Glossary of Terms
A B C D E F G H I J K L M N O P Q R S T U V W X Y Z
Accommodation - When others (family, coworkers, friends, etc.) help a person with OCD to ritualize (for example, by purchasing toilet paper and paper towels, by completing rituals, or by waiting while s/he ritualizes, etc.). Accommodation, although usually well-intended, actually makes a person's OCD worse. Family members can be helped by a therapist to learn different ways of being supportive without helping an individual to ritualize.
Automatic Thoughts - Thoughts that "pop" into one's mind during a certain situation. These thoughts, although sometimes very simple, can represent attitudes or beliefs that fuel feelings. See also 'Hot Cognitions.'
Avoidance Behavior - Any behavior that is done with the intention of avoiding a trigger in order to avoid anxiety. Avoidance behaviors are treated as a ritual.
Behavior Therapist - The therapist (or social worker or psychologist) who is in charge of one's treatment plan for OCD using behavior therapy, most often Exposure and Response Prevention.
Behavior Therapy - A type of therapy that applies learning theory principles to current problem behaviors that one wishes to change. As the name implies, the point of intervention is at the behavioral level.
Body Dysmorphic Disorder (BDD) - Obsessions about a body part being deformed in some way, resulting in repeated rituals involving checking, mirror checking, excessive grooming, inability to dress oneself, and avoidance behaviors. Sometimes individuals with BDD have plastic surgeries relating to their imagined defects, but the relief (if there is any) is short-lived, and soon the individual begins worrying again, or the focus of his/her BDD can change to a different body part.
Checking Compulsions - Repetitive checking behaviors in order to reduce the probability that someone will be harmed, or to reduce the probability that one might make a mistake. The checking can be behavioral (i.e. physically returning to a room to check if an appliance is turned off) or it can take the form of a mental ritual (i.e. a mental review in which a person imagines in detail each step he/she took to complete a task).
Competing Alternative Behaviors - When one is trying to stop a bad habit, one can engage in a competing alternative behavior, which is an activity that inhibits the ability of the person with OCD to engage in the habit that s/he is trying to break. For example, if one is knitting, one is unable to simultaneously pull one's hair. See also 'Habit Reversal.'
Compulsions - Compulsions, also known as rituals, are repetitive behaviors or thoughts that conform to rigid rules as far as number, order, etc. that function as an attempt to reduce anxiety brought on by intrusive thoughts.
Contamination Compulsions - These are washing and cleaning behaviors in a particular order or frequency in an attempt to reduce chronic worry about being exposed to germs or becoming ill. This can also be done for emotional contamination, in which a person washes and cleans in order to reduce the chances of taking on the characteristics of another person.
Contamination Obsessions - Excessive worries about germs, bodily functions, and illness. The risk is overestimated, given the chances of actually getting sick.
Distraction - A strategy used primarily outside ERP to enhance one's ability to resist rituals. One does another activity (for example, playing a board game, watching TV, taking a walk, etc.) while triggered in order to cope with anxiety without ritualizing.
Emotional Contamination Obsessions - Worry that one will be contaminated by the characteristics of another person. The worrier believes that the risk of "catching" the other person's personality is much like when one is exposed to germs. The spread of the "emotional germs" can be through touching, or can even be airborne. This usually includes magical thinking and superstitious behaviors. For more on Emotional Contamination, click here.
Exposure and Response Prevention (ERP) - The behavioral treatment of choice for OCD during which a person with OCD purposefully triggers an obsession and blocks his/her rituals in order to create habituation. ERP is initially done with a behavioral coach, who assists the person with OCD to resist rituals. Eventually the coaching is faded, as the person with OCD becomes more able to resist rituals without help.
Extinction - The process by which reinforcement is withheld in order to decrease or eliminate a target behavior. It is common to have an extinction burst initially, which is an increase of the target behavior when the extinction process is started.
Extinction Burst - An initial increase in behavior (can be obsessions or rituals) when one first stops reinforcing a behavior. When you start a new and more difficult ERP, you should not be surprised if initially you feel more ritualistic and the urge to ritualize feels stronger.
Fading the Prompt - Once a positive behavior is successfully initiated, the behavioral coach will stop giving the verbal or behavioral cue out loud, so the individual with OCD can practice the new behavior without help. See also 'Verbal Prompt.'
Functional Analysis - The therapist and the individual with OCD study the behaviors and thoughts that occur before and after a target behavior occurs.
Generalization - The transfer of learning from one environment to another, or from one stimulus to a broader range of stimuli in the same category.
Habit Reversal Treatment - This is the behavioral treatment of choice for Trichotillomania. In this treatment the patient becomes more aware of patterns of picking or pulling, identifies the behaviors that bring on the picking or pulling, and then works on developing alternative behaviors to block the destructive habit. For instance, when feeling high levels of anxiety a hair puller can knit, which keeps both hands occupied and keeps the individual engaged in a relaxing activity when s/he is at a high risk to pull.
Habituation - The process during which a person stops responding to a stimulus because it is no longer new. For example, after jumping into a cold swimming pool, one might initially feel that the water is too cold; however, after splashing around for a few minutes, the water begins to feel warmer (even though the water temperature has not changed at all) because the swimmer has gotten used to the water temperature. An example of this in OCD would be when someone who worries about germs touches a doorknob without a barrier for at least 1.5 hours. As time passes without the person ritualizing, the person can no longer maintain an anxious response.
Harm Obsessions - Excessive worries that one will be harmed, or that others will be harmed, due to intentional or accidental behavior on the part of the person with OCD.
Hierarchy - A list of situations or triggers that are ranked in order from easier tasks to more difficult tasks according to the patient's estimated SUDS ratings. Consider the hierarchy as a map or outline of future ERPs.
Hoarding Compulsions - Saving unreasonable amounts of an item "in case someone else might need it," even though one no longer has space to keep belongings. Objects are saved even when they are a health hazard.
Hoarding Obsessions - Worry that one must save more than is necessary in order to feel secure. The hoarder is not as disturbed by his/her saving and accumulation patterns as those around him/her.
Hot Cognitions - Automatic thoughts that generate strong or intense affect.
Insight - For someone with OCD, this is the understanding (when not triggered by an obsession) that one's worry is not realistic, nor does the logic applied to the person's ritual make any sense. Usually when one is triggered or experiencing high anxiety about an obsession, the level of insight decreases dramatically.
Mental Ritual - A mental act, done in response to an unwanted obsession, that is completed in order to reduce anxiety. Often a mental ritual must be repeated multiple times. It can be a prayer, a repeated phrase, a review of steps taken, a self-reassurance, etc. Often a mental ritual is repeated so often that the individual barely has any awareness of the thought.
Mindfulness - A focus on the present. This is a skill that takes a considerable amount of practice.
Negative Reinforcement - When a reinforcement is removed, the behavior increases. When a person's headache is eased after taking an aspirin, that experience will increase the likelihood that the person will take an aspirin the next time he has a headache.
Neutralization - Refers to when an individual with OCD "undoes" a behavior or thought that is believed to be "dangerous" by neutralizing it with another behavior or thought. This behavior is also considered a ritual.
Obsessions - Obsessions are repetitive intrusive thoughts or images that dramatically increase anxiety. The obsessions are so unpleasant that the person with OCD tries to control or suppress the fear. The more the person attempts to suppress the fear, the more entrenched and ever-present it becomes.
Obsessive Compulsive Disorder (OCD) - People diagnosed with OCD spend over one hour daily struggling with repetitive intrusive thoughts, impulses and/or behavioral urges that increase their anxiety. They try to control their obsessions with compulsive behaviors (rituals) that function as an attempt to reduce their anxiety. Over time, the rituals become less and less effective in controlling the obsessions.
Overvalued Ideation - When the person with OCD has great difficulty understanding that his/her worry is senseless.
Perfectionism - Unrealistically high expectations about one's performance on any task. Failure is catastrophic and unbearable. Anything less than 100% perfection is considered a failure. Consequently, perfectionists are paralyzed and sometimes unable to begin a task until the last minute, or are sometimes unable to complete a task. For more on perfectionism, click here.
Positive Reinforcement - An action or behavior is applied and the consequence is that the frequency of the behavior will increase. For example, when a teacher praises a student for raising his/her hand in class before speaking, the likelihood of the student's behavior of raising his/her hand before speaking will increase.
Praying Compulsions - This can include repetitive praying for forgiveness or asking God to protect a person perceived to be at risk, reading the Bible or watching religious TV programming for hours daily, and repeated confessing for possible sins.
Psychiatric Nurse - This mental health professional has a Bachelor's degree in nursing with a special emphasis on psychiatry and working with mentally ill populations.
Psychiatrist - This mental health professional has completed medical school and has specialized in psychiatry and mental illness. S/he can do therapy and prescribe medicine.
Psychologist - This mental health professional holds a doctorate in either clinical or counseling psychology. This individual can have a Ph.D., which is a research degree, or a Psy.D., which has a clinical focus.
Psychopharmacologist - This mental health professional prescribes psychiatric medicines and is an expert in how these medicines work together.
Reassurance Seeking - When a person with OCD asks others questions repetitively to reduce his/her anxiety (for example, "Do you think this food is spoiled?" or "Do you think I will get sick?"). Sometimes a person with OCD can get reassurance merely from watching another's facial expression and/or body posture. All reassurance seeking is considered a ritual.
Redirection - When a therapist tells an individual with OCD to change or stop a behavior that is interfering with treatment.
Reinforcement - Any response from an individual that will increase the frequency of a particular behavior from the recipient.
Relapse Prevention - A set of skills, both cognitive and behavioral, aimed at preventing an individual with OCD from slipping back into old compulsive behaviors.
Retrigger - A thought or behavior completed by the individual with OCD in order to undo the negative effects of the rituals. The person may feel relieved by a reassuring thought like, "I will be okay," but then he must say to himself, "Well, maybe I won't be okay. Anything is possible."
Ritual - Another word for compulsive behavior, which can be a behavior that others can see, or a hidden or unseen mental behavior. Many mental health professionals will identify anything that reduces one's anxiety as a ritual. For example, although avoidance behavior is done to avoid the trigger altogether, it still is the same as an outright ritual, in that it is an attempt to reduce anxiety.
Scrupulosity (Religious) Obsessions - Excessive worry about being moral, or worry about blasphemy.
Self-Directed Exposure and Response Prevention (SDERP) - Once you have learned to effectively block rituals with the assistance of a behavioral coach, you will practice your ERP on your own, with very little help. This task is much more difficult because you must resist your rituals when triggered and there is no one to hold you accountable or help you motivate yourself to resist.
Self-Reassurance - A thought or phrase said out loud or silently in order to lower one's anxiety (for example, "I'm not going to get sick," or "I would never hurt a child). This is considered a ritualistic behavior.
Sexual Obsessions - Unwanted, inappropriate sexual thoughts that are repulsive to the person affected. Often, thoughts are sexually aggressive towards a vulnerable population (children, the elderly, family, or strangers).
Social Worker - This individual has a Master's degree in social work, which specializes in psychotherapy, social adjustment and social justice issues.
Somatic Obsessions - Unrealistic worry about catching a particular illness (for example, HIV or Hepatitis).
Stimulus Control - When a person changes something in his/her environment that affects a particular behavior. For example, if a person can't sleep, lights are turned off in the room.
Subjective Units of Distress (SUDS) - This is a scale from either 1 to 10 or 1 to 100, in which the person with OCD rates his/her anxiety, 1 being the least anxious to 10 or 100 being the most anxious. The scale is each individual person's sense of his/her own anxiety.
Superstitious Behavior - Behavior that is accidentally reinforced by coincidence. The behavior increases but it does not have the influence that the person imagines it does.
Symmetry and Exactness Compulsions (also known as Just Right Compulsions) - Involves fussing with the position of an object for too much time. The person can't stop the behavior until it "feels right."
Symmetry and Exactness Obsessions (also known as Just Right Obsessions) - One fears that something bad might happen if the behavior is stopped before it "feels right." Some people with these obsessions do not worry that something bad will happen; rather, they report that something MUST feel right before ending a particular behavior.
Tic Disorder - A neurological disorder in which the body involuntarily moves in a random pattern. This is usually worsened by stress.
Tourettes Disorder - A neurological disorder in which a person engages in both involuntary physical and verbal behaviors in a random fashion. This is usually worsened by stress.
Trichotillomania - When a person is unable to stop impulsively pulling his/her hair from his/her head, eyebrows, eye lashes, arms, legs or pubic area. The hair pulling is often pleasurable and soothing. People report doing this behavior when stressed or bored. Skin picking also falls into this category. See also 'Habit Reversal Treatment.'
Trigger - This can be an external event or object or an internal thought that sets off an obsession.
Verbal Prompt - A verbal cue that directs the patient as to what to do to resist a ritual, distract from obsessing, or to manage the effect. See also 'Fading the Prompt.'
Y-BOCS - Yale-Brown Obsessive Compulsive Scale. Includes a symptom checklist of OCD obsessions and compulsions and a rating scale to measure the severity of the OCD. Usually, people who score over 16 also meet the DSM-TR criteria for OCD.
By Carol Hevia, Psy.D.
Behavior Therapist
OCD Institute, McLean Hospital
