22nd February 2024

Presentation

Obsessions

These are unwanted and intrusive thoughts, ideas, or impulses which sufferers would find disturbing, unsettling and difficult to get rid of despite trying to resist. The patient will often recognise these thoughts as being irrational and as being their own, unlike in other mental health disorders where there may be thought insertion or delusional beliefs. As OCD becomes chronic, the ability to resist these ideas or impulses can decrease or disappear.

There are common themes with these obsessions:  aggression (thoughts of harming others), contamination, infection, and morality (religion /sex)

Whilst having unpleasant thoughts can occasionally be normal, in persons with OCD these thoughts cannot be ignored or resisted. These obsessions make the patient feel unsettled, distressed and worried about what they’ll do if they keep having these thoughts or the danger their thoughts pose to them and their loved ones. 

Compulsions

A compulsion is the action patients feel they need to undertake to decrease or neutralise the obsession or intrusive thought. It is a safety strategy to prevent the frightening consequences caused by their obsession. These compulsions, also known as OCD rituals, are usually repetitive and usually follow a set of rules. The person usually recognises these rituals to be pointless and initially, they try to resist. These compulsions or rituals can be physical or mental tasks the patient needs to do to get rid of the obsessional thought or thoughts.

These compulsions or rituals can be put into 4 main categories:

1. Repeating actions e.g., patients checking locks a certain number of times to protect themselves from an intruder or repeating a word in their head constantly
2. Rituals to decontaminate e.g. excessive cleaning, showering several times a day, repeatedly washing hands.
3. Ordering and arranging e.g. mentally reviewing lists
4. Constant checking and reassurance seeking e.g. patients analysing or reanalysing things they’ve done or said several times in their head until it is perfect

These rituals can often take hours to perform and have a negative impact on the patients’ quality of life as they feel compelled to do these rituals to get rid of the distress caused by the obsessional thoughts. They often recognise these actions to be irrational or completely unrelated to the intrusive thought but feel compelled to carry them out anyway.