Obsession and compulsion

Obsession is an alteration of the content of thought

The thinking of an obsessive person is invaded by irrational and repetitive ideas, perceived by the subject as his own but absurd or exaggerated.

The content of obsessions is varied: ideas of being contaminated, of having sinned, of having to check if the light is off or the door is locked… and of any other type, come forcefully to the mind, without being able to be cut.

Obsessions produce important anxiety, which can be accompanied by compulsion, that is, an attempt to reduce the anguish and discomfort that provokes the mind, with a certain action.

Compulsions are precisely repetitive behaviors caused by these dominant and persistent (obsessive) ideas, which the person is unable to stop, even if he/she considers them exaggerated or absurd.

The compulsive action produces a decrease of the anxiety motivated by the obsessive thought, and for that reason it is reinforced and tends to be repeated.

A specific disease called obsessive-compulsive disorder (OCD)

Pathological obsessions go beyond a simple unwanted thought that eventually disappears. States of tension or anxiety and lack of sleep favor the difficulty to reject these ideas. In addition, facing a certain idea with too much determination or nervousness can cause the opposite effect, that is to say, to make it even more insistent.

It should not be confused with what in common parlance is said to be obsessed: for example, with a movie or a novel that absorbs the attention. In these non-pathological cases the obsessive idea is experienced with pleasure and, if “the obsession” is not carried out, one manages to go on without problems (if this were not the case, it would be a sign of pathology).

The difference of obsession, or obsessive-compulsive disorder, with an illness or delusional thinking is that the obsessive idea without delirium has a logic and the person perceives it as intrusive or exaggerated: he would like to stop thinking about it and does not believe it to be true. In delirium, the person is convinced that it is true, however strange it may be.

How to deal with obsession and compulsion

The explained measures serve to diminish the anxiety.

If one has difficulty to stop thinking about something, it is probable that it is not ill, although it could have an obsessive disorder or another disease.

It is not uncommon to have obsessions in periods of stress, in depression, after traumatic events, in eating disorders, etc.

If the obsession causes frequent anxiety or is accompanied by compulsive acts, medical help is more clearly required.

Drugs – in particular serotonin reuptake inhibitors, mentioned when discussing depression – manage to control the symptoms well, although a worsening may be observed at the beginning of therapy.

A refusal of the drug is a sign of a poor prognosis and often a sign that there is also a personality disorder.

Cognitive-behavioral psychotherapy, in which exercises are performed to modify obsessive ideas and compulsive rituals, has proved to be useful and capable of making the symptoms disappear in the long term.

The most frequent complication of obsessive disorder is secondary depression.

When diagnosed with obsessive disorder, it should be remembered that it is a disease for which there is a quite effective therapy. Medications and psychotherapy help to see compulsive rituals in the right perspective, to understand their genesis and, with patience, to overcome them.

It is important not to favor the compulsive rituals of a sick person, as it could happen if one anticipates to open a door or facilitates the excessive washing of the hands, or not to let anybody enter at home, etc.

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