What are OCD obsessions?OCD obsessions are the thoughts that pop into your head that cause anxiety and distress. You don't ask for these thoughts, they are just there. We all experience this as humans but people with OCD respond to them differently. In therapy, we call these intrusive thoughts. They are often in direct conflict with what is important to you as a person. OCD is a bully and like a bully will pick on the things that mean the most to you, making you feel afraid and unsafe. You are probably finding that you are not able to ignore and distract yourself from these thoughts. These lead to feelings of shame, embarrassment and guilt and of course, anxiety and fear. The most well-known obsessions are around the fear of contamination. That could be from germs, illness, asbestos and all sorts of other things. This can lead to behaviours to try to keep yourself and others safe such as excessive handwashing, bleaching everything, changing your clothes often, frequent showers or other forms of cleaning (see compulsions). Whilst the above is the most well known, in reality obsessions can be about so many different things. Other examples are fear of causing harm in some way to others, fears around leaving appliances on, plugs switched on and causing floods or fires often leading to relentless checking (another compulsion). Other obsessions can be around violence, death of others, blasphemy and unwanted sexual thoughts. Children often find it difficult to say what their fears are around them or are too scared to say them out loud in case they come true (we call this ‘magical thinking’ in therapy). If you child start unusual behaviours such as, only being able to settle to sleep if they have said good nite to you in a specific way, check things, touch things or have routines they get really upset about if they are interrupted, do consider OCD (this can be due to other things, of course). Children may hide these behaviours at school for fear of bullying and/or ridicule.

What are OCD Compulsions? Compulsions are the behaviours that result from obsessions (thoughts) and the fear and anxiety they provoke. Compulsions, sometimes called rituals, are an attempt to get from that unsafe, anxious place to a feeling of safety. Clients will tell me that they cannot resist, checking, excessive cleaning, excessive handwashing, endlessly seeking reassurance from others that things are ok and safe and that their fears are not going to come true, saying prayers, having special numbers, counting and touching things in certain patterns or number of times or until it feels right and many many others. You may experience having to have things in certain places, doing things in certain orders, doing some things repeatedly or until it feels just right. These are just some examples, there are many more. You may experience one, some or all of these, or something totally different. I didn’t want to put a 12 page list here! All OCD clients know that these behaviours make no sense but feel powerless to resist in an attempt to keep others or themselves safe and reduce that feeling of fear and anxiety. None of us like feeling anxious, and OCD whispers in your ear, hey I am your friend, do this thing and you will feel better. Temporarily it may feel better and so you think, ahhhhh, and repeat. Sometimes compulsions are not physical but can be more in the mind. We call these ruminations or mental obsessions. An example of a mental obsession might be saying a particular word 4 times or until it feels just right, in response to an obsession to make the thought (obsession) safe. Everyone’s OCD is unique to them, so you may experience some of the above or something different, the content may be different, but the result is the same.

We don’t really know! I would go so far as to say that if anyone tells you they know, they are lying! There are many theories and ideas, but we don't actually know! It can often start, even on just a small scale, from 9 years up. If you are a parent, you may notice your child start doing odd things that they get upset about if they are interrupted or are stopped. If you are on reflecting on yourself as a child, can you remember those things you did to better about things. A common story I hear is a child having a thought “what if my parents die”. A lot of children have that thought, but children that go on to develop OCD will tell me (as adults or children) that they feared it would happen because they thought it. They then think if they say good nite to their parents in a certain way, it won’t happen, or they may turn light switches on and off or tap things a certain number of times. The permutations of this are infinite. In therapy we call this ‘magical thinking’. Meaning, that if we think a thought, it will come true. Unfortunately, we cannot win the lottery by thinking about winning it, believe me, I have tried! Magical thinking is fear based, not evidence based. In OCD you will be doing compulsions to temporarily reduce your anxiety along with probably avoiding certain things. This has given you an “evidence base” that it appears to help, even though you know it doesn’t. But as it does work on some level, you have bought into it and now find it impossible to stop as the anxiety of not doing what OCD says is too much to cope with. People with OCD often believe that they can influence and prevent bad things happening, we call that an ‘overinflated sense of responsibility’. There is often a sense of having “magical” powers, in that, thoughts can come true and then trying to avoid that happening by doing what OCD may tell you. You will be seeking certainty in an uncertain world, as the anxiety of not knowing what may happen next is too much to cope with. People with OCD often experience being called a “control freak”. But it is not about that, it is just about trying to feel safe and keep others safe. It is a result of fear. There is also the possibility that families may have a genetic predisposition to anxiety or children learn OCD, unintentionally, as the way to manage anxiety from other family members. Stressors in life can also start OCD off. Once OCD has begun, the brain struggles to regulate. The good news is, I have helped many many people with OCD learn to manage it so that it does not interfere with their lives anymore. This is not to say you will never feel anxious again (beware of people telling you they can help you achieve this) as anxiety is needed at times and is a natural human state. But you can learn to manage and regulate your anxiety so you can live your life in the way you want to, not the way OCD tells you too.