The Fine Line Between Preoccupation and Obsession

We all have worries from time to time that disturb our thoughts and interrupt our daily lives. They affect our performance at work and occupy our attention while we’re having a conversation or watching a movie. Some people worry too much, or about things that shouldn’t merit such attention or anxiety. When does worry stop being normal and become pathological? How do you know when you’ve crossed the line between preoccupation and obsession?

There are various different anxiety disorders that are classified depending on the type, quantity, and intensity of worry, as well as the reason behind it. These include generalized anxiety disorder, specific phobias, social phobias, and post-traumatic stress disorder.

But obsessive-compulsive disorder, characterized by obsessions that invade the mind, has been separated from anxiety disorders in the new DSM.

The prison of obsession

• Is the concern unrealistic? – The thing you’re worried about is very unlikely, which means you’re simply anticipating a very rare or almost impossible event to occur.
• Is the concern disproportionate? – Your level of concern doesn’t correspond to the severity of the issue.
• Do you spend a lot of time thinking about a specific subject or issue? – You spend the entire day worrying, to the point where it interferes with your daily life.
• Is your constant preoccupation causing distress? – Obsessions are egodystonic, meaning they cause a lot of distress that you’ll want to eliminate from your mind, although it seems impossible.
• Are these thoughts pushing you to do something you know is absurd or unlikely solve the problem? – Examples  include constantly washing your hands, opening and closing the door a certain amount of times, not touching any object with your hands, etc.
• Are you embarrassed to admit it to others? – You know that you have a problem, that your thoughts and/or behaviors are not normal, but you prefer to keep it a secret because nobody would understand or because they’d think you’re weird.
• Are you unable to control when or how long you worry for? – Disturbing thoughts appear suddenly, without warning, and you can do little to control them or make them disappear.

If you answered yes to many of these questions, consider consulting a professional to assess the problem. The fundamental differences between preoccupation and obsession are that obsessions appear involuntarily, interfere with your thoughts, cause distress, take up a large part of your day, and in some cases, push you to perform actions and rituals (compulsions) meant to reduce the associated anxiety.

Common obsessions

Although obsessions are very mixed thought patterns that can be expressed in many different ways, there are some typical ones. Here are some of the most common:

• Fear of contamination. Being afraid of touching objects directly with the hands for fear of contamination, thinking that the hands are dirty even when constantly washed, being afraid of being near someone who is sick and catching the illness, etc.
• Health and physical appearance. Obsession over physical appearance, finding defects where there are none, constantly looking in the mirror, etc.
• Sex. It’s very common for those who have this type of obsession to wonder whether they’re gay, which they usually aren’t.
• Aggressive in nature. Fear of doing something violent, attacking someone, or something horrible happening to a loved one.
• Psychosomatic or hypochondriac. Fear of getting sick and getting multiple tests done to check. With obsessions like these, it’s common for the person to think they’ve contracted HIV or another potentially dangerous disease.
• Having bad or obscene thoughts that won’t go away, such as hurting another person. These thoughts cause a lot of torment and guilt.

In many cases, compulsions follow obsessions, with the goal of reducing the anxiety caused by the obsession. Sometimes the compulsion isn’t obviously related to the obsession, and the intensity with which it is performed doesn’t usually match reality. Just like there are typical obsessions, there are also typical compulsions, which include the following:

• Washing the hands over and over again, even to the point where it damages the skin.
• Constantly checking whether the gas door was left open, the light was left on, etc.
• Needing to touch an object a certain amount of times.
• Counting up to a certain number mentally or out loud before beginning an action like opening the door.
• Organizing, putting everything in its place, going back to put it there even though it’s already there until everything is perfect, and starting over if anything changes or moves out of place, or even sometimes when everything is still intact.
• Hoarding, being unable to get rid of something. Even if it’s been years since it was used or it clearly will never be needed, the idea of throwing it causes anxiety.
• Praying over and over again for sinning or having intolerable or unforgivable thoughts, as an attempt at redemption.

Although compulsions can reduce anxiety in the short term, the effect doesn’t last and you have to continue performing rituals afterwards. Even though these rituals never give you any gratification or pleasure, they do give you a short and false sense of control over the obsessions that invade your thoughts.

Is there an escape from obsession?

Judith L. Rapaport, an expert on the subject, has studied and experimented with different treatments in people who suffer from obsessive-compulsive disorder. Her studies focus specifically on the use of clomipramine (Anafranil) as a treatment for obsession.

A large percentage of people showed a reduction in obsessive thoughts, although some people showed no effect. Today, SSRIs are used, which are antidepressants that have fewer side effects but work towards the same goal, although the medication of choice can vary.

Exposure and Response Prevention (ERP) is a type of psychotherapy in which the patient faces the object of their obsession, either directly or through imagination, and avoids performing rituals and compulsions. This is considered an effective treatment, and when combined with SSRIs, can produce a very positive response and alleviate the patient’s suffering.