Obsessive Compulsive Disorder

Here is the next in my series on the most common psychological disorders in Australia.

“I’m in tears after almost every shift”. Gareth is a 2nd year ICU nurse with a checking problem. “I worry myself sick about missing medication, giving the wrong medication, giving too much medication…”. Home life is little better for Gareth “When I’m really bad, even leaving the house is hard, I check doors, power-points, oven”. And it’s not just fears of his own safety, or that of his patients, that plagues Gareth. “I often turn my car around and retrace my steps to check that I haven’t knocked a pedestrian over on my drive to work”.

Marilyn is easily disgusted. “I just can’t stand the thought of germs”. Marilyn spends over an hour each day scrubbing and disinfecting surfaces, especially the kitchen and bathroom, she washes her hands at length, multiple times. Always a clean freak, since her kids started day-care, her germ-phobia has become progressively worse. “My hands are raw and swollen, but I can’t let the thought go that someone in the family has touched poo or something dirty and brought it home”.

Obsessive thoughts

All organs have functions. The heart pumps blood, the lungs breath air, and the brain produces thoughts. Even when we don’t want to think, the brain just keeps humming along, spitting out dozens of thoughts every waking minute. We just can’t control this.

And these thoughts are just thoughts. We could think anything from the sublime to the grotesque and it matters not a jot to the rest of the world. Even if our thoughts are scary or disgusting or morally reprehensible, it just doesn’t matter. This is our private world. Violent, perverse, sadistic, sinister, as long as we don’t act on our thoughts, they are infinitely harmless.

For people with Obsessive Compulsive Disorder (OCD) however, thoughts mean more. Intrusive, unwanted, recurrent, distressing thoughts, images or urges are cause for alarm, and need to be controlled. But the harder they try to supress, the more insidiously intrusive they become. Why?

The White Bear Experiment

Open the stopwatch on your phone. Now imagine a white dancing bear. Picture it in detail. Now you have a detailed picture of the bear. Start the stopwatch – for the next minute you are not allowed to think of the bear. Whatever you do, do not think of that bear!

How did you go? Most people to whom I give this challenge have trouble keeping the bear out of their mind for even a few seconds.

But this is just a harmless white bear. Just imagine if it were a disturbing thought instead. A loved one dying. A disgusting image of a wound or faeces. A thought of going to hell or being cursed.

And imagine that you felt that a thought was not just a thought. You felt as though a thought was like an invitation or an invocation for the object of the thought to materialise. And imagine that you felt responsible for the catastrophic fear emerging. Well then, the stakes of the White Bear Experiment would be greatly raised.

And wouldn’t you feel the need to control these thoughts?

Compulsive behaviours

And in its ingenuity, the mind develops a method to cope with these thoughts. To find relief and feel in control.

Compulsions are rigid, repetitive, rule-based behaviours or mental acts. The person with OCD feels driven to perform these acts in order to supress, distract or neutralise a catastrophic outcome or to reduce anxiety or distress related to the obsessive thought.

These acts may or may not be rationally related to the obsession. For example, Gareth feels that if he checks medication an odd under of times, he is inviting catastrophe. He needs to check everything an even number of times. Twice, four-times, six-times etc. Gareth knows that this makes no sense but doesn’t want or need the anxiety that comes with ending on an odd.

For Marilyn, her compulsive cleaning is rationally related to her obsessive contamination fears. However, the cleanliness is well in excess of what is warranted. After coming back from the shops, she used to spend almost as much time hand washing as shopping. Then she took to wearing gloves outside of the house. But this only provided temporary relief and she continued to obsessively wash her hands even after wearing gloves.


Medications and Psychological Therapies have been proven to be effective in treating OCD. One of the most well studied psychological treatments for OCD is exposure and response prevention. This treatment involves facing the obsessive fear (exposure) whilst preventing the accompanying ritual. For Marilyn this meant imagining that her hands had touched a clean dog and holding back on washing them.

Another common treatment, often used in conjunction to the above, is cognitive therapy. This treatment involves challenging the validity of the obsessive thoughts. For example, Gareth was informed about just how unusual house fires started by ovens are. Gareth was sceptical that this rational fact would make a difference to his compulsions. But when fighting the urge to go back and check the oven, he found that this knowledge did give him extra confidence to walk away.

Talk to your GP if you identify with something here. Remember, OCD is not a life sentence. There are treatments that can provide relief.

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