Obsessive-Compulsive Disorder: How It Develops and Is Treated

Obsessive-compulsive disorder involves obsessive thinking and compulsive behaviors. Obsessive thinking consists of recurrent, persistent "thoughts, urges, or mental images" experienced as insistent, intrusive, and anxiety-provoking. In response to these obsessions, a person may engage in compulsive behaviors or mental acts intended to reduce the anxiety they cause.

These obsessions and compulsions usually consume a great deal of time—more than one hour a day—and clearly disrupt social interaction or performance at work.

So how does obsessive-compulsive disorder develop? What obsessive thoughts and associated compulsive behaviors occur, and how does the cycle unfold for someone with the disorder? These are the questions we will answer in this article.

How does obsessive-compulsive disorder develop?

The roots of obsessive tendencies in a person’s character lie in attempts to achieve perfection. How does that happen?

Because of early upbringing and previous life experiences, this person feels inferior and inadequate and tries to compensate through obsessive behaviors that raise their sense of worth and gain the acceptance and love of others. In reality, however, they will never reach a degree of the desired perfection that satisfies them, because human beings are simply fallible and imperfect. The person striving for perfection therefore continues these behaviors and keeps chasing a mirage, consuming their time and energy and impairing their performance in many areas.

All of this is accompanied by anxiety that they will not achieve their goal or are not doing what they should in the appropriate way. It is worth noting that the anxiety accompanying obsessive-compulsive disorder is an exaggerated form of the innate anxiety everyone experiences in proportion to potential dangers and threats, which serves to warn and protect them.

One form of perfection sought by people with obsessive-compulsive disorder is complete control over the disturbing obsessive thoughts that enter their minds. But this is impossible to achieve. The harder they strive to control these thoughts, the more their anxiety grows and the more intense the disturbing thoughts become.

Below are some examples of obsessive thoughts and their associated compulsive behaviors:

Obsessive thoughts and their associated compulsive behaviors:

• Obsessive thought:Fear of contamination
• Compulsive behavior:Excessive handwashing and cleaning
• Obsessive thought:A need for symmetry
• Compulsive behavior:Meticulous arranging and organizing
• Obsessive thought:Aggressive or sexual mental images, or negative thoughts about sacred matters 
• Compulsive behavior:Excessive religious rituals, actions intended to counteract the thought, seeking reassurance, and avoiding triggers for these images and thoughts
• Obsessive thought:Feeling unsafe about something, such as a gas cylinder or door locks
• Compulsive behavior:Checking and repeated inspection behaviors
• Obsessive thought:Fears about losing something valuable
• Compulsive behavior:Excessive saving and hoarding

Reflect calmly and carefully on yourself. Record your obsessive thoughts and any compulsive acts you perform, even if they seem unrelated to those thoughts. Beside each one, record how often it occurs each day.

How does the cycle unfold for someone with obsessive-compulsive disorder?

To better understand how events unfold for someone with obsessive-compulsive disorder, consider the following example:

If you believe that even minor contamination could threaten your health, a triggering event such as using a public restroom may be enough to provoke an obsessive thought such as, "I have contracted AIDS," and allow it to take over. Your anxiety then rises sharply. To relieve it, instead of disregarding this extreme obsessive thought, you visit doctors and undergo excessive, unnecessary tests. This temporarily reduces your anxiety but leaves you more vulnerable to such thoughts in the long term. As soon as you encounter another trigger, you repeat the same compulsive behaviors even more intensely.

So how can you help yourself if you discover that you have a form of obsessive-compulsive disorder?

How can I overcome obsessive-compulsive disorder?

1. To begin with, being here and reading these words is a step in the right direction. Increasing your awareness and educating yourself about this disorder can greatly help reduce its impact on your life.
2. Know that you are not alone: around 90% of people experience thoughts they find disturbing and anxiety-provoking. These may concern contamination, sex, violence, mistakes, religion, harming themselves or others, losing control, and other subjects. People differ in the intensity and frequency of these thoughts and in the level of anxiety they cause. Many people’s lives are not greatly affected because they do not view the thoughts as threatening or significant. One study identified obsessive thoughts that occasionally pass through the minds of the general public. You can make your own list using your thoughts or those of relatives and friends, and you will find an endless number of such obsessive thoughts.
3. You may misinterpret why these thoughts appear in your mind, telling yourself, "They appear because I am a terrible person who has bad thoughts," "I am insane because I cannot adequately control my mind," or "I could easily sink into anxiety and distress." But their appearance is a sign that part of your brain is strained and exhausted. You need to understand what is causing that exhaustion and learn how to rest your brain and restore its balance.
4. Begin practicing relaxation skills and use them regularly every day so that you can turn to them when your anxiety rises after a trigger for your obsessive thoughts. Relaxation exercises can help you reduce anxiety in a healthy way, which may lessen your compulsive behaviors.
5. If you examine your obsessions realistically, you will find that your thinking is unfairly and extremely biased toward the negative—contamination, disorder, or thoughts that are socially or religiously unacceptable, for example. Recognizing this can motivate you to work on balancing these thoughts and bringing them into the realm of reason and fairness.
6. Giving the obsessive thought in your mind its proper meaning is very important in your journey with obsessive-compulsive disorder. For example, you may believe that thinking about possible harm to yourself or someone else makes you responsible for preventing that harm. In reality, negative events depend on many factors far beyond your compulsive act. For instance, if you think a relative may develop a particular illness, repeatedly arranging medical tests will not change the illness’s natural course.
7. At this precise point, I tell you: "Do not resist." Resisting these obsessions, devoting your mental energy to fighting them, and trying to erase them completely from your mind will make them fiercer and more persistent in the long term. It is just like falling into a thorny bush: every attempt to break free causes more pain.
8. You may believe that obsessive thoughts will eventually overpower you unless you make an enormous effort to resist them. This feels extremely threatening because being overcome by them may mean failure and weakness to you. You may tell yourself, "This disturbing thought must be very important because it keeps returning and insisting despite my attempts to control and resist it." Your fear of failure will drive you to exert even more effort in these attempts at control, trapping you in an endless cycle.
9. I fully understand that you are deeply concerned about what might happen if you do not try to resist these thoughts. For example, if your obsessive thoughts involve an unacceptable sexual act, you may mistakenly believe that failing to resist the thought with all your strength will inevitably make you act on it. In reality, this is magical thinking. Obsessive thoughts have no control over you and do not control your behavior, so these fears have no basis in reality.
10. Just as I asked you not to resist the obsessive thought, I also urge you not to give in to compulsive acts. Giving in, even slightly, draws you further into the disorder because responding to the thoughts means treating them seriously, which gives them strength to return with even greater urgency.
11. Conduct some simple experiments to test how accurate the obsessive thoughts pursuing you really are.
12. Consider the obsessive thoughts that cause you the greatest anxiety, then think about the situations and circumstances that trigger them. Arrange these situations in ascending order and begin with the easiest. Expose yourself to the triggering situation for a short time and record the intensity of the associated anxiety. Repeat the attempt, increasing the duration each time. You will notice a gradual decline in the anxiety caused by that situation. Then move to the next situation and follow the same steps until you reach the stage of becoming "accustomed" to that thought. You can begin by imagining the situations and then progress to facing them in reality.
13. Because of certain obsessive thoughts, you may avoid many situations out of fear that they will be triggered. I recommend recording the situations you avoid in ascending order and gradually beginning to engage in them. Your anxiety will rise until it reaches a peak, then—with the relaxation exercises you practiced earlier—it will begin to fall little by little until it reaches its lowest level. In this way, you will have managed your anxiety healthily and without linking it to compulsive behaviors, while also reducing the number of situations you previously avoided.
14. List the days of the week and, beside each day, record how many times the thought entered your mind. Monitor whether you are improving so you can assess the role of the steps you are following in reducing the thoughts’ impact on you.
15. Enjoy your small successes. Whenever you refrain from a compulsive behavior, even if you merely delay it, engage in something you previously avoided, or successfully challenge an obsessive thought, reward yourself with something you enjoy. Have some ice cream, watch a film, or take a short outing. You deserve a reward for your effort and commitment to the treatment steps.

How can I get rid of disturbing thoughts?

• Try to ignore and disregard them. Imagine these thoughts as background noise in a larger scene. Do not let them occupy too much of the overall picture and distract you from its important events.
• Imagine these thoughts as the words of a child who is bullying you. Pay them no attention; ignoring them will eventually make the child leave you alone.
• Keep yourself occupied with something enjoyable and useful to divert your attention from them.
• You could take part in physical activities such as climbing, playing on a team, or any activity that engages your mind and body together. Running or walking alone, for example, may not help much because they leave time and mental space to think about your obsessive thoughts again.
• Listen to your favorite music or sing your special song out loud. You can dance too.
• Call a friend and talk about anything except your obsessive thought.

How can you test the accuracy of obsessive, disturbing thoughts?

• Gather concrete evidence of the harm or danger arising from your thought.
• Choose a disturbing thought and rate its perceived importance and the distress it causes you. Repeat the exercise, but each time exaggerate the thought’s importance, rate its importance and the associated distress again, and observe the results.
• Choose several major tasks at home or work that are associated with perfectionism. After completing them, rate the level of perfection, effort, and anxiety associated with each task. Then ask yourself how much additional time and effort would be needed to make it more perfect. Consider both the costs and the benefits of achieving this additional level of perfection and whether it is worth that amount of anxiety.
• Choose some tasks that involve compulsive acts. Perform them while deliberately introducing minor imperfections and without adhering to complete precision. Then record the results of this imperfect performance.

Finally, remember that the goal of treatment is not to eliminate obsessive thoughts and compulsive behaviors completely. It is to reduce them enough for you to function across the different areas of your life and interact more smoothly with your surroundings. If you try to follow these suggestions but do not succeed in reducing the disorder’s impact, consult a psychiatric specialist who can prescribe medication that, alongside the suggestions mentioned above, may help you regain control over the areas of your life affected by the disorder.

Remember that you can challenge yourself and turn your obsessive anxiety into a ladder toward further successes and achievements. You will need to equip yourself with flexibility and perseverance. We wish you success on your journey of recovery from obsessive-compulsive disorder.

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