thought could cause harm – for example, thinking bad thoughts about others or thinking about illness and death. Others may fear that Nemesis will take revenge if they feel too sure that their obsessions can do no harm in real life. In some people this can make them take an extremely humble approach to life, and give them the idea that nothing can be taken for granted.

A fear of dirt, bacteria and chemicals. Fear of contagion is centered on a fear of getting sick from dangerous bacteria or chemicals. In connection with this, there may also be a fear of spreading contagion so that others will fall ill.

Fear of bacteria may be centered on foodstuffs (e.g. meat or eggs), bacteria in the environment or fear of blood, mucous, urine and feces. The latter will often cause extreme discomfort during the use of public toilets.

To avoid contagion, long and elaborate washing rituals (hands, body, surroundings) may be used. A fear of chemicals may be seen in connection with the use of strong cleaning agents or during laboratory work. There may also be a fear of the environmental pollution in the air or in poisonous waste.

A fear of losing things, or that things will break. For example, checking through a purse to make sure that wallet, keys, cell phone, etc. have not been lost or stolen. The fear of breaking something may relate to the more valuable items in the home, such as the television, stereo equipment and computer.

A need to collect things, or difficulty in discarding. The items that are collected may in the eyes of others seem to be without any great value. They might be old school projects, bus tickets, newspapers and magazines, old letters or official notifications.

A strong impulse to count things/thoughts/words. The numbers often take on “magical” significance, and there may be a tendency to act in accordance with lucky or unlucky numbers.

Sexual or religious obsessions. These thoughts can give rise to many speculations about morally correct thoughts and behavior. Religious obsessions can include a fear of thinking blasphemous thoughts, especially while in church. Sexual obsessions can be highly unpleasant, and they are never related to feelings of pleasure.

A strong impulse in favor of repetitive rituals. Apart from checking the stove, front door, electrical installations, water faucets etc. due to a fear of damage, there can also be repetitive behavior for the sake of repetition. A person may thus repeatedly turn lights on and off, turn the volume up and down, or place a glass on a table again and again.

Others will have an impulse to reread or rewrite. Repetitive rituals may be driven by ”magical rules” for preventing or avoiding something unpleasant. Repetitions may also be seen at “crossings”; when moving from the street to the sidewalk, for example, or from room to room, the “crossing movement” may be repeated.

A need for order and symmetry. This symptom is especially prominent in relation to compulsions where items in the home must be arranged in a special way or a certain order. There may be a need to scratch the right arm if the left arm has just been scratched (symmetry), or to sort the clothes in the closet or on the clothesline by color (order). To classify this as OCD, it must be unpleasant to see disorder or asymmetry in the areas where one normally wants to see symmetry and order. Compulsions are driven either by something feeling right or by magical thinking in which something could go wrong if one does not obey the “rules of conduct”.

Somatic obsessions and compulsions. Obsessions relating to the body will in many cases result in anxiety with regard to illness and a checking of the body for tenderness and asymmetry. A doctor will rarely be consulted due to a fear that a serious illness will be discovered.

Treatment of OCD

At Rigshospitalet, I worked together with the Anxiety Clinic’s medical specialists to develop a treatment program for people with OCD. It is based on the cognitive and behavioral therapy treatment method. Most patients here were offered OCD treatment in the form of group therapy. This type of OCD treatment has in follow-up proven to be both effective and long-acting for a great many of our patients. The treatment program at Ulrichsen’s Clinic in Copenhagen will follow many of the same principles and methods used at Rigshospitalet. Most of those who come to Ulrichsen’s Clinic ask for individual psychotherapy, but an OCD group will be established if desired by those who seek help here.

If needed, Ulrichsen’s Clinic can also offer OCD treatment in the form of support for the behavior therapy portion of the treatment. This will be provided by a psychology student who has been trained in the treatment method. You are welcome to call us at 38 28 88 72 or send us a message on pboks.dk to learn more about our OCD treatment.

We gladly accept patients from Copenhagen and all of northern Zealand.

This chapter was written by licensed psychologist Michelle Ulrichsen.