Written By Brian E. Hill, LSCSW
Published by the Salina Journal, October 2018
Quite often, we hear people say, “I'm a little OCD.” However, many of the people making, hearing, or agreeing with this comment are likely not aware of what this actually means or what OCD really looks like. Since October 7th through 13th is the International OCD Foundation's OCD Awareness Week, this could be an opportunity to increase your awareness. Obsessive-Compulsive Disorder (OCD) is a mental disorder that consists of people experiencing unwanted, intrusive, and repetitive thoughts that result in discomfort and/or distress (Obsessions). Following the experience of the disturbing thought, the person feels compelled to carry out some sort of act or ritual in order to decrease or eliminate their discomfort (Compulsions). These acts or rituals may be observable behavior, or they may be performed internally or mentally. The affected individual may experience impairment in their ability to work or study, or their personal and social relationships may be negatively impacted. In the United States, OCD is estimated to be present in 1.2% of the population according to the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition. Although this may not sound like many people, if you know 100 people, then one or two of them have OCD. Thus far, my description of OCD is rather sterile and does not accurately portray an image of what OCD looks like in “real-life” or the suffering that is endured by those afflicted with it.
A “real-life” example of this experience could go something like this: A parent has the thought, “I could kill my children with an axe.” A person without OCD may be able to easily disregard the thought as an unlikely possibility passing through their mind, but the OCD sufferer may assign a meaning to having the thought such as “If I can have that thought, then I might really be capable of doing it. I can't let myself have that thought again.” Unfortunately, the individual may then have the same or similar thoughts, see images, or be reminded of their perceived capability by various triggers. As a way to diminish their distress when confronted with an obsessive thought, they may carry out certain rituals such as saying a particular prayer a certain number of times, locking up all of the possible lethal weapons in their home, or seeking reassurance from others that they would not ever kill their child. Despite taking these measures, the thoughts persist, become more frequent, and branch into other possible violent obsessions. The affected individual never feels sufficiently reassured or certain that they would not kill their own child. They may become afraid to look at knives, watch movies with violent scenes, or even be alone with their children. It is important to note that people with OCD are very unlikely to actually commit any of the acts about which they obsess and are no more a danger to themselves or anyone else than any other member of the general public.
Another “real-life” example may be of a person concerned about contamination. This is what people often imagine when they think of someone with OCD. A college student experiences the thought, “There are horrible germs everywhere, and I don't want to get sick.” A person without OCD may be satisfied with common precautions such as washing their hands once after using the restroom, but a person with OCD would feel compelled to take excessive measures in order to avoid contamination. For example, the student, after washing their hands the first time, may think, “I don't quite feel like I did it right, so I better do it again.” This may progress to, “If I wash my hands correctly three times, then I can be certain that they are clean.” However, a miniscule deviation from what is deemed the “correct” ritual for washing one's hands may cause the student to have to begin again. In addition, the desire for certainty that they are clean may result in an increase in the number of rituals required or more strident practices such as using chemicals or abrasive tools may be adopted. The individual may find that they are spending hours each day performing rituals and are caught in a never ending cycle of attempting to gain the elusive certainty that they are clean. In addition, some individuals have caused themselves to develop medical complications due to the impact of their rituals upon their flesh.
For a third “real-life” example, a child could have the thought, “What if I tied my dog to the bumper of the car?” No, this is not a nod to the movie, “Vacation,” and, yes, even children can have OCD. In fact, OCD can develop anytime between preschool and adulthood. It is common for children to think of all sorts of possible things that they can do - my niece and nephew enjoyed putting macaroni up their nostrils simply because they fit when they were slightly younger. However, when a child is repeatedly worried that they will do something wrong or violent that they obviously do not want to do, then they could be experiencing obsessive thoughts. (Children can experience any of the obsessive thoughts that adults do.) The child that wonders “What if I tied my dog to the bumper of the car?” may feel compelled to check the bumper before they get into the car. They may then graduate to asking their parents to stop the car so that they can check again even though they just looked. Each time the child goes for a ride in a car they may conduct a ritual that they hope will give them certainty that they have not committed the same horrible act that Clark Griswold committed in “Vacation.”
As you might imagine, all of these obsessions and compulsions take up a great deal of time and interfere with work, school, social activities, and family functioning. Often, the members of the person's family are just as desperate for relief as the individual with the disorder. So, if it is so disruptive and distressing, why don't they “Just Stop!”? There is nothing that they would like more. However, there is more going on with this disorder than meets the eye. Upon experiencing an obsessive thought, the affected individual experiences a feeling of intense anxiety that does not respond to rationale thought. Research studies indicate that the brains of people with OCD have a problem with communication between structures of the brain that use the neurotransmitter serotonin. From a biological perspective, the person's body is responding as if there is an imminent threat to be addressed. If you thought that you could avoid eternal damnation if you prayed just the right way just one more time, would you not consider doing so? This is the unending dilemma faced by OCD sufferers. Doing what seems natural and intuitive actually serves to reinforce the cycle that feeds OCD, but to not do it seems to be a risk equivalent to death or being doomed to hell.
So what is to be done? Fortunately there is treatment for OCD, and the treatment is becoming more readily available and effective as more is learned about the disorder. A combination of medication and Cognitive-Behavioral Therapy (CBT) that includes a procedure known as “Exposure and Response Prevention” (ERP) has been shown to be effective in both research and in “real-life.” In addition, there are resources for education and support through organizations such as the International OCD Foundation (www.iocdf.org). There are excellent self-help books available such as “Stop Obsessing!” by Reid Wilson, Ph.D. You can even find videos on YouTube about OCD including a series called “OCD Stories.” Increasing awareness and education is probably the most important thing that you can do if you want to help someone specific or in general with OCD. If you want to contribute to further suffering, I guess you can tell people, “Just Stop!” and add to the stigma that prevents people from pursuing help for their condition.
Unfortunately, there are barriers to getting help. In addition to the embarrassment and stigma that often cause people to hide their difficulty, a lack of mental health professionals with training in treating OCD and even with a general awareness of it has posed a barrier for many individuals. It is not unusual for an individual with OCD to know more, sometimes much more, than their therapist about OCD. According to the International OCD Foundation (IOCDF), an average of 14 to 17 years go by from the time the symptoms begin until the affected individual obtains appropriate treatment. During those years, the individual is likely to see a number of mental health professionals who may cause harm due to their lack of knowledge or awareness. Of course, it is a bit unreasonable to ask mental health professionals to be experts on every facet of the human experience; therapists have to pick and choose what to study. My hope is that, equipped with a little more information and awareness about OCD, the readers of this article will be able to obtain or help others obtain qualified help that is available. If you are inclined to learn more about OCD, I would encourage you to go to the IOCDF website – www.iocdf.org. There is plethora of information available there including a directory of mental health professionals that are qualified to diagnose and treat people with OCD.
Brian E. Hill, LSCSW is a mental health therapist practicing in Salina, Kansas and a professional member of the International OCD Foundation.