Obsessions are thoughts, images, or ideas that won't go away, are unwanted and cause extreme distress.
Everyone has strange, unusual or even disturbing thoughts pop up from time to time. Most people continue about their daily routine without giving these experiences a second thought, but if you have obsessive compulsive disorder (OCD), these kinds of occurrences can become both distressing and debilitating.
What are Obsessions?
There are many different types of obsessions, including:
- worrying constantly about catching a deadly disease and/or that you will contaminate others with your germs
- fears about contamination with environmental toxins such as lead or radioactivity
- an intense fear that something horrible will happen to a loved one
- profound worry that you will do something extremely embarrassing, like screaming out an obscenity at a funeral
- believing you may hit someone with your car or injure someone unknowingly
- aggressive or disturbing ideas, such as thoughts of murdering your partner or child
- disturbing sexual and/or religious imagery that might include sexual assault or inappropriate sexual acts
- a strong need to re-order things until they feel "just right"
- a fear of harming inanimate objects
Obsessions are not simply worries about your everyday problems; they often feel impossible to control -- even if you can recognize their irrationality. Often, the obsessions are so debilitating that you have difficulty keeping up at work or maintaining personal relationships. Obsessions can be so distressing that they cause you to try to get rid of them with other thoughts or actions, like compulsions.
Compulsions are behaviors that have to be done over and over again to relieve anxiety. Compulsions are often related to obsessions. For example, if you are obsessed with being contaminated, you may feel compelled to wash your hands repeatedly. Common compulsions include cleaning, counting, checking, requesting or demanding reassurance and ensuring order and symmetry. As with obsessions, people with OCD usually (but not always) have insight into the irrationality of their compulsions.
Obsessions and Thought Suppression
Given that distressing thoughts called obsessions are at the core of OCD, it has been suggested that thought suppression may play a role in causing some of the symptoms of OCD. People with OCD may overreact to dangerous thoughts by trying to suppress them, which only causes them to come back worse than before. Of course, this leads to more thought suppression, which leads to more distressing thoughts.
For example, as part of a research study, people with OCD were asked to suppress their distressing thoughts some days while allowing themselves to have these thoughts on other days. At the end of each day, they were asked to record the number of intrusive thoughts they experienced in a diary. Not surprisingly, people with OCD recorded twice as many intrusive thoughts on the days they tried to suppress their thoughts than the days when they let their thoughts flow freely.
Obsessions and OCD Spectrum Disorders
There are a number of other disorders that while not technically meeting the DSM diagnostic criteria for OCD, have very similar symptoms and fall within the so-called OCD spectrum. This spectrum captures different clusters of symptoms that are reminiscent of, but not exactly the same as, those of OCD. Often (but not always) the only difference between OCD and a given OCD spectrum disorder is the specific focus of the obsessions and/or compulsions.
For example, people with hypochondriasis have obsession-like concerns primarily related to their health. These concerns often have to do with developing a serious medical condition, such as cancer. Hypochondriasis is often mistaken for OCD; however, each illness has a number of unique features, which healthcare providers can use to tell these two disorders apart.
In another example, body dysmorphic disorder is a form of mental illness in which the person has obsessive thoughts about a slight anomaly or imagined defect in their appearance.
Although the obsessions associated with OCD can be debilitating, there are a variety of treatment options that are safe and effective for many people. These include medications, psychotherapies, self-help techniques and in extreme cases, surgical procedures.
American Psychiatric Association. "Diagnostic and Statistical Manual of Mental Disorders, 4th ed., text revision" 2000 Washington, DC: Author.