How Anxiety Drives OCD

Ph.D., CPsychol., AFBPsS, Health Professional
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For those of us without Obsessive-Compulsive Disorder (OCD) our response to an anxiety situation follows a predictable trajectory. First, something happens which stimulates our flight-or-fight response and this puts us on edge. Once the moment passes we gradually start to relax. One of the big issues that people with OCD confront is that their OCD actually creates anxiety. Once an anxiety trigger passes their anxiety is not only maintained, it tends to increase. Why?

The key to the issue relates to the person’s perception of risk. OCD is driven by fear and this is typically wrapped up in a number of negative interpretations about what could, or might, happen. Anxiety is maintained and increases as thoughts expand. This leads the person to the point where relief is only forthcoming if certain rituals (compulsions) are undertaken. Unfortunately, relief is often short-lived, as the original obsession tends to reassert itself. This vicious cycle of obsessions, leading to anxiety, resulting in compulsions in order to provide some sense of relief, is what characterizes OCD.

An Anxiety Disorder

OCD is classified as an anxiety disorder. Although obsessions (thought processes) and compulsions (actions) tend to be thought of as the components of OCD, this isn’t always the case.

Some people experience obsessive thoughts and do not attempt to seek relief through rituals. Others may have routines involving multiple checks or rituals without knowing why they perform them. I knew one lady who touched and stroked the leaves and flowers on certain hedges. Were it not for the fact she did this routinely and would sometimes return several times a day to the same place, it would have appeared she was enjoying nature on her walk. This same person had awareness of what she did but had no real idea why she did it. Dig a little deeper and we discover issues of uncertainty, discomfort and anxiety. Rituals serve to bring an element of certainty, predictability and comfort.

Like all anxiety disorders, OCD reflects a pattern of thinking that centers on fear. In OCD this fear may be focused as much on others as it is on the person with the disorder. An example of this is the person who fears that if he drives a car he may crash and be responsible for the injury or death of others. Another may be the person who fears that if she comes anywhere near knives she may lose control and harm others. This "What if something happens?" feature points to an anxiety over loss of control, and can cause great distress.

Treating OCD

OCD is a very treatable condition but various issues may block it being identified or properly diagnosed. Many people suffer with the condition for years, partly out of guilt, or shame, or embarrassment, but sometimes because the condition isn’t recognized for what it is. Ultimately, Cognitive Behavioral Therapy (CBT) is the most effective method of treatment, but in order to be effective it may be necessary to combine treatment with medication. Medication can help reduce anxiety to a level where the patient can actively and productively work with a therapist.

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