Different Types of Obsessions in OCD: How to Deal with Intrusive Thoughts

Imagine thinking about the germs and bacteria on your hand every time it extends to turn a doorknob, reaches out to greet another, or goes into your mouth to bite nails. Now imagine thinking of these germs and bacteria on your own hands every single waking moment. It can be exhausting! This can be a very harsh reality for those with Obsessive-Compulsive disorder (OCD). Obsessions are recurrent, persistent thoughts, urges, or images that the person finds intrusive and unwanted.  These thoughts, urges, and images are ignored or suppressed. But, these unwanted thoughts are only half of the issue. An individual with OCD will attempt to neutralize these thoughts with other thoughts or actions, referred to as compulsions.

Compulsions are often repetitive behaviors which follow obsessions. The individual feels driven to perform these actions in order to neutralize the obsessions. They feel that the behavior or mental act will prevent or reduce the given anxiety and distress, or prevent a dreaded situation, even though the two are realistically unrelated or excessive. Compulsions may include washing hands, checking things, counting, or repeating words.

These intrusive thoughts and subsequent repetitive behaviors are what make up Obsessive Compulsive disorder. The most common repetitive behaviors include harm, religious obsessions, symmetry, or unwanted sexual thoughts.

Harm/Safety

When an individual is experiencing obsessions concerning harm, it can be a very scary, distressing situation. Obsessions may include hurting another person or controlling the fate of another individual. For example, someone may be extremely cautious and careful to never drop or spill anything on the floor out of an extreme fear that if they do, someone else will slip and die. Another common obsession in this category includes being fearful of doing something to harm themselves or others.

Religion

Religious thoughts may allow an individual to constantly be stuck in a battle between right versus wrong, and thoughts of morality may live in the forefront of their mind. Another common obsession is being concerned with offending or disappointing God. These religious obsessions can cause individuals to engage in compulsions, such as excessively praying or repeating scripture.

Symmetry

Most TV shows and movies that depict characters with OCD are acting out obsessions and compulsions related to symmetry, or exactness. An individual with OCD may be seen as a perfectionist. Counting things for the majority of their day, checking things over and over, and making sure all of their belongings are perfectly organized are all obsessions of symmetry. These individuals will often want things “just right”, but have a difficult time explaining exactly what that entails.

Sexual thoughts

Because sex is deeply laden with moral, emotional, and religious overtones, it can become a major theme for those with OCD. Unwanted sexual thoughts may concern homosexuality, aggression, incest, or fantasy. Even if these thoughts are never acted on, they are extremely persistent and repetitive. As the thoughts are occurring, they may seem real. Of course, those with these thoughts can become obsessed with the idea that they could potentially act on them, even if they do not.

Although these obsessions may seem daunting and endless, there are different types of treatment to help subdue and potentially erase these obsessions and compulsions. Exposure and response prevention may help curtail many of these intrusive, unwanted obsessions. This treatment consists of exposure to the very thing that warrants the anxiety or fear. The prolonged exposure to the obsession will gradually desensitize and help decrease the compulsion to perform behaviors following the obsession, such as washing hands. The goal in this treatment is to increase awareness that anxiety will decrease even if compulsions aren't acted upon.

Obsessions can manifest in many different ways, some of which were not touched on in this article. If you or someone you know is have obsessive or overwhelming thoughts and behaviors, contact me for a complimentary initial consultation at 818.925.0501 or Hadley.Tarantino@gmail.com

Sources:

Booth, B. D., Friedman, S. H., Curry, S., Ward, H., & Stewart, S. E. (2014). Obsessions of child murder: Underrecognized manifestations of obsessive-compulsive disorder. Journal Of The American Academy Of Psychiatry And The Law, 42(1), 66-74.

Gordon, W. M. (2002). Sexual obsessions and OCD. Sexual And Relationship Therapy, 17(4), 343-354. doi:10.1080/1468199021000017191

Radomsky, A. S., Ouimet, A. J., Ashbaugh, A. R., Lavoie, S. L., Parrish, C. L., & O’Connor, K. P. (2006). Psychometric Properties of he French and English Versions of the Vancouver Obsessional-Compulsive Inventory and the Symmetry Ordering and Arranging Questionnaire. Cognitive Behaviour Therapy,35(3), 164-173. doi:10.1080/16506070600827198

Siev, J., Steketee, G., Fama, J. M., & Wilhelm, S. (2011). Cognitive and clinical characteristics of sexual and religious obsessions. Journal Of Cognitive Psychotherapy, 25(3), 167-176. doi:10.1891/0889-8391.25.3.167