When Thoughts Become Obsessionsby Jerry Kennard, Ph.D. Medical Reviewer
Some estimates suggest that as much as three per cent of the population have significant Obsessive Compulsive Disorder (OCD) at some point in their lives. In this Sharepost I look at some of the features of obsessions and ask, where do these intrusive and repetitive thoughts come from, and why are they so hard to control?
Obsessions refer to thoughts whereas compulsions refer to actions. In OCD, obsessions and compulsions are closely linked, but the nature of thought processes is they are repetitive, unwelcome and full of content that is repugnant. Typically, the pattern of thinking revolves around sex, religion or inflicting harm on others, in isolation or in combination. Although the person realises they are generating these thoughts and that they make no particular sense, they continue to defy rational thought and continue to cause distress. The person wrestles with their own thoughts as though involved in a personal battle of will.
Obsessions increase anxiety. One feature of the obsession is something called thought-action-fusion. This refers to the common belief that the more the person thinks something may happen, the greater the chances of it actually happening. For example, repeatedly thinking about loved ones dying in a fire sets up an internal conflict between the thoughts and attempts to suppress them, leading to high levels of anxiety. The thoughts are often generated internally but external sources (a flame, the color red, heat) for example, may contribute.
Cognitive psychologists suggest that obsessions are caused by a significant personal misinterpretation of intrusive thoughts (Rachman, 1997). Thought processes in people without OCD are broadly similar. Everyone knows the experience of unwanted intrusive thoughts or images. The difference appears to rest on the significance of these thoughts to the individual and attempts to deny or suppress such thoughts have entirely the opposite effect.
The extent to which obsessions are linked to certain traits of personality is interesting. For example, people with ICD tend to score highly in terms of perfectionism and indecisiveness. High scores are also seen with regard to responsibility and the fact that they have an exaggerated sense of responsibility for their actions.
Psychological treatments for obsessions usually focus on moving the significance of thoughts to a point where they are just so much passing noise. This is how most people dismiss or cope with such thoughts. However, depression is a common feature of OCD and most patients are likely to be treated just with selective serotonin reuptake inhibitors (SSRI's). There is good evidence that such treatment works well in a proportion of cases, but the preferred method is a combination of medical and psychological intervention.