Patterns of thought and behaviour

Most people with obsessive compulsive disorder (OCD) generally fall into a set pattern or cycle of thought and behaviour. This pattern has four main steps which are described below.

• Obsession: your mind becomes overwhelmed by a constant obsessive fear or concern such as the fear that your house will be burgled.
• Anxiety: this obsession provokes a feeling of intense anxiety and distress.
• Compulsion: you then adopt a pattern of compulsive behaviour in order to reduce your anxiety and distress, such as checking that all your windows and doors are locked at least three times before leaving your house.
• Temporarily relief: the compulsive behaviour brings temporary relief from anxiety, but the obsession and anxiety soon returns, meaning that the pattern or cycle begins again.

Obsessive thoughts

Almost all people have unwanted and unpleasant thoughts, such as a nagging worry that their job may not be secure, or a brief suspicion that a partner may have been unfaithful. Most people can usually put these type of thoughts and concerns into context and are able to carry on with their day-to-day lives.

However, if you experience a persistent, unwanted and unpleasant thought that dominates your thinking to the extent that it interrupts your other thoughts, you may have developed an obsession.

Some common obsessions that affect people with OCD are listed below.

• Fear of being harmed.
• Fear of causing harm to others.
• Fear of contamination by disease, infection, or other unpleasant substance
• A need for symmetry, or orderliness. For example, someone with OCD may feel the need to ensure that all the labels on the tins in their cupboard face the same way.
• Fear of committing an aggressive, or unpleasant, act.
• Fear that you will commit an act that would seriously offend your religious beliefs.
• Fear that other people will consider you to be a sexual deviant.
• Fear that you will make a mistake that has serious consequences. For example, your house will burn down because you left the gas on, or all your possessions will be stolen because you forgot to lock your door.

Compulsive behaviour

Most compulsions arise from the initial obsession. In some cases, the type of compulsive behaviour is in some way logically connected to the obsession, such as repeated hand washing in order to prevent disease.

However, in many cases of OCD, the compulsion has no logical connection to the obsession. Instead, it is a type of ‘magical’ or superstitious behaviour that the person believes has the power to prevent the object of their obsession from occurring.

For example, a person with OCD may feel compelled to count every red car that they see on the road because they believe that doing so will prevent their mother from dying in a car crash.

This type of ‘magical’, compulsive behaviour is particularly common in children with OCD.

Although most people with OCD realise that such compulsive behaviour is irrational and makes no logical sense, they're unable to stop acting on their compulsion.

Some common types of compulsive behaviour found in people with OCD include:

• Checking that doors are locked, and that gas taps and light switches are turned off.
• Cleaning and washing.
• Repeating certain acts or rituals such as having to touch every second lamp post while walking down the street.
• Constantly repeating certain words or phrases in your mind.
• Hoarding or collecting objects that usually have no value, such as supermarket bags and junk mail.
• Counting.