A person with obsessive compulsive disorder (OCD) suffers from persistent unwanted thoughts that cause extremely high levels of anxiety and stress. The sufferer feels compelled to perform compulsions, either physically or mentally, in an attempt to drive away the obsessions and lessen the fear.

OCD is very different from typical worrisome thoughts or anxiety. The obsessions, which are sometimes morbid or extremely unrealistic, may feel foreign to the person with OCD as if they are not even their own thoughts. The sufferer often realizes to some extent that the thoughts do not make sense, but because they are so chronic and powerful, he or she feels powerless to make them stop. Furthermore, since the obsessions cause overwhelming anxiety, the sufferer may become further “convinced” that they must be true.

OCD manifests in many different forms. Most obsessions revolve around a fearful thought, resulting in the performance of a physical compulsion (checking the stove to make sure it is off) or a mental compulsion (repeating a particular thought to combat the obsession). Some sufferers, however, are enslaved to feeling like things need to be “even” or in order.

Primarily obsessional ocd, or “pure O,” takes place solely in the mind. Rather than having outward compulsions, such as handwashing or doorknob checking, the compulsions are played out in the sufferer’s thought patterns. For example, if a person with OCD has a fearful thought that he doesn’t love his wife enough, he will go through several mental compulsions to assure himself that he does: “I remember having lots of feelings of love on our wedding day.” “I always let her drive the good car, so that must be love,” etc. In response, the anxious OCD brain will counteract these thoughts with “maybe my love has faded. Just because I loved her then doesn’t mean I love her now,” etc. It is a continuous thought cycle that begins to create much suffering and interfere with daily life.

Obsessions may revolve around innumerable fears. Some of the more common ones include the fear of contamination or disease, fear of going to hell or engaging in religious blasphemy, fear of harming oneself or others (either accidentally or intentionally), fear of being gay (or of being straight if the person is gay), fear of damage to one’s body or belongings, fear of embarrassment, fear of not truly caring about a loved one, fear that the world is not real, fear of being stupid or losing mental faculties, fear of developing schizophrenia, fear of having inappropriate or deviant sexual desires and many many more.

The first line of treatment for OCD typically involves exposure and response prevention (ERP), a type of cognitive behavioral therapy (CBT). The sufferer is exposed to his/her greatest fear and taught to tolerate the anxiety until it lessens in strength. Treatment may also involve antidepressant drugs.

Example: Mallory’s fear of hitting someone with her car was becoming unbearable and time consuming. Every evening after work she became convinced that she had bumped into someone and left them to die on the street. She would turn around and retrace her path, making sure she hadn’t killed anyone. When it became so bad that she stopped driving, her husband talked her into seeking ERP therapy.