Identifying and Understanding Obsession Problems

Obsessional problems are among the most disabling of common emotional behavioural problems. People with obsessional problems can spend many hours a day plagued by upsetting thoughts and feel driven to repeatedly carry out rituals or avoid situations.

Some degree of obsession is entirely normal – for example, around half of all people have a particular thing that they check more than they think is necessary, such as whether the gas cooker has been switched off or the door’s been bolted. Obsessional problems have their roots in normal experiences, but the rituals and avoidance behaviours serve to make the frequency, severity, and duration of obsessions worse. The more you try to rid yourself of doubts, the more they tend to play on your mind.

Here are some terms of obsessions:

• An obsession is a persistent, unwanted thought, picture, doubt, or urge that intrudes into your mind, triggering distress. Obsessions are said to have reached a ‘psychiatric problem’ level when they cause significant levels of distress, interfere with your life, and are present for more than an hour a day.
• Preoccupation means being absorbed with something troubling that’s on your mind. In this book we focus on preoccupations with appearance and health. Preoccupations are usually the result of you frequently focusing your attention on an idea or doubt that is distressing to you. Preoccupations are similar to obsessions in that they are regarded as problematic when they cause significant distress, interference in your life, and last for more than an hour per day.
• Compulsions, are the actions you may take in response to your obsessions or preoccupation, but do not particularly help you in your life. Compulsions can be observable behaviours or can be carried out in your mind. Compulsions are usually attempts to either get rid of a thought, image, urge, or doubt; an attempt to reduce danger; or an attempt to reduce discomfort.
• Avoidance behaviours are things you do to avoid triggering your obsession or preoccupation. Your avoidance behaviour may be avoiding driving; avoiding visiting a hospital; or avoiding being seen in bright light.

Rituals and avoidance behaviours are the lifeblood of obsessional problems. Add to these catastrophic thinking and attention bias and you have the anatomy of obsessional problems.

Understanding obsessive-compulsive disorder (OCD)

Common obsessions in OCD include the following:

• Fear of contamination
• Preoccupation with order or symmetry
• Religious obsessions, for example fear of offending God
• Sexual obsessions, for example fear of being a paedophile
• Fear of losing something important (such as a possession, paperwork, or ideas)
• Fear of becoming cruel or destructive 

Compulsions frequently associated with OCD include the following:

• Checking (for example, if a light is switched off)
• Cleaning or washing
• Counting
• Repeating actions or special words, images, or numbers in one’s mind
• Ordering and making things ‘just so’
• Hoarding (excessive keeping of possessions such as newspapers that have no real, value, interest, or function)
• Making lists
• Replaying or repeating scenes, images, or actions in your mind

The prevalence of OCD is estimated to be around 2 per cent of the population, with some studies suggesting more. The severity and impact of OCD varies greatly, and in its most extreme form individuals can become totally housebound, even bedridden. Whilst the severity of symptoms can wax and wane, most people with OCD do function, do have relationships, and do hold down jobs or education, but will be under considerable extra strain. Clearly, very many people may recognise some degree of the excessive worries and rituals outlined above. The question is how much choice you feel you have to stop a ritual without distress, and how much interference OCD is causing in your life.