"I feel so anxious because I keep thinking I might suddenly become violent and hurt someone."

"I find myself checking the stove several times a day because I'm afraid I may have left it on and it would be my fault."

"I know I shouldn't, but I just can't stop myself from taking 3 or more showers a day."

What is obsessive-compulsive disorder (OCD)?
Obsessive-compulsive disorder (OCD) is characterized by obsessions and compulsions.

Obsessions are recurrent and persistent intrusive thoughts, images, or impulses that are unacceptable and unwanted and cause significant distress or make it difficult to carry out daily activities, including work, household duties, or even leisure activities. Even when the person tries very hard to suppress the obsession, it continues to intrude. The most common obsessions involve fears of contamination by dirt or germs, worries about losing control and harming oneself or others, doubts about one's words or actions, unacceptable thoughts of sex, blasphemous thoughts or images, and excessive concerns about order or symmetry.

Compulsions are rigid and repeated behaviors or mental acts that are performed in order to prevent a feared outcome (such as contracting AIDS from a contaminated toilet seat) or to reduce the distress caused by the obsession. People often feel driven to perform the compulsion even though they do not want to and try to resist it. Common compulsions include excessive washing, repeated checking of situations or actions, and counting or repeating certain phrases.

Cognitive-behavioral model of OCD
Nearly everyone has experienced unwanted intrusive thoughts or impulses (e.g., a disturbing image, an urge to hit someone, a song that repeats in your head). According to the cognitive-behavioral model of OCD, these unwanted thoughts, images or impulses (i.e., obsessions) generate anxiety or distress when a person believes that they are important and meaningful. For example, a woman who is dominated by fears of harming others might have the obsession, "If I don't clean up that spot of water on the grocery store floor, someone will slip and fall" and then thinks I must pay attention to this thought or "it will be my fault if someone gets hurt. I'll be tortured by guilt and remorse for the rest of my life."

As a way to relieve distress, individuals with OCD will engage in compulsions, such as behaviors (finding a rag to clean up the water) or mental acts (for example, repeating a prayer three times) to neutralize their anxiety or prevent the feared outcome. Individuals with OCD are often driven by the belief that unless they carry out their compulsions, the danger or distress caused by the obsessions will persist indefinitely. Using the same example, the woman feels extremely anxious about causing another person being injured, and then proceeds to wipe the floor until her anxiety is relieved. Although engaging in compulsions temporarily reduces distress, it further reinforces the idea that the obsession is important and that the person should be vigilant to notice such thoughts, which then increases the likelihood the person will have their feared obsessions.

Cognitive-behavior therapy for OCD

• Education. Clients are taught about the cognitive, physical, and behavioral components of obsessive-compulsive disorder, especially the role that appraisals and compulsions play in feeding obsessions.
• Monitoring. Clients learn the specifics of their symptoms (triggers, content, frequency, and intensity of obsessions, and details of the mental and behavioral compulsions); this provides much needed perspective as well as information to guide the treatment.
• Behavioral interventions, especially exposure with response prevention. Approaching and remaining in situations that trigger obsessions (exposure) while blocking mental and behavioral compulsions (response prevention) results in a decrease in the intensity and frequency of obsessions and in urges to carry out compulsions.
• Cognitive strategies. Clients learn to identify what their obsessions mean to them and the reasons why their obsessions feel so important. They then develop skills to test and change their beliefs about the importance of their obsessions.