By Elaine Ryan
What is OCD?
Most people have heard of OCD or watched programs about it on television. People often think of it as hand washing or repeatedly having to perform some sort of ritual, but there is a lot more to Obsessive Compulsive Disorder than that. OCD is one of my favorite conditions to work with, as there can be such a change in a person’s life when they break free from OCD. For those of you new to this site, I am a psychologist and specialize in anxiety disorders.
I want to provide a quick tour of OCD for those of you that are seeking information.
I am going to break this down into obsessions and compulsions. Most people with OCD have both, although you might just have obsessive thoughts.
Signs and Symptoms of OCD
Obsessions can be thoughts or images. You might have obsessive or intrusive thoughts relating to somehow causing harm to yourself or others. This can be directly hurting yourself or others, or indirectly. For example, you may be afraid that your actions might somehow cause harm. You might be concerned that something you do or do not do, may make someone ill or even kill them. You may be afraid that you might become ill or die yourself by contracting some disease.
Understandably, if you are concerned that you might cause harm to yourself or others you will take steps to stop this from happening. This might mean ensuring that everywhere is spotlessly clean and germ free. The obsessive thoughts then lead to rituals, otherwise known as compulsions.
Compulsions are developed in a way to reduce the anxiety associated with the obsessive thoughts and/or images. We all have compulsions or rituals to a certain degree. For example, think about superstitions, throwing salt over the shoulder, not putting an umbrella up indoors, not walking under ladders or splitting a post or pole with a friend when out walking. Do you really think that throwing salt over the shoulder will stop something from happening? Or that a long term friendship may be lost because while out walking you both walked either side of a post? Maybe not, but a lot of us do not risk it or “tempt fate” all the same. So well all have a bit of OCD.
It becomes problematic however, when the compulsions or rituals interfere with daily life.
When OCD becomes a problem
If you have OCD, you will realize, that the compulsions are more complicated than the examples given above. For example, if you cannot get the thought out of your head that you may cause harm to yourself or to the people you care about, by spreading germs or contaminating them in some way, you will not risk causing this harm. These thoughts and feelings will raise your anxiety and fear levels sky high and once you wash your hands or clean the kitchen, your anxiety goes down a little. This is the start of the compulsions.
However, your anxiety and fears quickly return and you wash your hands and clean again. Anxiety lowers, but quickly returns so you wash again. A vicious cycle quickly emerges, thought, compulsion, thought, compulsion, until it all becomes a blur and is just something that you do. Not being able to carry out compulsions, creates anxiety in itself. You may feel very distressed if you are not, for example, able to wash your hands. In fact, it can feel terrifying.
For some people the things that they do to reduce the anxiety, in an attempt to avoid something bad from happening, can seriously interfere with daily life. It can take hours to get out of the house in the morning. Work is problematic as you may not want people knowing what you do, but you still have to do it. And your anxiety is not as well controlled anymore by just washing your hands or cleaning.
Types of OCD
People who clean With OCD you may have a fear (as mentioned above) that somehow you can contaminate yourself or others, or somehow make people around you ill. You may obsess about germs and will try to ensure against the spread of germs by cleaning not only yourself, but also surfaces and objects. You may also have difficulty touching things as this would pass germs onto your hands that you have already washed. Even showering can be problematic. Once in the shower, it can be difficult to use shampoo or shower gel, you might find that you need to clean this as you go along, or may also have to avoid touching the shower screen or clean it as well. As you can see from this brief example, every day things become complex and create an extreme amount of external anxiety.
This helps to explain why many people with OCD find it difficult to get around or go out of the house. For people who do not have OCD, you are probably not aware how often we touch things as we go about our day. The alarm clock when we wake up. Door handle for the bathroom, all the objects in the bathroom. In our home, we can have some degree of control over this. Once we leave the house, however, there are door handles, bathrooms, people bumping into us, which for a person with OCD, can cause extreme anxiety, discomfort and fear.
People who hoard: Do you have difficulty throwing things out and your home is so cluttered that it is difficult to move freely? Some people with OCD experience difficulty throwing things out and would experience a spike in anxiety at the thought of it. The things may be needed at some stage. This can cause problems in relationships and your living environment as closets may be over flowing, work surfaces covered and piles of “stuff on the floor.” Again, this is a symptom of the underlying anxiety that OCD creates.
People who check: Nearly every one of us experience this to a certain degree. Leaving the house, only to return to check that the alarm was on, the oven was turned off. However, if you “check” as a result of OCD, it can affect your quality of life. It becomes more complex than just checking that the oven is off. You may have developed a routine that you check a certain number of times, only to leave the house, and wonder “is it really off?” This thought causes your anxiety to spike and your brain quickly learns that your anxiety decreases (albeit temporarily) when you return to the house and check again. Which leads to on to:
People who repeat: With the oven example, you may have to check it a certain number of times or wash your hands a certain number of times. You might repeat certain words or phrases in your head.
All of the above examples, although different, have one big thing in common. They all exist to lower your anxiety for a while. The thought comes into your head and you perform some of the above listed things, and anxiety goes down for a while. However, it does not stay down and the cycle starts to repeat, only now, it takes more compulsions or rituals to help to control your anxious thoughts.
There are also, what are known as Maintaining Factors in OCD.
Often the people around you, who love and care about you may in fact be maintaining your OCD. Again, we do not mean to, but we try to help the person we care about, by not touching the things that have been disinfected, or eating somewhere else, or driving back to check that the oven is off. This is done out of nothing but good for the other person, but long term, it stops you from fully recovering, as you do not get the chance to see that everything is ok.
Regardless of what way your OCD manifests itself, I always see one common factor. That somehow something bad will happen and it will be your fault.
This “something bad” can be causing harm to others. Something bad happening to you or your family. You can have disturbing intrusive thoughts that you believe that you could harm others. These can be of a sexual nature or inflicting bodily harm and are very frightening indeed. These thoughts may lead you to avoiding children or other people, or staying away from the knives in the kitchen or actually removing them in case you hurt someone. They are just thoughts. Alarming ones yes, but thoughts all the same.
Everyone that I have worked with, with OCD has never carried out any of the scary thoughts they have in their head. Nor have they unwittingly caused harm to others. This in itself can be problematic, as the person may believe that they have prevented something bad from happening by the rituals (compulsions) they perform and are very reluctant to stop doing them, in case something bad happens.
But this is what people who have recovered from OCD achieve. Firstly by reducing and finally eliminating their compulsions and then, seeing their thoughts for what they are – just mental activity in their brain. Cognitive Behavioral Therapy is what I mostly use to help people recover from OCD.
Treatment for OCD
The cornerstone of treatment is to help you to reduce and eliminate your compulsions and for you to stop having distressing thoughts and images. In order to achieve this we work with your thought processes and help you to reduce your overall levels of anxiety. When you are feeling calmer you are then in a good position to start working towards reducing and finally eliminating your compulsions.
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