Cognitive Pearl #032 Tevet 22, 5775 January 12, 15

Today I had the good fortune to listen to a fascinating interview1 about Obsessive Compulsive Disorder. Taking that as a sign from Heaven, it seems like a great opportunity to speak about OCD, something that more and more people turn to cognitive therapy for help with. With that in mind, I’ll put my previous discussion about engaging clients on the side. Don’t worry though; we’ll get back to that.

When I began my career 25 years ago, OCD was grouped in the DSM III with other anxiety disorders such as panic disorder, generalized anxiety disorder, and post-traumatic stress disorder. The DSM V changed all that: OCD is now grouped with other repetitive type disorders such as trichotillomania and excoriation disorder. While all of these disorders may be pathological attempts to reduce dreaded anxiety, they may reflect other underlying needs and dysfunctions as well.

Here are two of the most well known:

1) Obsessions and compulsions are the result of the mis-exaggeration of the importance of the stray thoughts that crisscross consciousness. These are intrusive and usually upsetting thoughts that ‘really’ get one’s attention; in that moment of awareness, time comes to a standstill. The sufferer then ponders and obsesses about the thoughts. They may develop rituals to ‘neutralize’ the thoughts. For sure, anxiety and the reduction of anxiety are significant supporting actors in OCD; in this view however, the lead role goes to the mis-exaggeration. In future posts, I’ll go more into detail about the some of the cognitive factors behind this.

2) Obsessions and compulsions are the most visible manifestations of brain malfunction. In some cases the brain malfunction can be traced to areas involved in regulating anxious arousal. In others, it can be traced to areas involved in accepting and receiving reassurance. In still others, it can be in the areas related to regulation of pleasure and the evaluation of risk.

In coming posts, we’ll consider case conceptualization and some of the suggested cognitive approaches.

In the meantime, stay well!


1 For those wanting to hear an excellent, brief interview with a journalist who has suffered with terrible OCD for decades, listen to Terry Gross of NPR’s Fresh Air speaking with David Adam here.