The Obsessive thoughts, compulsive behaviours and the daily difficulties they bring
Did I lock the door before I left for the day? Is my lucky jersey washed for the game? I need to scrub my hands after that trip to the mall. These thoughts, habits or rituals are normal and quite common when they occur only occasionally. When our memory has us second-guessing, our team needs a little luck, or our need for cleanliness kicks in, we react so that we quickly feel better or can make our lives more efficient.
But when these fleeting thoughts, quick checks and clean habits begin to take over, interrupt normal life and 'feeling better' doesn't come easy, it is no longer a case of being cautious, superstitious or organized. When these behaviours are excessive, cause anxiety and complicate easy actions, it may be a case of Obsessive-Compulsive Disorder.
WHAT IS OCD?
Obsessive-compulsive disorder, or OCD, is a mental illness. It is an anxiety disorder that affects approximately 2% of the population. As the name suggests, it is characterized by obsessive thoughts and/or compulsive behaviours that cause anxiety and interfere with everyday life.
Obsessions are unwanted and seemingly uncontrollable thoughts, images or impulses that consume the mind repeatedly and don't go away on their own. They are time consuming, intrusive and cause a great deal of distress. Obsessions often lead to compulsions in an attempt to undo or correct the fixation.
Compulsions are certain acts or rituals that are repeatedly and excessively performed in a very deliberate way. Compulsions are most often performed in an attempt to rid oneself of the anxiety caused by the obsession or because individuals inexplicably feel the need to perform them. Unfortunately, those who carry out such compulsive behaviours often become slaves to their actions leading to increased, long-term anxiety. Added stress may also result if a compulsion can't be completed.
Those who suffer from OCD generally recognize that their thoughts and behaviours are irrational and often become increasingly anxious over this realization. Despite acknowledging the illogical nature of their obsessions, individuals with OCD still feel it necessary to carry out their behaviours no matter how senseless they seem.
OCD doesn't discriminate. It affects both men and women throughout all ethnic groups and of all ages. The illness often manifests at a young age with symptoms first recognizable in teenagers or young adults. Those with OCD can often trace the beginning of their symptoms back to their childhood yet young adults between the ages of 18 to 24 years old are most at risk for developing the illness. Males tend to be affected at an earlier age than their female counterparts.
It is not known exactly what causes OCD; however, researchers have concluded that both biological and psychological factors, including family history and life experiences, lead to the illness to varying degrees.
“OCD is an illness like any other, in that people do not chose it, and that it is not due to factors such as willpower or parenting,” says Dr. Evelyn Stewart, Associate Professor of Psychiatry at the University of British Columbia and Director of the Pediatric OCD Program at BC Children's Hospital.
TYPES OF OCD
While those with the illness can exhibit a varying degree of symptoms and in various ways, sufferers of OCD can often be categorized into a certain type.
• Washers: Obsess over the fear of contamination that causes cleaning compulsions.
• Checkers: Fear harm or danger which causes repeated checking of items and people.
• Doubters: Worry that if everything isn't perfect or just right, terrible things may occur.
• Counters: Obsess over order and symmetry that leads to number, colour or arrangement rituals.
• Hoarders: Fear bad things could happen if they don't keep items despite their use or necessity.
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Common Obsessions
• Fear of harming yourself or others
• Fear of being responsible for something terrible happening
• Superstitious ideas about numbers and colours
• Intrusive and perverse sexual thoughts
• Fear of contamination or contaminating others
• The need for everything to be 'just right'
• Excessive concern over religious or moral ideas
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Common Compulsions
• Excessive washing of hands, clothing or rooms
• Constant checking of locks, switches, appliances or for mistakes
• Constant checking in with loved ones to
confirm their safety
• Repeating actions in multiples
• Arranging items until it 'feels right'
• Avoiding situations that may trigger obsessions
DIAGNOSIS
An OCD diagnosis is best left up to medical and mental health professionals despite how easy it may seem to offer an uneducated opinion. To be diagnosed with OCD, means that obsessive and/or compulsive behaviours not only exist but they are distressing, intrusive and go beyond what would be considered normal worries and reactions. While the phrase 'OCD' often gets thrown around as a term to characterize someone who likes things organized, avoids germs or is overly particular, it is more than just caring about clean lines or washing your hands too much.
“Many individuals participate in behaviours that look a bit like symptoms of OCD, although these do not cause problems, explains Dr. Stewart. “For example, it is very common to double check a lock or spelling on an email, to reorganize belongings, and to clean or count objects. These can even be helpful. We only call them OCD symptoms when they cause marked distress, when they take up more than an hour a day, or when they get in the way of normal functioning.”
Those who suffer from the illness, suffer on a daily basis as they scrutinize and stress about their thoughts and actions. This obsessive behaviour affects how they live their life to the point that it interferes with everyday activities. School, work, relationships, and social outings can all be affected by an individual’s ability to control their OCD.
“The expressions of OCD vary tremendously from obsessions related to doing things perfectly, to obsessions about contracting HIV, to obsessions about contaminating other people with a serious illness,” explains Dr. Ingrid Söchting, registered Psychologist and Assistant Clinical Professor at UBC. “A psychiatrist or psychologist qualified to offer mental health diagnoses usually makes the diagnosis. Often family doctors suspect a patient may have OCD, and they will refer to a psychologist or psychiatrist.”
To be diagnosed with obsessive-compulsive disorder, one must spend a significant amount of time consumed by their obsessive thoughts or compulsive behaviours. This time spent consumed by the disorder can have a profound negative impact on going about day-to-day activities without interruption. When leaving the house is a chore in itself, going out for groceries, completing projects at work, or attending social gatherings are not as simple as they may sound and don't often occur. This causes an enormous amount of perpetual stress on an individual who is in a constant battle with their own mind.
Those suffering from OCD often find themselves in a debilitating and never-ending cycle – obsessions cause anxiety which is eased through compulsive behaviours. These rituals bring brief relief before obsessive thoughts return and the cycle begins again. Without psychological or medical intervention, the cycle isn't broken and OCD continues to be a problem that may worsen over time or become increasingly debilitating in times of stress, illness or fatigue.
These seemingly irrational thoughts and behaviours are difficult for outsiders to understand. Because of this, OCD is commonly misunderstood. Söchting explains that it is often believed that sufferers can just use their willpower and stop the cycle of repetitive thoughts and rituals. However, this is one of the biggest misconceptions surrounding the disorder. “OCD symptoms are extremely powerful and completely overrides ordinary levels of will power,” she says.
Additionally, certain misconceptions also bring about prejudice judgments from those not affected by the disorder. “Some symptoms of OCD such as fears of being a pedophile or of causing other kinds of harm such as violence toward loved ones may lead other people to think the OCD sufferer may indeed act on their obsessions and that they are perhaps unsafe people. That is not true!” says Söchting. “People with bona fide OCD are some of the most gentle, caring and conscientious people.”
TREATMENT
For some sufferers, the hardest part about OCD is being able to seek help. The strong feelings behind the disorder make it hard to explain to those that aren't affected and, consequently, guilt, shame and embarrassment leave the illness untreated. It is estimated that less than 10% of those with the disorder are currently undergoing treatment.
“OCD is highly treatable but clinicians hesitate to promise any cures,” says Söchting. “People who get treatment for their OCD often say their OCD is now on the back-burner as they resume productive and more ordinary lives.”
Thankfully for sufferers, there are several approaches that allow individuals to fight back against the dominating disorder. “We talk about OCD being like other chronic illnesses such as, for example, diabetes where the patient learns a number of behavioural management strategies to control their symptoms,” says Söchting.
One such strategy is Cognitive-Behavioural Therapy, or CBT. This type of therapy provides the tools and skills to help work through the complications that come with the debilitating diagnosis. Individuals are taught how their thoughts and feelings work together and they are provided with problem-solving, stress-reducing and relaxation skills that allow them to look differently at their obsessions and compulsions. An aspect of this strategy is called Exposure and Response Prevention (ERP) where those with the illness are repeatedly exposed to the source of their obsession and encouraged to avoid performing the usual accompanying compulsive behaviour.
“ERP is a treatment in which individuals learn to 'fight back' against what the OCD is telling them, and supports individuals to face their obsessive fears and to respond by doing the opposite of what OCD would urge them to do,” explains Dr. Stewart.
Support groups are a helpful tool for those who suffer and often feel as though they suffer alone. Group therapy can provide encouragement and support from those who understand what it is like to be a slave to the illness.
As with many mental health illnesses, self-care is a difficult yet effective treatment option that can provide welcome relief during times of extreme stress. A healthy diet, proper sleep habits and regular exercise all help to decrease anxiety which can in turn decrease stressful triggers and lessen the effects of the disorder.
For more severe cases, medical professionals can prescribe certain medications, such as antidepressants, that will help minimize the effects of the obsessive and compulsive behaviours when used in conjunction with CBT.
If someone in your life suffers from obsessive-compulsive behaviours, it may be difficult to offer your support, advice or comfort, especially without a thorough understanding of the disorder and its treatment.
“The best support loved ones can offer is to express empathy and understanding that their loved one is not trying to be annoying but is in a grip of a powerful and horrible illness,” says Söchting. She suggests that loved ones can “encourage the OCD sufferer to seek help from a mental health clinician who has demonstrated qualifications and expertise in assessing and treating OCD. Loved ones often become part of the patient's treatment as they can learn better ways to support the sufferer to not comply with their need for compulsions.”
By celebrating even small victories over the illness, it demonstrates to your loved one that they have your support as they work hard to make difficult changes and break free from a crippling and complicated illness.
