Obsessive Compulsive Disorder (OCD) is an anxiety disorder, first and foremost. It is not a thought disorder. Although the thoughts associated with OCD are bizarre, they are not at all the focal point of the therapeutic objective. The essential features of OCD are recurrent obsessions (thoughts) that create an awareness of alarm or threat. (e.g., "I might get AIDS from the germs on that door knob;" "Since I had the thought of killing my baby, I might be capable of doing it;" "If I don't pick up that Band-Aid someone else might get sick from it, and I would hold myself culpable;" etc.). One may typically engage in some avoidance or escape response in reaction to the obsessive threat (I typically refer to the obsessive threat as a "spike."). Obsessions take the form of either a perceived threat of physical harm to oneself, or to others; or in some cases more of a metaphysical or spiritual threat to oneself, to others, or to perhaps a deity. I conceptualize the overall syndrome of OCD to consist of three primary branches; within all three branches, in approximately 80% of all cases, one performing the above rituals are painfully aware that his or her behavior is unreasonable and irrational (see my article, "Speak of the Devil").

This insight alone, however, provides no relief, and attempting to help sufferers through reassurance has no long lasting positive effect.     It is not unusual for one to question whether he or she may qualify for a diagnosis of OCD, given that most of the following examples are not unlike what most do, albeit to a limited degree, on an everyday basis. Everyday examples of OCD-like behavior include using one's foot to flush a toilet, knocking on wood three times to ward off a bad omen, throwing salt over one's shoulder for a positive future, or feeling inspired to say "God forbid!" after mentioning the potential death of a living person. Simplistic tests to determine whether these behaviors cross the line into the OCD realm include, for example, asking one's self, "how much money it would take for me not to perform this 'safe' behavior". One operating in the non-OCD realm would most likely accept between $10 to $100 to do something that would make them feel uncomfortable. One with OCD typically would not accept upwards in the neighborhood of $100,000 to face his or her feared concern. Another criterion involves the degree to which anxiety-driven behavior disrupts the life of the concerned person.

We all have quirks that take up small bits of the day. Very often, one wrestling with OCD invests hours of his or her day avoiding these concerns. All of us periodically hear a song repeat itself over and over again in our mind. For the great majority of us, the repetition becomes mildly annoying; for one with OCD, the intolerance and rejection of this mental experience generates a tremendous amount of agitation and anxiety over losing control of one's mind!    The most common and well-studied branch of OCD involves the OC where the undoing response generally involves some overt behavior. The most commonly conceived form of OCD involves contamination. Here, an awareness of germs, disease, or the mere presence of dirt evokes a sense of threat and an incredible inspiration to reduce the presence of these contaminants. Most commonly, the escape ritual involves a cleaning response (e.g., hand washing, chronic cleaning). The next most common form of OCD involves "checking". Typically checking involves door locks, light switches, faucets, stoves or items that, if left unchecked, might pose a risk to either one's own well-being or the well-being of others. It is not at all uncommon for a person with this manifestation to check items between 10 to 100 times before he or she is able to carry on with his or her day. The overwhelming impulse to recheck remains despite the fact that the items in question were secure from the beginning.