This manual is both a guide to treatment and a workbook for persons who suffer
from Obsessive‐Compulsive Disorder. During treatment, it is a workbook in which
individuals can record their own experience of their disorder, together with the
additional advice for their particular case given by their clinician. After treatment
has concluded, this manual will serve as a self‐help resource enabling those who
have recovered, but who encounter further stressors or difficulties, to read the
appropriate section and, by putting the content into action, stay well. 1. The Nature Obsessive-Compulsive Disorder
Obsessive-compulsive disorder (OCD) is an anxiety disorder that, until quite recently, was
regarded as a rare condition. Recent studies have shown that OCD is considerably more common
than previously thought and as many as two in every hundred people may suffer from the
condition.
OCD is characterized by persistent, intrusive, unwanted thoughts that the sufferer is unable to
control. Such thoughts are often very distressing and result in discomfort. Many OCD sufferers
also engage in rituals or compulsions that are persistent needs or urges to perform certain
behaviors in order to reduce their anxiety or discomfort. Often the rituals are associated with an
obsessional thought. For example, washing in order to avoid contamination follows thoughts
about possible contamination. For some, there is no apparent connection between the intrusive
thought and the behavior for example, not stepping on cracks in the sidewalk in order to avoid
harm befalling one’s family. Others still have no compulsive behaviors and suffer from
obsessional thoughts alone, while others do not experience obsessions but have compulsive
rituals alone.
The one common element to the various symptoms in OCD is anxiety or discomfort. For those
suffering both obsessional thoughts and compulsive rituals, it is the anxiety or discomfort
associated with the thought that drives the ritual. In other words, the ritual is performed to reduce
the anxiety produced by the thought. For those suffering from obsessional thoughts alone, anxiety
is often associated with the thought, and mental rituals, distraction, or avoidance may be used to
lessen the discomfort. It is much the same for those with compulsive rituals alone in that the
behavior is performed in order to lessen the urge to ritualize. The role of anxiety is important in
OCD and will be discussed in much greater detail in subsequent sections.
Most OCD sufferers can see the uselessness and absurdity of their actions but still feel compelled
to perform their various rituals. They know that their hands are not dirty or contaminated and they
know that their house will not burn down if they leave the electric kettle switched on at the wall.
Because they are aware of how irrational their behavior is, many sufferers are ashamed of their
actions and go to great lengths to hide their symptoms from family, friends, and, unfortunately,
even their doctors. It is extremely important that your therapist is aware of all of your symptoms
no matter how embarrassing or shameful they may be, as this is the only way that a suitable
treatment program can be designed for you. Rest assured that a therapist experienced in the
treatment of OCD will have heard of symptoms worse than yours many times over.
1.1 Symptoms Obsessive-Compulsive Disorder
Obsessional thoughts are usually concerned with contamination, harm to self or others, disasters,
blasphemy, violence, sex or other distressing topics. Although generally called thoughts they
can quite often be images or scenes that enter the sufferer’s mind and cause distress. For example,
one sufferer may have the thought “My hands are dirty” enter his head. This thought will trigger
washing rituals. Another sufferer will actually have enter his head the scene of his house burning
down. This scene will trigger checking rituals. Individuals who suffer obsessions alone may also
experience thoughts, images, or scenes. For example, someone who has obsessions about harming
his or her children may have the thought of harming them or have a frightening scene of hurting
them or an image of the children already hurt.
As was pointed out earlier, many obsessions produce anxiety or discomfort that is relieved by
performing rituals. The most common rituals are washing and checking, although there are many
others such as counting, arranging, or doing things such as dressing in a rigid, orderly fashion.
Although rituals are performed to alleviate the anxiety or discomfort that is produced by the
obsession, the anxiety relief is usually short-lived. An individual who washes in order to avoid or
overcome contamination will often find him- or herself washing repeatedly, because either they
were uncertain whether they did a thorough enough job or because the obsessional thought that
they are contaminated has recurred. Similarly, someone who checks light switches, stoves, and so
forth in order to avoid the house burning down, often has to repeat the behavior over and over,
because he may not have done it properly or the thought or image of his house being destroyed
has recurred. Even individuals who have obsessional thoughts alone may find that they have to
repeat the cognitive rituals such as counting or praying many times over as they may not have
done them perfectly in the first place.
An important point to keep in mind is that many sufferers have more than one type of symptom
so that individuals may engage in more than one type of ritual or have more than one type of
obsessional thought. Another point to note is that symptoms change over time and someone who
is predominately a washer may, over time, develop checking rituals that eventually supersede the
original complaint. In addition to changes in symptoms, the course of the disorder may also
fluctuate over time, with periods of worsening and periods of improvement. Other sufferers may
find that their symptoms remain static, while yet others may find a gradual worsening of
symptoms since the onset of the disorder.
For many sufferers of OCD, these symptoms take up a great deal of time, often resulting in their
being late for appointments and work and causing considerable disruption and interference with
their lives. Apart from disrupting their own lives, it also frequently interferes with the lives of
family members as the typical sufferer often asks the other members to do things a certain way or
not to engage in certain behaviors, as this may prompt the sufferer to engage in rituals. Thus, the
symptoms are not only controlling, frustrating, and irritating to the patients, but also to their
family, friends, and workmates.
Avoidance of certain situations or objects that may trigger discomfort and rituals is also quite
common among OCD sufferers. It seems logical to avoid contact with contaminants if you are a
person who washes compulsively, or to avoid going out of the house if you must check all the
electrical equipment, the doors, and windows. While this seems like a reasonable way of coping,
it actually adds to the problem, as the typical sufferer avoids more and more situations and
gradually the problem comes to rule their life. Second, avoidance does little to deal with the
problem as it only serves to reinforce the idea that such situations are dangerous. Because the
situation or object is constantly avoided, there is no opportunity for the individual to learn that
there is no danger.
from Obsessive‐Compulsive Disorder. During treatment, it is a workbook in which
individuals can record their own experience of their disorder, together with the
additional advice for their particular case given by their clinician. After treatment
has concluded, this manual will serve as a self‐help resource enabling those who
have recovered, but who encounter further stressors or difficulties, to read the
appropriate section and, by putting the content into action, stay well. 1. The Nature Obsessive-Compulsive Disorder
Obsessive-compulsive disorder (OCD) is an anxiety disorder that, until quite recently, was
regarded as a rare condition. Recent studies have shown that OCD is considerably more common
than previously thought and as many as two in every hundred people may suffer from the
condition.
OCD is characterized by persistent, intrusive, unwanted thoughts that the sufferer is unable to
control. Such thoughts are often very distressing and result in discomfort. Many OCD sufferers
also engage in rituals or compulsions that are persistent needs or urges to perform certain
behaviors in order to reduce their anxiety or discomfort. Often the rituals are associated with an
obsessional thought. For example, washing in order to avoid contamination follows thoughts
about possible contamination. For some, there is no apparent connection between the intrusive
thought and the behavior for example, not stepping on cracks in the sidewalk in order to avoid
harm befalling one’s family. Others still have no compulsive behaviors and suffer from
obsessional thoughts alone, while others do not experience obsessions but have compulsive
rituals alone.
The one common element to the various symptoms in OCD is anxiety or discomfort. For those
suffering both obsessional thoughts and compulsive rituals, it is the anxiety or discomfort
associated with the thought that drives the ritual. In other words, the ritual is performed to reduce
the anxiety produced by the thought. For those suffering from obsessional thoughts alone, anxiety
is often associated with the thought, and mental rituals, distraction, or avoidance may be used to
lessen the discomfort. It is much the same for those with compulsive rituals alone in that the
behavior is performed in order to lessen the urge to ritualize. The role of anxiety is important in
OCD and will be discussed in much greater detail in subsequent sections.
Most OCD sufferers can see the uselessness and absurdity of their actions but still feel compelled
to perform their various rituals. They know that their hands are not dirty or contaminated and they
know that their house will not burn down if they leave the electric kettle switched on at the wall.
Because they are aware of how irrational their behavior is, many sufferers are ashamed of their
actions and go to great lengths to hide their symptoms from family, friends, and, unfortunately,
even their doctors. It is extremely important that your therapist is aware of all of your symptoms
no matter how embarrassing or shameful they may be, as this is the only way that a suitable
treatment program can be designed for you. Rest assured that a therapist experienced in the
treatment of OCD will have heard of symptoms worse than yours many times over.
1.1 Symptoms Obsessive-Compulsive Disorder
Obsessional thoughts are usually concerned with contamination, harm to self or others, disasters,
blasphemy, violence, sex or other distressing topics. Although generally called thoughts they
can quite often be images or scenes that enter the sufferer’s mind and cause distress. For example,
one sufferer may have the thought “My hands are dirty” enter his head. This thought will trigger
washing rituals. Another sufferer will actually have enter his head the scene of his house burning
down. This scene will trigger checking rituals. Individuals who suffer obsessions alone may also
experience thoughts, images, or scenes. For example, someone who has obsessions about harming
his or her children may have the thought of harming them or have a frightening scene of hurting
them or an image of the children already hurt.
As was pointed out earlier, many obsessions produce anxiety or discomfort that is relieved by
performing rituals. The most common rituals are washing and checking, although there are many
others such as counting, arranging, or doing things such as dressing in a rigid, orderly fashion.
Although rituals are performed to alleviate the anxiety or discomfort that is produced by the
obsession, the anxiety relief is usually short-lived. An individual who washes in order to avoid or
overcome contamination will often find him- or herself washing repeatedly, because either they
were uncertain whether they did a thorough enough job or because the obsessional thought that
they are contaminated has recurred. Similarly, someone who checks light switches, stoves, and so
forth in order to avoid the house burning down, often has to repeat the behavior over and over,
because he may not have done it properly or the thought or image of his house being destroyed
has recurred. Even individuals who have obsessional thoughts alone may find that they have to
repeat the cognitive rituals such as counting or praying many times over as they may not have
done them perfectly in the first place.
An important point to keep in mind is that many sufferers have more than one type of symptom
so that individuals may engage in more than one type of ritual or have more than one type of
obsessional thought. Another point to note is that symptoms change over time and someone who
is predominately a washer may, over time, develop checking rituals that eventually supersede the
original complaint. In addition to changes in symptoms, the course of the disorder may also
fluctuate over time, with periods of worsening and periods of improvement. Other sufferers may
find that their symptoms remain static, while yet others may find a gradual worsening of
symptoms since the onset of the disorder.
For many sufferers of OCD, these symptoms take up a great deal of time, often resulting in their
being late for appointments and work and causing considerable disruption and interference with
their lives. Apart from disrupting their own lives, it also frequently interferes with the lives of
family members as the typical sufferer often asks the other members to do things a certain way or
not to engage in certain behaviors, as this may prompt the sufferer to engage in rituals. Thus, the
symptoms are not only controlling, frustrating, and irritating to the patients, but also to their
family, friends, and workmates.
Avoidance of certain situations or objects that may trigger discomfort and rituals is also quite
common among OCD sufferers. It seems logical to avoid contact with contaminants if you are a
person who washes compulsively, or to avoid going out of the house if you must check all the
electrical equipment, the doors, and windows. While this seems like a reasonable way of coping,
it actually adds to the problem, as the typical sufferer avoids more and more situations and
gradually the problem comes to rule their life. Second, avoidance does little to deal with the
problem as it only serves to reinforce the idea that such situations are dangerous. Because the
situation or object is constantly avoided, there is no opportunity for the individual to learn that
there is no danger.
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