Obsessive-compulsive disorder (OCD)

Definition

The obsessive-compulsive disorder (OCD) is a mental disorder characterized by:

recurrent, persistent thoughts (obsessions), and/or
repetitive behaviors or mental acts (compulsions) that are performed to reduce anxiety or tension.

According to the DSM, OCD is a classification based on symptoms. It therefore describes what someone experiences, but does not explain why.

OCD can vary greatly in severity. For some, it takes up a lot of time and hinders daily functioning; for others, the symptoms are milder and more manageable.

Contextual thinking and OCD

OCD can be understood from a contextual thinking perspective as a form of extreme first-degree thinking:

In the absence of contextual relativization, thoughts remain literal and absolute.
Without the ability to include nuance or alternative explanations, certain beliefs can get stuck.
Compulsive behavior is then an attempt to restore control and predictability.

Examples

Fear of contamination → endless hand washing (fear of contamination).
Fear of making a mistake → checking again and again (e.g. gas stove or door).
Persistent belief that the partner is cheating → always checking or seeking confirmation.
Hypochondria: being convinced that you have a disease, every signal is seen as confirmation; doctors to quacks to 'keep it under control'.

Obsessions vs. compulsions

Obsessions' are persistent thoughts, images or impulses that evoke fear or tension.
Compulsions' are the behaviors or mental actions that someone performs to neutralize or reduce the fear of the obsessions.
But: by performing these compulsions, the obsessions are actually maintained or confirmed. This creates a vicious circle in which the obsessive thoughts keep coming back stronger.

Distribution

OCD is estimated to affect 1 to 2% of the population worldwide.
The disorder often occurs together with other conditions, such as depression, anxiety disorders and autism.
The first symptoms usually appear in adolescence or early adulthood.

Coping strategies

Applying structure and predictability.
Active activities that interrupt worrying.
Cognitive behavioral therapy (CBT), often in the form of exposure and response prevention (ERP).
Medication: SSRIs, sometimes antipsychotics in severe forms.
Contextualizing learning: helping to put thoughts into perspective.