40 christian counseling today SPECIAL EDITION In this brief article, I will offer a concise overview of what OCD is and what it is not. I want to familiarize the reader with several of the very effective treat- ment options available, as well as to clarify some of the more common misconceptions about OCD. The Two-headed Monster OCD is a disorder that can be simpli- fied by understanding the two symptoms from which it is named: obsessions and compulsions. Obsessions are intrusive and very troubling thoughts, doubts, worries or images that seem to pierce the individ- ual’s conscious thoughts unexpectedly and without invitation. These obses- sions can take many different forms, but they all have the same effect on the individual—intense anxiety. A few of the more common types of obsessions include: n fear of germs or contamination (what if that doorknob has a disease on it?; or what if that funny feeling in my head means I have a brain tumor?) n doubts (what if I didn’t turn off the stove before I left the house?; what if I touched that child in Sunday school inappropriately?; what if I cheated on a test by letting my eyes stray from the test for a few seconds?; or what if I have committed the unpardonable sin?) n intrusive and unacceptable thoughts or images (thoughts about having incest with a family member or sacred or holy images coupled with intrusive aggressive or sexual themes or content) n the need for things to feel “evened up” or symmetrical (if I bump into something with my left arm, I must deliberately bump it with my right arm; if I see something out of balance with my left eye, I must make sure to view it out of my right eye; or my shoes must be tied with the same tension on both feet) n fear of throwing anything out for fear that I might need it someday (and this “packrat syndrome” can lead to a home filled with junk from floor to ceiling) These are just a few of many types of intrusive thoughts, images, doubts, or worries that people with OCD experience. The other head of the OCD monster is compulsions . Compulsions are behav- iors and include things that people with OCD do in response to obsessions in order to alleviate the anxiety caused by the obsessions. Like obsessions, compul- sions take many different forms. Some of the more common include: n counting things repeatedly (counting objects, words people say, etc.) n doing things a certain number of times (often avoiding certain numbers) n silently spelling words that you or others say aloud n washing your hands or objects excessively n checking things repeatedly (checking to make sure appliances were turned off, checking to make sure you did not harm an object by “accidentally” bumping into it) n “undoing” thoughts that you feel are unacceptable (by repeating certain prayers, saying “no” over and over in your mind, concentrating on a thought that is the “opposite” of the unacceptable image or thought, etc.) n rubbing, touching, or tapping objects n “confessing” and/or seeking reassurance excessively and/or unnecessarily Again, these are only a few exam- ples of the more common types of compulsions.