Anxiety
Obsessions & Compulsions
By Les Linet MD
Jan 19, 2008

Obsessions are persistent but unwanted ideas, thoughts, impulses, or images that cause marked anxiety or distress. The most common obsessions are about contamination or repeated doubts (e.g., whether one has performed some act such as having hurt someone in a traffic accident or having left a door unlocked). Additional obsessions include having aggressive or horrific impulses (e.g., to hurt one's child or to shout an obscenity in church) or sexual imagery (e.g., a recurrent pornographic image).

Compulsions are repetitive behaviors (e.g., hand washing, ordering, checking) or mental acts (e.g., praying, counting, repeating words silently) that the person feels driven to perform in response to an obsession, or according to rules that must be applied rigidly. The goal of the compulsion is to prevent or reduce anxiety or to ward off some perceived harm or danger. The most common compulsions involve washing and cleaning, counting, checking, requesting or demanding assurances, repeating actions, and ordering. Patients’ compulsions are intended as harm avoidance devices. “If I wash my hands, my family will not die from my contamination of them.”

Dr. Linet has extensive experience in treating obsessive compulsive disorder. He uses both medication and non-medication approaches. One treatment technique is to imagine a large move screen onto which patients projects the horrifying and disturbing consequence they fear. Patients are then taught techniques to stop these thoughts. Often, they reach a point at which they are able simply to subvocalize the word “stop” and, thus, turn off the frightening image they were projecting onto the screen. Patients are further instructed that they can change the image from their obsessive danger to a pleasant scene. They are also instructed on how to practice and use these techniques at home.

Other non-medication therapy Dr. Linet employs includes cognitive behavior therapy and a well-researched technique called exposure and response prevention. A number of medications are also effective in treating most cases of OCD.

Dr. Linet appeared as guest three times on The Mental Health Report, a cable access television program produced by Elaine Edelman. One program was on the topic of Obsessive Compulsive Disorder.