"I know it's crazy to take three showers a day, but I just can't stop it."

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
Unwanted thoughts, images, or impulses (obsessions) enter awareness and generate anxiety or distress. For example, a man 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 it will be my fault. I'll be tortured by guilt and remorse for the rest of my life." He carries out compulsions, such as behaviors (finding a rag to clean up the water) or mental acts (for example, repeating a prayer three times) to neutralize his anxiety or prevent the feared outcome. As soon as he wipes the floor dry, he feels better. In this way, compulsions increase in frequency and complexity because they provide relief of the anxiety or distress caused by the obsessions. The person with OCD is often driven by the belief that unless he or she carries out the compulsions, the danger or distress caused by the obsessions will persist indefinitely.

Cognitive-behavior therapy for OCD

• Education. Clients are taught about the cognitive, physical, and behavioral components of obsessive-compulsive disorder, especially the role that 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 control strategies. Cognitive strategies help clients alter the thoughts and beliefs that maintain their obsessions and compulsions..

Additional resources
Web links:
The Anxiety Disorders Association of America
The Association for Behavioral and Cognitive Therapies
Obsessive-Compulsive Foundation
Freedom from Fear

Books:
For links to purchase these books and others, please go to Self-Help Books for Adults

Baer, L. (2000). Getting control: Overcoming your obsessions and compulsions. New York, NY: Plume Books.

Foa, E. B., & Wilson, R. (2001). Stop obsessing!: How to overcome your obsessions and compulsions. New York, NY: Bantam Books

Hyman, B.M., & Pedrick, C. (2005). The OCD workbook: Your guide to breaking free from obsessive-compulsive disorder. (2nd Edition). Oakland, CA: New Harbinger Press.

Steketee, G., & White, K. (1990). When once is not enough: Help for obsessive-compulsives. Oakland, CA: New Harbinger Publications.