Compulsive behaviours are excessive and repetitive behaviours that are carried out without reward or pleasure. Most often the person will engage in the compulsive behaviour in an attempt to reduce stress or anxiety, or to gain control over a situation. Frequently the degree of the behaviour or it’s excessive nature is not connected to the purpose behind the behaviour. In other words, in many cases, the compulsive behaviour cannot logically relieve the stress that causes it.
There are a variety of compulsive behaviours such as shopping, hoarding, gambling, eating, skin picking, hair pulling (trichotillomania) and checking, counting or washing to name but a few. Most compulsive behaviours are associated with obsessive thoughts. The obsessive thoughts result in anxiety, which the person then attempts to relieve through a particular behaviour. Carrying out this behaviour becomes a compulsion – almost as if they have little control over whether or not to carry out the behaviour. The overriding feeling is mostly anxiety and fear of negative consequences if the particular behaviour is not carried out. This is the basic picture of obsessive compulsive disorder (OCD).
What is Obsessive Compulsive Disorder?
Obsessive compulsive disorder (OCD) is an anxiety disorder that is characterised by unwanted intrusive thoughts (obsessions) which result in fear and anxiety. Obsessive thoughts tend to get stuck and play repeatedly in the person’s mind generating ever more anxiety. The thoughts are intrusive in that they appear whenever and wherever in an unpredictable and uncontrollable fashion. The person feels compelled to carry out certain behaviours which they believe will reduce the anxiety or “undo” the “damage” caused by the thoughts. These are known as compulsive behaviours. They are compulsive because the person feels that there is no other option but to continue with the behaviour, they are compelled to do so. Most obsessive thoughts are irrational, as are the compulsive behaviours carried out. In this sense, there is often no evidence for the anxiety felt, or the compulsive behaviour is not logically connected to the obsessive thought.
Talking through the anxieties with one of our trained Brisbane psychologists and having logical steps in place to ease the thinking can be highly beneficial when facing these concerns.
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The different faces of OCD
Obsessive compulsive disorder presents in four major symptom patterns;
This is the most common pattern of OCD presenting with a fear of contamination either by touching something dirty, coming into contact with germs, or contaminating others. The resulting behaviour is compulsive checking and washing. In this sense, the person may repeatedly check body, hands and clothes for signs of dirt or contamination. If using gloves for working (in the case of health care workers) the gloves will be repeatedly and excessively checked for holes and damage. Excessive and repetitive washing may also be an associated compulsive behaviour. In such cases, washing may become so extreme that the skin is damaged by literally washing the skin off. Some people struggling with this disorder may find it difficult to leave home and function socially due to their fear of contamination.
The second most common pattern is an obsession of doubt implying danger of some kind. Examples include doubt about whether the door has been locked properly, the stove turned off, or the toilet flushed. The obsession results in a fear of negative consequences for example, an intruder through an unlocked door, a fire from the stove, shame and disgust from an unflushed toilet. The person is then compelled to check and re-check whether the door is locked, for example. This pattern is normally associated with guilt feelings and belief that they have forgotten or committed something.
The third most common pattern includes instrusive obsessional thoughts without any compulsive behaviours. These obsessions are usually repetitious thoughts of a sexual nature, an aggressive act, or a religious nature. These people are often disgusted by and afraid of their own thoughts and may consult with a priest, or report themselves to the police.
Sometimes, although not often, there is a compulsive behaviour associated with the obsessive thought where the person is compelled to “undo” the thought by carrying out an unrelated behaviour such as counting, tapping, or a configuration of behaviours designed to “undo” the obsessive thought.
The last common pattern is the need for symmetry and precision. Here the person is obsessed with needing things perfectly aligned, or a behaviour carried out perfectly. The compulsive behaviour is normally a general slowness, taking them hours to eat a meal, shave their faces or clean their homes. Often the task is started over as precision and perfection were not attained the first time around.
Other patterns that are less common include religious obsessions, compulsive hoarding, trichotillomania and skin picking.
Diagnosing OCD – when to seek treatment.
A diagnosis of OCD is made if the person presents with either obsessions or compulsions.
Obsessions are defined by all of the following:
- Recurrent and persistent thoughts, impulses, or images that are experienced as intrusive and inappropriate and cause marked anxiety.
- These thoughts, impulses or images are not just excessive worries about real-life problems.
- The person tries to ignore or suppress the thoughts, or tries to neutralise the thoughts with a particular behaviour or action
Compulsions are defined by the following:
- Repetitive behaviours such as hand washing, checking, ordering, as well as mental acts such as praying, counting or repeating words.
- The person feels driven to perform these behaviours in a response to an obsession.
- The repetitive behaviours or mental acts are performed in an attempt to reduce anxiety or to prevent a dreaded event or situation.
Furthermore, if the person recognises that the obsessions and compulsions are excessive or unreasonable and these obsessions and compulsions are causing significant distress and impairment in normal functioning then it is certainly time to seek treatment and professional assistance with one of the experienced professional Brisbane Psychologists at CFHP.
OCD is most generally treated with psychotherapy with Cognitive behaviour therapy is the most useful treatment method. This form of therapy helps teach the person a new way of thinking and, therefore, behaving, as well as teaching more adaptive ways of coping with and managing anxiety and stress. Sometimes medication can be prescribed to assist the person manage the anxiety. In this case, antidepressants and anti-anxiety medications are most commonly prescribed.