Far more common than previously thought, obsessive-compulsive disorder (OCD) now receives widespread attention from the general public. Reports in the media are frequent, but not always correct. The terms “obsession” and “compulsion” are sometimes incorrectly applied to various psychological difficulties, such as gambling or overeating, which are in fact quite different from OCD. Since the treatment methods used for OCD are not necessarily useful for other types of problems, it is important to understand exactly what OCD is.

What Are Obsessions?

Obsessions are ideas, thoughts, images, or impulses that are senseless and “get in the way.” They continue even though a person may try to ignore or forget about them. They are experienced as unpleasant and unwanted and may provoke anxiety, guilt, shame, or other uncomfortable emotions.

The most common obsessions are concerns that objects or other people might be “contaminated” by contact with germs, disease, dirt, chemicals, or some other source. The feeling of contamination is accompanied by an urge to wash or to clean. Other obsessions focus on fears that doors or windows have been left unlocked, appliances have been left on, important papers have been thrown away, mistakes have been made, and so forth.

Frightening thoughts about burglary, fire, and other losses often accompany these fears, forming part of the obsessive ideas. Some obsessive thoughts concern accidents or unfortunate events that might occur unless one superstitiously repeats particular actions or thoughts to prevent the disaster. Other obsessions take the form of unwanted urges or impulses to do something harmful, such as to stab one’s child with a kitchen knife. Some people experience horrific or upsetting images having to do with religious figures.

Obsessions can take many forms. Ordinary people are concerned by many of the ideas, thoughts, images, or impulses underlying obsessive fears. Most of us are concerned about AIDS and other diseases, and about harmful chemicals in the environment. We are careful not to leave hot appliances near materials that might catch fire. We periodically experience odd impulses or form upsetting images. However, for those with OCD, the fear and guilt or other unpleasant emotions are out of proportion to the actual risk of danger or harm, driving them to carry out compulsions to rid themselves of the worry.

What Are Compulsions?

Compulsions, also called rituals, are usually actions that are repeated, but sometimes are thought patterns that are performed to rid oneself of a disturbing obsession. Rituals are usually carried out according to certain rules or in a rigid fashion and are clearly excessive. The person recognizes that the rituals are not reasonable but feels unable to control them. Most compulsions are logically related to the type of obsessive ideas they attempt to reduce or prevent, although this is not always true. Because they temporarily reduce discomfort, rituals become habitual, and the person with OCD often has difficulty control-ling them.

Examples of compulsions include hand-washing, showering, or cleaning to remove “contamination”; checking to prevent feared dangers such as theft, fire, or loss of important things; repeating actions or thoughts to prevent a catastrophic event from happening; having to arrange objects in a particular way before beginning an activity; or needing repeated reassurance from others that a feared event has not or cannot happen. Some compulsions are performed mentally without any behavioral manifestation.

Examples include praying to relieve guilt about an unwanted idea and repeating phrases or images in one’s mind to prevent a catastrophe.

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