Obsessive-compulsive disorder: When your head is screwed on too tight

As sophisticated as our mind is, every now and then it does strange things to us. Almost everyone knows it when a thought really bites and keeps coming back, no matter how much you distract yourself. The proverbial pink elephant, for example. The mind can also give us pretty nonsensical instructions for action, and we carry them out before we realize that they don’t actually do us any good. For example, we sometimes check the locked front door four times, even though we know for sure that it was locked by our own hand. This happens from time to time. In obsessive-compulsive disorder, however, the phenomena described take on a completely different scale.

Captured in compulsions

Let’s take a closer look at obsessive-compulsive disorder: It is first important to recognize the difference between obsessive thoughts and obsessive actions. These two forms of obsessive-compulsive disorder can occur alone or, in severe cases, in combination.

Obsessive thoughts

These are rising images, impulses and thoughts that are not necessarily put into action or spoken.

Compulsive acts

Concrete actions, such as washing or checking, that affect the affected person and his or her environment by their magnitude.

But whether compulsive thoughts or compulsive actions dominate in the affected person, he/she always feels an inner, subjective urge to do or think these certain things. Even if she tries to suppress the compulsion in her mind, it keeps popping into consciousness. Actually, the person knows that the thought or action is pointless, but still can’t break away from it with rational arguments. In the worst case, everyday life can be massively restricted because there is hardly any space or time left for normal life. Obsessive-compulsive disorders are also not as rare as many people think: just over 2% of the German population suffer from an obsessive-compulsive disorder.

Important: Obsessive-compulsive acts should be distinguished from rituals. Rituals, for example, emotional events such as weddings or funerals, give us support and security. Other common rituals are greetings, honors, table manners and so on. However, these rituals are usually performed to a similar extent by quite a lot of people of the same culture.

Typical symptoms of obsessive-compulsive disorder

Obsessive-compulsive actions and obsessive thoughts can occur in isolation, but they can also occur in tandem. However, in most cases, compulsive actions are preceded by a troubling thought. Interestingly, OCD sufferers show similar patterns in their obsessive-compulsive symptoms. Although the specific content is individual, the basic theme is often repeated:

Frequent obsessive thoughts

  • The possibility of saying or doing something unpleasant
  • Considerations of hurting or harming oneself or others
  • Contagion or dirt
  • Symmetrical arrangement of things
  • Sexual practices/preferences
  • Religious content

Frequent compulsive behaviors

  • Washing compulsions (hands, clothes, home…)
  • Compulsion to control (stove, windows, doors…)
  • Compulsion according to symmetrical arrangement
  • Counting according to certain patterns
  • Repetition of prayer phrases, words or sentences

You might also think some of the compulsions are hidden anxieties. Most often, however, the underlying emotion in OCD is not anxiety, but rather restlessness, tension, or disgust. In the past, anxiety and obsessive-compulsive disorders were even grouped together, but today a distinction is made between them.

Compulsive Disorders: A real-world example

A young woman (mother of two young children) is receiving treatment at a psychiatric hospital. She has been suffering from obsessive-compulsive disorder for two years. At first, compulsive acts occurred: for example, the woman had the inner urge to change her clothes exactly ten times before leaving the house. At first, she was able to integrate this compulsion into her daily routine quite well; for example, she got up extra early in order to still be able to complete all her tasks in the morning. Gradually, however, obsessive thoughts came in. She kept having the thought that she could hurt her little daughter.

Most recently, she did not pick up any sharp or heavy objects (e.g., knives or bottles) in her daughter’s presence because her obsessive thoughts put her under such pressure. Shortly before admission to the clinic, she had a breakdown because she could no longer withstand the pressure of the obsessive-compulsive disorder and feared she was going crazy.

The diagnosis of obsessive-compulsive disorder

Many sufferers live with their OCD for a long time without seeking help. The reason is that they are ashamed of not being in control of their thoughts and actions. OCD often runs in episodes, which means that its severity changes in phases. Why obsessive-compulsive disorder occurs is unclear. However, several perspectives are discussed.

  • Vulnerability: People vary in their susceptibility to mental (and physical) illness. This is due to genetic makeup, biological factors, and psychological factors.
  • Familial factors: Obsessive-compulsive disorders are clustered in some families.
  • Developmental/educational: an upbringing that provides little security can lead to compulsive behavior, which then maintains an illusion of control.
  • Psychological models: an initially harmless but intrusive thought is evaluated as dangerous. This leads to restlessness and agitation. Through the compulsive action, this restlessness is “down-regulated”. A self-reinforcing vicious circle is created.

What helps with obsessive-compulsive disorder?

For a long time, obsessive-compulsive disorder was considered difficult to treat. In the meantime, however, great improvements can be achieved with cognitive behavioral therapy. Depending on the severity of the disease, drug treatment with antidepressants is also considered (as with depression, the balance of neurotransmitters in the brain can also be disturbed in obsessive-compulsive disorder)

In cognitive behavioral therapy, an individual model of the development of the obsessive-compulsive disorder is first worked out together. Possible starting points are then filtered out. This often involves dealing with emotions and the internal evaluation of intrusive thoughts. In the case of obsessive thoughts, the affected person is confronted with the triggering situation and learns how to prevent their compulsive reaction. Treating obsessive thoughts is a bit trickier, since they can’t be seen or willingly suppressed. Here, the main work is on internal appraisal and acceptance of the compulsive thoughts.

Escaping the compulsions

If you find your own symptoms or those of a loved one reflected in this article, we encourage you here to seek help and treatment options. You are not alone in your suffering!

Don’t let your life be ruled by obsessive thoughts and actions. With the right therapy, perhaps inspired by a song lyric by Udo Jürgens, you can “escape from all compulsions” and shape your life freely again.


(1) Wittchen, H. U., & Hoyer, J. (2006). Clinical psychology & psychotherapy (Vol. 1131). Heidelberg: Springer

(2) Deutsche Gesellschaft Zwangserkrankungen e.V. (n.d.) http://www.zwaenge.de/diagnose/frameset_diagnose.htm Accessed on: 19.07.2019

Verena Klein
Autor Verena Klein
"Die LIMES Schlosskliniken haben sich auf die Behandlung von psychischen und psychosomatischen Erkrankungen spezialisiert. Mit Hilfe des Blogs möchten wir als Klinikgruppe die verschiedenen psychischen Erkrankungen näher beleuchten und verschiedene Therapien sowie aktuelle Themen vorstellen."

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