What are Obsessions?
Obsessive-Compulsive Disorder (OCD) is a complex disorder that can show up in many different forms. Some of these forms look like other disorders, or just "little quirks." I often joke that OCD needs a new image consultant, because most people who think of OCD have a very specific and narrow view of something that is in fact very different person to person. There are a few things we look for when diagnosing OCD.
First, we look for intrusive, ego-dystonic thoughts. Ego-dystonic means the thought violates your understanding of yourself or reality. For instance, someone might fear harming people they love, and think about that every time they see a weapon. Because these thoughts violate their values, they often start asking themselves what those thoughts could indicate or predict about the future. Will they actually harm their family? Are they secretly a bad person? This is where the "intrusive" part comes in. Believe it or not, most people who have thoughts will experience these nonsensical thoughts that don't mesh with who they are. The OCD experience is different because we put weight on those thoughts and believe that they mean something, when the average person might just say, "oh, that's weird," or forget it entirely, except as an anecdote they might share later.
These thoughts can target just about anything you value. It would probably be impossible to categorize all intrusive thought, as personal and cultural values shift over time. Some examples, though, are:
1. If I don't do/say/think/write something just the right way, will it cause a bad outcome that is unrelated? Example: If I don't flip the light switch until it feels right, someone I love will die.
2. Am I a bad person, or damned, even though I try to live according to my values?
3. Am I secretly attracted to people who I wouldn't normally want to be with?
4. Will my body's automatic functions (such as breathing, or blinking) stop if I don't focus on them?
5. Are certain colors, numbers, or words somehow capable of protecting me or inviting disaster?
6. Is my romantic partner really attracted to me? Am I attracted to them?
7. Did I do something bad and then forget? Example: Wondering if I hit someone with my vehicle, or sent someone something inappropriate.
8. Will I do something uncontrollable that violates my values, like shout a slur in public?
9. Am I hurting people's feelings or minimizing them when I don't mean to?
10. Will I hurt myself or others even though I know I don't want to? This question gets an extra footnote. Like all of the questions, an important diagnostic criteria is that it has to violate your understanding of yourself. If you feel like you want to do this (especially if you have a history of doing so), please call 911 or seek immediate crisis assistance.
Almost everyone will deal with these thoughts throughout their life. Many of these are thoughts that we use to reflect on our past and figure out whether we want to change something we're doing. They can be helpful for our growth. But if that reflection is fueled by fear, and feels highly urgent, it may be driven by OCD, especially if it seems like you can never get an answer, no matter how many hours you spend on it.
The good news is OCD is very treatable, and there is a well-researched, structured way of dealing with it. This is Exposure and Response Prevention (ERP) therapy. It is an intense form of treatment that can be somewhat distressing. However, it is also a collaborative form of treatment. An ERP therapist shouldn't be telling you "do this exposure or else!" Instead, a good ERP therapist will work with you to identify what type of treatment you can tolerate, and help walk you through that. I'll discuss what compulsions are, as well as the broad aspects of ERP treatment in another post. In the meantime, if these symptoms sound like something you've struggled with, I encourage you to speak with a counselor - preferably one trained in ERP.
If you are looking for a Therapist or Counselor in San Antonio, Texas look no further than Sonatus Counseling!