Obsessions are unwanted, annoying thoughts, motives, or images, which usually cause pronounced discomfort or anxiety. The dominant theme of obsessive thoughts can be harm or risk to oneself and others, danger, infection, doubt, loss, or aggression. For instance, patients may be haunted by the thought of contracting bacteria through dirt if they do not wash their hands every 2 hours or more often. Obsessions are unpleasant for patients, so they try to ignore or suppress these thoughts, motives, or images. Another way to deal with them is to neutralize them through compulsions.
Compulsions are excessive, repetitive, purposeful actions. Patients feel an urgent need for them to prevent or reduce anxiety caused by obsessive thoughts, or to neutralize obsessive thoughts themselves. Most compulsive rituals, such as washing hands or checking locks, are obvious. However, some rituals, such as silently pronounced phrases, are not seen by others. Usually, compulsive rituals must be performed in a certain way in accordance with strict rules.
A common way of OCD treatment is cognitive-behavioral therapy. During treatment, the therapist must convince the patient of the possibility of recovery. The patient should believe in the treatment effectiveness, provided that the prescriptions are systematically followed. If the patient has rituals, the improvement usually occurs when the reaction prevention method is combined with placing the patient in conditions that exacerbate these rituals. Significant but not complete improvement can be expected in approximately two-thirds of patients with moderately severe rituals. If, as a result of such treatment, the severity of the rituals decreases, then the accompanying obsessive thoughts usually recede as well. However, such therapy is significantly less effective for obsessive thoughts that are not accompanied by rituals. Thus, the most productive treatment is a combination of this and other treatment methods with drug therapy.