Obsessive Compulsive Disorder
Before we start looking at what OCD is I want you to understand that about 1 in 100 people have OCD. Some estimates are as high as 1 in 40. That’s a lot of people. If you go to a Phillies game on a good day there are more than 40,000 people there—at 1 out of every 100, that is 400 people! So, you are certainly not alone.
No need to label yourself either. We need to name the condition in order to productively talk about it and we need to research it in order to be able to effectively treat it. Please know that while you may have OCD it is treatable and does not reflect who you are. You are not weak, some of the most courageous people I have met have OCD. You are not your OC, but you may have it.
The American Medical Association (AMA) and the American Psychological Academy (APA) still recommend Exposure/ Response Prevention as the first line psychological treatment of choice. OCD responds best to a specialized CBT treatment using primarily exposure/response prevention.
What are obsessions?
Obsessions are defined as thoughts, images or urges that come repeatedly without request, are stubborn and almost always create uncomfortable anxiety and distress. The person having the obsession finds them intrusive and doesn’t want them and attempts to ignore or suppress these thought, images or urges or tries to neutralize them some other thought or action (compulsion).
It is not obsessive to have occasional thoughts about anything you fear or about the safety of loved ones but watch out for a demand for perfect certainty. You know how you can’t really read people’s minds or predict the future 100% of the time and you get along just fine. It is the same with certainty, you can’t really have that either but you can and do also get along fine without it.
What are compulsions?
Compulsions are repetitive behaviors like hand washing, checking, ordering or mental acts like counting, praying or any other act that is designed to reduce the anxiety produced by the obsession. The behaviors and mental acts are all designed to reduce anxiety or prevent some feared consequence. The compulsions, also called rituals become excessive as we will see below.
This does not include harmless religious rituals, bed time stories or the like. Look more at the context. Reading to child at the same time each night is different than having to read at the same time each night because you are trying to neutralize or stop something bad from happening.
Now that you have some understanding of what obsessions and compulsions are let’s look at the cycle of obsessive compulsive disorder in the form of contamination. We’ll call this made up character Bill.
Action: Bill opens the door to the bathroom at work with a tissue in his hand (to protect from contamination) but thinks that he feels something wet come through the tissue. He looks at his hand and doesn’t see any moisture… but?
Obsession in the form of a thought: I don’t see anything, but what if it dried quickly after I got it on me and it’s still there dry, and toxic.
*Bill has experienced obsessions regarding fear of contamination to chemicals, pesticides in particular for about 3 years.
*You may have noticed that Bill didn’t see any moisture on his hand and his logical mind said move on but he didn’t, why?
The disorder is telling him that before he moves on he must be certain, absolutely perfectly certain of no toxin…this creates doubt in what he senses and experiences is true, no moisture.
The only method any of us have for knowing is our best logical guess. That leaves us to face some risk in this life. Risk is a normal part of living even if we don’t want it. Who do you know that has the ability to have perfect safety? It doesn’t exist and we do not need it to live a full life. Bill has stopped trusting his senses and experience and is opting for his minds distorted virtual reality.
People who don’t have OCD would have movedon without having to have more evidence. They would have lived with what they considered a small, very small risk. But Bill is now anxious and stuck because he has OCD and this distorted thinking demands something that can never be accomplished as a requirement for being ok! Perfect Certainty!
We all live with the low probable risk of dying from a toxin we can’t see. Trying to get a certainty that there is no risk will cause you to worry your life away. Try it! Bill is being fooled by an OCD distortion. The distorted thinking tells him that he can have perfect choice of no risk, like no one else on earth gets. This is why it is a disorder and makes him look past reality. The truth is that perfect certainty for any of us is simply not attainable, nor do we need it.
Next Obsession is in the form of an image. Bill sees himself getting sick, missing work, perhaps getting fired or maybe God forbid, dying!
*At this point bill is anxious, very anxious. Although his (and our) nervous system is complex and wonderfully efficient and effective his (our) perception guides what signals to send it. Can you guess what Bill’s stress response is hearing… danger of illness, unemployment or even death!
Remember what obsessions are: Obsessions are thoughts, images or urges that come repeatedly and are stubborn and almost always create uncomfortable anxiety and distress.
His distress comes in the form of very high anxiety and an urgency to fix the problem. He is reacting as if all his obsessions (thoughts) are imminent. How would that make you feel?
*His high anxiety sets the stage for his next very normal next move when confronted with apparent danger. If anxious there must be danger so get rid of it (this is called emotional reasoning in this case). Keep in mind that his perception is that he is in immediate life threatening danger and must be certain that this is not true. Watch what happens!
Seeing an obsessive image of himself as getting sick, missing work, perhaps getting fired or maybe God forbid, dying (All negative predictions about the future)! He has an unshakable urge to fix this danger. His efforts to fix this are his compulsions. Remember what a compulsion is?
*Compulsions are repetitive behaviors like hand washing, checking, ordering or mental acts like counting, praying or any other mental act that are designed to reduce the anxiety produced by an obsession. The behaviors and mental acts are all designed to reduce anxiety or prevent some feared consequence or to otherwise neutral or make the obsessive thought go away. The compulsions, also called rituals, will become excessive as we will see below.
Compulsion in the form of a behavior, hand washing. Bill uses 3 paper towels taken carefully from the dispenser to turn on the handle of the water faucet and then to squirt soap from a dispenser. He begins to feel his anxiety go down slowly as he washes his hands for the fifth time. He pays special and exhausting attention to what he believes is the affected area. He feels better.
As he cautiously dries his hands he has a thought: What if I didn’t get all? Although he tries to talk himself out of it with reassuring thoughts he washes 5 more times and then (he washes in blocks of 5 times it used to be 3 time)…he thinks what if I have just spread it…what if-wash…what if-wash…what if…
It will never stop. Demanding certainty is the engine of (OCD) and it will only keep saying: what if and hand him another possible negative problem that will make him wash as a way to try to get certainty of no risk this will make the virtual reality repeat until he somehow gets out of the virtual reality of no risk in living.
There is no Perfect Certainty
Bottom line, he will never become perfectly certain. He will finally say that is good enough and walk away. He will walk away because he is too tired, embarrassed, humiliated and his hands are chapped and cracked–but he is still not perfectly certain. Walking away is what a person who does not have OCD would have done in the first place. This is what Bill will need to learn as his OCD tries to fool him.
Having OCD Takes Time and Quality from Your Life
You may have noticed how many times Bill washed his hands and that it might interfere with his life. In fact, it is likely to increase. This is also an important element in deciding if you have a problem with OCD that could benefit from treatment. The compulsions must take more than an hour a day of your time or cause distress, interfere with your social, occupational or other important areas in your life.
Symptoms that you are experiencing cannot be attributed to the psychological effects of drugs, medication or another medical condition.
There are many other disorders that can present with symptoms like OCD but are not OCD. It is best to find a professional to make a formal identification of OCD. In fact OCD is still misdiagnosed and inappropriately treated often.
Types of Obsessions
OCD content can vary greatly. If the human can think of something it can also obsess about it. Some say that OCD is only limited by a creative imagination. Here are a few well known areas of obsessive concern.
*None of the lists that follow are exhaustive so please check with an expert who specializes in the treatment of OCD if you have questions.
Obsessions of Contamination
Bodily fluids or waste, household chemicals, environmental chemicals, germs, dirt, garbage, radiation, particular places or people, certain thoughts, certain events…
Obsessions of Harm to Self/Other
Losing control and harming others, losing control and harming self, causing harm to others/self through thoughts, negligence or carelessness, doubt if you have harmed someone in the past…
Obsessions of Aggression
Fear of harming self/others intentionally, fear of going crazy and harming others, fear of shouting or writing out embarrassing obscenities, fear of making obscene gestures, of having insulted or offended someone…
Obsessions of Perfection
Questioning if you have told the truth perfectly, questioning if others have understood you perfectly, keeping your possessions in perfect order, wanting to have a perfect appearance…
Fear of having forbidden perverse thoughts, images or impulses, fear of acting out sexually or being sexually excited by children, fear of desiring or having sex with animals…
Fear of being sinful or blasphemous on purpose, fears of having acted sinfully, having undesirable thought about religious deities…
Health and Body-Focused Obsessions
Believing that parts of your body are ugly or disfigured, asymmetry of parts of your body, fear of brain damage, fear of a serious undiagnosed illness…
Excessive awareness of your own thoughts, counting for no special reason, bothered by certain sounds, words or music, excessively aware of normal bodily functions, blinking, breathing, heart…
Having bad luck, lucky/unlucky numbers, colors, numbers, multiples of numbers…
Types of Compulsions
Washing your hands or body repeatedly and excessively, using gloves, paper or some other item to touch or pick up things, disinfecting yourself, your possessions or having others disinfect themselves, changing or having others change clothes frequently in order to avoid contamination, frequent avoidance or avoidance of touching for fear of contamination…
Keeping your things perfectly neat and clean, not using newly purchased items for fear of messing them up, avoiding using rooms, closets anything once it has been arranged perfectly, saying things perfectly…
Locks, doors, windows, stoves, car doors, headlights, water faucets, electrical appliances, extinguished cigarettes, matches, repetitive praying, crossing self, what you have read, columns of numbers, your memory, item you think you may have left behind, food for fear of contamination…
Repeating something with a good thought in it, rethinking thoughts, thinking thoughts in reverse, performing actions or movements in reverse, touching things in a special way…
Think thoughts in a specific or special way, know or learn everything on a specific topic, create specific thoughts or images, checking memory for past harm to self/others…
Counting while performing certain activities, repeating behaviors a certain number of times, performing behaviors odd or even numbers of times.
Touching or Movement Compulsions
Posing or gesturing in a certain way, move in specific ways while doing specific activities, tic or grimace in a special way, touch, tap or move your body in a certain fashion.
Warning others repeatedly of potential harm or danger, confessing to having done things that may have caused harm to others, asking others repeatedly if things will turn out ok or will turn out well for you.
Checking for imperfection or problems with your body in the mirror, checking your body for symmetry, cutting your hair for long periods of time to get it perfect…health—frequently seeking medical consultations for possible illnesses, frequent self-exams, frequent reading on the internet about illnesses you fear that you have…
Saving items simply because they belong to you or a loved one, saving broken, irreparable or useless items, inability to throw out items due to fear of accidentally throwing important items away.
Please remember that these lists do not reflect by any means the full scope of content in which obsessive and compulsive thoughts and behaviors can manifest. You are unique and so your OCD content can also be unique.
It is best if you suspect that you have OCD, from reading the above lists, to let a professional help figure it out and guide you in your treatment. Given my experience over the years it is likely that you may have been suffering for a log time without knowing that you have OCD or you may not have been receiving appropriate treatment. Our service areas include but are not limited to Philadelphia, Montgomery County, PA, the Main Line, and surrounding zip codes such as 19152, 19114, and and 19149.