OCD can be a complicated condition to understand, whether you have it yourself or know someone who does. Sometimes the triggers leading to an OCD flare-up can seem to come from nowhere, but there’s a lot more to it than meets the eye.

We’re digging deeper to shine a light on all things OCD; what it is, what a ‘trigger’ is, what causes them, what’s going on inside the brain, and what can be done to help. At Augmentive, we aim to provide holistic, tailored mental health support to everyone so they can live their life to the fullest, so if you have questions about OCD triggers, we’re here to help.

What is OCD?

OCD stands for obsessive-compulsive disorder, and it is a mental health condition causing obsessive thoughts and compulsive behaviours. It is thought to impact around 1.2% of the UK population and can affect men and women of all ages. Although symptoms can start from around 6 years old, OCD often begins in early adulthood, but it can start later in life too.

"OCD is at its heart a special kind of anxiety disorder. It is broken into obsessions and compulsions. Obsessions are incurrent intrusive repetitive irrational thoughts which are encompassed by anxiety. The sufferer knows the thoughts are irrational but they can’t stop ruminating on them. It is accompanied by a mounting sense of anxiety. People temporarily relieve themselves of the thoughts and the accompanying anxiety by carrying out actions called compulsions. These might take the form of checking rituals or cleaning rituals." - Dr Adrian Lord, Consultant Psychiatrist

OCD can cause obsessive, usually unwanted or unpleasant thoughts or urges that are difficult to push away. The result of such obsessive thoughts is usually feelings of anxiety. Compulsions are obsessive thoughts that are acted upon, and it’s usually a repetitive behaviour the person feels “must” be done to temporarily relieve the unpleasant feelings.

This could be something like checking things over and over, counting objects, arranging things in a satisfying order, obsessively worrying about doing something wrong, or something else. OCD thoughts and behaviours look different for everyone, so you may experience something of this nature or your own individual symptoms.

“… Continually tormented by an inner sense of imperfection, connected with the perception that actions or intentions have been incompletely achieved.” — Pierre Janet, Psychologist

What is OCD not?

This is a great distinction to make, as OCD is often misunderstood. It has been reduced in popular culture to simple things like obsessive hand washing to avoid germs, or flicking a light switch on and off a certain amount of times. In reality, it can manifest in many ways, and the details of one’s obsessions and behaviours are unique.

OCD is not simply a series of triggers, a habit of being particular about things, or obsessively cleaning. It is a mental health condition that, although can be difficult to break free from, is possible to manage in daily life, and in many cases completely recover from.

What is an OCD trigger?

"OCD is a condition that normally lasts for many years and waxes and wanes over time. Triggers and relapses can come out of no apparent reason, for example life event stresses can trigger it." - Dr Adrian Lord, Consultant Psychiatrist

An OCD trigger is something external that sets off someone’s OCD. To clarify, we’re not talking about the initial causes of OCD (we’ll get to those later) but rather, what causes the issues to flare up in someone who already suffers from OCD.

Triggers are thoughts or situations that give your obsessions and compulsions a kick start. You might have gone hours, days, weeks or months without any OCD-related problems, but something happens to set them off again. Some examples might be:

• If your obsession is dirt and germs, OCD might flare up if you sit beside someone at a dinner party who has just gotten over the flu.
• If your compulsion is ordering and arranging things, your trigger might be someone touching your things.
• If your OCD is related to worrying that you have done something wrong, your trigger might be someone confronting you about something trivial that you take seriously.

Triggers often depend on the compulsions so they are unique to the individual. Identifying your own triggers can be helpful so you can learn to think it through logically in your mind before engaging in a compulsion.

Here’s a great example of a trigger from Vice writer Shayla Love (vice.com): “The sink is another trigger area for me, because we put our dirty dishes in it and I feel like its surface is extremely contaminated…. if the sink looks dirty in the morning, I’ll spend hours of the day remembering and picturing how dirty it was and thinking about how it’s infecting all of my forks and spoons and other things I’ll eat off of later.”

What do OCD triggers feel like when one is happening?

The stress caused by an OCD trigger is different for everyone, as each person’s obsessions and compulsions are different. Here are a few examples of how you might feel:

• A fixation with dirt or germs might make you feel like you have been ‘contaminated’ if you come into contact with any.
• Obsessive doubts (for example, about having turned off the oven) might make you feel anxious and like you can’t concentrate on anything until you check again.
• Thoughts about hurting someone might make you worry you will act on them without realising, or someone will discover what you’re thinking.
• Compulsive behaviours related to thoughts of having done something wrong might make you obsess about confessing, or want to excessively research on the internet, or desire reassurance from others.

"Common rituals may be intrusive thoughts that you have dirt or an infection on your skin or hands from things you have touched. You will know on an intellectual level you don't but the thoughts are so intrusive the only way to get rid of the anxiety is to excessively clean yourself and your environment. This gives a temporary relief from the anxiety and obsessional thoughts but before long it resumes again." - Dr Adrian Lord, Consultant Psychiatrist

How do I know if I have OCD or not?

There is a big difference between experiencing some of the traits of OCD and actually having OCD. Everyone exhibits OCD-like behaviours every so often, for example, triple checking the oven is off after you’ve cooked dinner.

Actually having OCD involves experiencing a much higher frequency of obsessive thoughts and compulsive behaviours that start to overtake your life in a negative way. If you double check the oven is off after cooking, that’s normal. If you check it multiple times and can’t stop thinking about it to the point where you can focus on nothing else until you check it is off, or check multiple times, you may have OCD and should speak to a professional for clarity.

Although there are ways to help yourself with OCD thoughts and behaviours, working with a specialist can be so important with OCD in particular to give you perspective on what is and is not an OCD thought or behaviour.

Fletcher Wortmann, author of Triggered, explains the difference very well; "I think everyone experiences these kind of things. Your mind will just sort of settle on something really distressing and upsetting ... most people are able to shake it off. Unfortunately, with obsessive-compulsive disorder, the thoughts take on kind of a life of [their] own…'"

What sort of things can lead to OCD developing?

By now you know OCD triggers are things that cause people’s existing OCD to flare up, but you may be wondering what causes OCD to develop in the first place. The underlying causes of OCD are usually related to either personal experiences, personality, or biological factors, but each person is different so there can be many reasons for its initial development.

Here are some of the common theories surrounding the causes of OCD:

• Genetics - Some specialists believe biological and genetic factors contribute to OCD, centred around having a reduced level of serotonin in the brain. Studies on genetic factors have examined how different parts of the brain could be involved in causing OCD to develop (more on this below). It’s also thought that some people have specific character traits making them more susceptible to developing OCD, such as neat, meticulous people.
• Learned behaviours - People with OCD may have learned their behaviours as a way to stay ‘in control’. This might happen by copying a parent’s tendencies, or starting a new job with high performance goals.
• Pregnancy - Something called ‘Perinatal OCD’ can develop during pregnancy or in the first year after giving birth. This can cause obsessive worries or doubts related to being a parent or your child’s health, or repetitive behaviours related to parenthood.
• Trauma - A traumatic event or PTSD has been found to be a major cause of OCD. One study investigated the onset of OCD in people with or without traumatic experiences, and found 61.2% participants had experienced various stressful life events, and 34% had had traumatic experiences before the onset of their OCD.

What happens to your brain during an OCD trigger?

Interesting studies have found certain areas of the brain are more active in OCD patients. They have excess activity in the frontal regions of their brain, including the orbitofrontal cortex and anterior cingulate cortex which are involved in emotion and decision-making. This is thought to explain the propensity for intrusive thoughts and high levels of anxiety.

In a nutshell; the cortex projects to the striatum in the brain, then to the thalamus, and back to the cortex, creating a positive feedback loop. In people with OCD, this loop appears to be in overdrive, especially when shown triggers. Treatment for OCD tends to normalise this activity.

Working with a professional to develop an individual framework for how to deal with these triggers when they arise can be helpful, and in some cases, brain and life-changing.

Are there any other conditions associated with OCD?

It has been established that a number of conditions can co-occur with OCD. Although it can also exist alone, OCD is associated with ADHD (Attention Deficit Hyperactivity Disorder) and autism.

Researchers have analysed brain scans to identify any similarities in those with OCD, autism or ADHD, and found many of the traits of these conditions work on a sort of sliding scale, so people don’t always fall into one category or the other.
According to one study, there is a high comorbidity between ADHD and OCD, especially in paediatric OCD. Another study found those first diagnosed with autism had a 2-fold higher risk of later being diagnosed with OCD, while those with OCD had a nearly 4-fold higher risk of being diagnosed with autism later in life.

What treatment options are available for OCD?

The main treatments often used for OCD include:

• Medication – A type of antidepressant may be prescribed in order to adjust the balance of chemicals in the brain. Your therapist can work with you to find the appropriate medication and dosage to help keep compulsions under control.
• Cognitive Behavioural Therapy (CBT) – Some talking therapies are recommended to help face triggers and obsessive thoughts without feeling the need to engage in compulsions. CBT focuses on how thoughts and beliefs affect feelings and behaviours.
• Exposure and response prevention (ERP) – This is more OCD-specific, and encourages you to confront obsessions and resist urges with the help of an experienced therapist who can support you throughout. The idea is, instead of engaging in compulsions to quell anxiety, you are encouraged to ride the anxiety wave until it passes.

Can you calm an OCD trigger yourself?

The above therapies can be challenging and will usually make you more anxious first. This is why it is important to work with a professional instead of trying to face triggers alone. It’s best to discuss your plans to expose yourself to your triggers with a specialist first to ensure you are taking appropriate measures. It can be very difficult to calm an OCD trigger, and there’s no shame in asking for help.

If you do feel ready to, there are ways you can help yourself day-to-day. Mainly this involves

stopping avoiding your fears and triggers altogether, and breaking them down into smaller, more manageable steps. For example, if you have a fear of touching door handles because of germs, start by:

• Opening a door with a glove on
• Then open it with your sleeve rolled down
• Then tap the handle with one finger without washing your hands
• … and so on
  

The first step should always make you slightly anxious, but not so frightened that you’re too intimidated to try it. Again, depending on the severity of your OCD symptoms, it may be best for you to work with a professional on this.

Anxiety will likely arise when you try to face triggers, so be prepared with some ways to calm anxious feelings. For you this might be journalling, mindfulness activities like meditation, speaking to a trusted friend, or distracting yourself with something relaxing like reading a book. Try these 8 tried and tested ways to calm your mind.

Remember, you don’t need to face OCD alone or feel ashamed to talk about your thoughts and compulsions. Although OCD looks different in each person, a specialist can help you feel better about your condition while offering a toolkit of ways to calm triggers and work through your OCD.

At Augmentive, we offer a free 15 minute consultation to help guide you towards a specialist who can help with your OCD symptoms, whether you’re looking for a therapist or a psychiatrist. We also have specialists available for a private OCD assessment to get a better understanding of your situation and the best way forward.

Whether you’re feeling off-kilter or want to shake up your routine, our state-of-the-art mental wellbeing platform gives you quick and seamless access to world-class support on your terms, from private psychiatric assessments to helping you find a therapist near you for support on your journey.

DISCLAIMER: The content published by Augmentive is not designed to treat, diagnose, cure, or prevent any disease or condition. Always consult your GP or a qualified healthcare provider with any questions regarding a medical condition and before starting any therapy, diet, exercise, or any other health-related programme.