In OCD, individuals have obsessions which are distressing, persistent, repetitive intrusive thoughts and related compulsions or “rituals”, which are performed with the attempt to alleviate the anxiety brought on by the obsessions. Common obsessions include fears of becoming ill; fears of poisons or bodily fluids; fear of harming or hurting others, excessive doubt, fears of being immoral or not being religious enough, and fears of doing something embarrassing such as shouting obscenities.
Common compulsions or rituals include excessive and ritualistic washing or cleaning; repeated checking, such as checking the door over and over to make sure it is locked; repeating actions a set number of times; hoarding and difficulty in discarding unnecessary items; and putting objects in a set pattern or order, such as making sure everything in a room is symmetrical. While engaging in compulsion or a ritual often reduces discomfort, the relief is temporary. People with OCD often avoid situations or events that are likely to bring on obsessions (e.g., avoiding keeping knives in the kitchen for fear they will act aggressively, avoiding public bathrooms for fear of contracting a disease, etc.)
OCD can cause serious problems. People with OCD can spend hours obsessing or engaging in rituals. OCD symptoms are often kept as secrets so that friends and family members are not always aware of the extent of the problem.
In CBT patients learn that they can control and tolerate their anxiety without performing the rituals. Patients learn coping strategies like relaxation exercises that help reduce their anxiety, while gradually eliminating ritualistic behaviors. With exposure to the feared object or concept, patients habituate to the anxiety-producing situation and realize that the anxiety level drops considerably. In other words, facing the fears rather than avoiding them will diminish their impact. While OCD is considered a chronic condition, studies have shown that over 80% of patients who completed CBT for OCD showed significant progress. Furthermore, most clients were able to sustain their gains long after treatment had ended.