Although there is great variation in how OCD is manifested, it is helpful to first understand the common ground of these manifestations: compulsions and obsessions. Obsessions are “persistent impulses, ideas and images that intrude into a person’s thinking and cause excessive worry and anxiety.” Compulsions are “mental acts or repetitive behaviors performed in response to the obsessions to relieve or to prevent worry and anxiety.” In other words, obsessions are thoughts that interfere with one’s ability to focus on what he or she wants to focus on, whereas compulsions are behaviors or thought patterns that are used as a way to decrease the discomfort caused by intrusive thoughts. Altogether, Obsessive-Compulsive Disorder “is characterized by obsessions and or compulsions that are time-consuming, distressing, and interfere with normal functioning.”
The following is a list of common types of belief patterns or compulsions:
- Checkers experience an excessive, irrational sense of being held responsible for catastrophes that may befall others as a result of the checkers “imperfect” actions. They feel compelled to repeatedly check objects such as doors, locks, etc., in order to avert potential disasters.
- Washers and cleaners have obsessions about the possibility of dirt, germs, viruses, or foreign objects. They experience the constant dread that harm will befall them or others.
- Orderers feel they must arrange certain items in a particular, exact, or “perfect” way. They become extremely distressed if things are moved, touched, or rearranged.
- Pure obsessionals experience unwanted, intrusive, sometimes horrific thoughts and images of causing danger or harm to others. Instead of behavioral rituals, many engage in repetitive thoughts such as counting, praying, or repeating certain words to counteract their anxious thoughts. They also may mentally review situations obsessively to ward off doubt and relieve anxiety.
- Hoarders collect insignificant items and have difficulty throwing things away things that most people would regard as junk.
- People with scrupulosity obsess about religion and moral issues. Their compulsions may involve prayer and seeking reassurance from others regarding their moral purity
The above list describes behaviors or thought pattern categories that individuals engage in to decrease their level of anxiety. The following list identifies common Cognitive Distortions which are irrational thoughts that can influence our emotions and/or behaviors. These cognitive distortions are usually the precursors to developing obsessions and/or compulsions.
1- All-or-nothing thinking
Example: I know I can’t get an A on the test, so why should I bother studying at all?
2- Magical thinking
Example: I thought about my grandma dying, now if anything happens to her it’s my fault.
3- Overestimating risk or danger
Example: If I let my 10-year-old cross the street by himself, he will get hit by a car, therefore, I must always go with him.
Example: I received a raise and promotion at work, but was only rated “good” and not “excellent,” so I let everyone down.
Example: I noticed that a clerk did not charge me for a pack of gum when I got home-I can’t manage how I feel knowing that I stole something.
6- Overresponsibility for others
Example: My husband had a hard day at work so it’s up to me to make him happy tonight by doing all his chores.
7- Thought-action fusion
Example: Oh no! I thought about tripping that stranger and now it’s going to happen just because I thought it.
Example: Anytime I attend a social event, I just know that others are rejecting me. Nobody ever approaches me.
9- The Exclusivity Error
Example: I know thousands of people fly on planes, but if one crashes, it will be the one with me on it.
10- The martyr complex or sacrificial lamb—
Example: How noble and wonderful I am to sacrifice my needs to performing these rituals (in order to protect others).
11- “What if” thinking
Example: What if I get contaminated by touching that door knob.
12- Intolerance of uncertainty
Example: Unless I’m 100 % sure that I won’t feel anxious, I’m not going out to the restaurant.