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COD
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“Some people with OCD are compelled to pick up pieces of broken glass from the street. They worry that, if they don’t, then someone else might cut themselves on the glass. If the person with OCD fails to prevent that happening, they think, well I may as well have walked up to the stranger and deliberately hurt them.”
OCD involves obsessive thinking and compulsive acts.
Obsessions are repeated unwanted thoughts and images that intrude into the mind, often without any clear reason. They are frequently triggered by external factors and provoke intense discomfort or anxiety, along with fear and uncertainty about potentially harmful consequences.
Obsessions trigger the urge to reduce anxiety through mental or physical actions. These compulsions aim to counter the obsessive thoughts, lower anxiety, and restore a sense of certainty and safety. Avoidance strategies serve a similar function.
Although compulsions and avoidance reduce obsessive anxiety in the short term, the relief does not last. The obsessive thoughts return and require endless repetition of the same rituals and avoidance. Over time, these patterns intensify to the point of disrupting important areas of life.
Four subtypes of OCD have been identified. Contamination obsessions are paired with washing or cleaning compulsions. Harm obsessions are paired with checking compulsions. Symmetry obsessions are paired with ordering, arranging, and counting compulsions. A fourth subtype involves obsessions without visible compulsions, the rituals being entirely mental.
Cognitive behavioural therapy (CBT) with exposure and response prevention (ERP) is the first-line psychological treatment for OCD. It involves deliberate exposure to situations that trigger obsessive thoughts, without enacting the associated compulsion, and reduces anxiety over time. Psychodynamic therapy can complement this work by offering a deeper understanding of the symptoms and their meaning in the person's life.
References
Abramowitz, J., Taylor, S., & McKay, D. (2008). Obsessive-compulsive disorder. The Lancet, 374, 491–499.
Shedler, J. (2012). The efficacy of psychodynamic psychotherapy. In R. A. Levy, J. S. Ablon, & H. Kächele (Eds.), Psychodynamic psychotherapy research: Evidence-based practice and practice-based evidence (p. 9–25). New York: Humana Press.