Obsessive-Compulsive Disorder is a chronic disorder in which a person experiences excessive thoughts of worry or concern which give rise to anxiety that can only be abated by performing repetitive, compulsive behaviors. Both the excessive thoughts and behaviors tend to be irrational, and thus they typically add little benefit to a person’s life. Often they are a nuisance, and occasionally they are disruptive. In some cases OCD becomes debilitating. OCD is a common psychological disorder, and it’s quite treatable.
Depending on who you ask, mental health professionals will identify anywhere from 4 to 7 different major categories of OCD, and each has various subcategories. And there exist other varieties of OCD that are not described here. Regardless of how you choose to classify them, the main thing to remember about OCD is its cycle of thoughts and behaviors:
1. Obsessive thoughts, which lead to…
2. Fear or anxiety, which leads to…
3. Compulsive Behavior, which leads to…
4. An uneasy peace of mind, which leads back to (1)
In this form of OCD, the individual suffers from obsessive thoughts about the threat of some form of contamination, usually germs. This gives rise to the compulsion to clean one’s environment constantly and protect oneself from germs. The more severe an individual’s case is, the greater the time wasted on cleaning behaviors.
In this variant, the individual suffers from obsessive thoughts about keeping things organized. This can simply mean putting things away, but it often also involves putting them in meticulous order such that they have a distinctive visual appeal or symmetry. Of course, such individuals’ obsession gives rise to compulsively organizing their environments or possessions.
People with this form of OCD may compulsively count in their mind, and need to repeat actions symmetrically a certain number of times. If they step on a line in the sidewalk with their left foot they must do the same with their right foot the same number of times. Often the numbers they hold in their mind have an innate symmetry to them. As this type of OCD becomes more pervasive it can take increasingly more mental energy to maintain the imagined symmetry in the mind.
Individuals who suffer from this form of OCD are obsessed with the possibility of harm or danger, in particular as it pertains to some sort of behavior within the individual’s control. For example, a person might compulsively check to make sure that he or she has turned off the stove. One element of this compulsion is that the individual can lose trust of their memory, and thus they can begin to doubt whether or not they have “checked” to make sure they are safe. If the individual is only 99% sure that they have turned the stove off, they will have to repeat the behavior as soon as the doubt begins to arise in order to enjoy peace of mind once again. In some forms of Harm OCD the person may fear irrationally that they will act out in ways that impinge on their values or identity, that they may cheat on their partner, kill someone or commit suicide.
Hoarding stems from the tendency to over-value items, or to project some meaning onto them. Thus, the hoarder experiences anxiety at the possibility of losing them, or of throwing or giving them away. Hoarders tend to hold onto things that most people see as worthless – even trash. Many will go to great lengths to store items in their homes, which can result in clutter and even unsanitary conditions. In extreme situations the hoarder’s environment becomes dangerous, requiring family or even local government intervention. This can cause intense emotional suffering and shame for the individual.
We all can get caught in rumination from time to time. An individual suffering from obsessive ruminations will overthink pretty much anything. As they ponder and ponder different aspects of something, they will spend considerable time, often to the detriment of their careers, families, or relationships. Such thoughts are not limited to important decisions; they can also pertain to mundane or trivial matters.
Intrusive thoughts enter the individual’s mind as an unwelcome suggestion to engage in certain kinds of behavior. Typically, the behavior is something the individual usually avoids, finding it repugnant or unwholesome. For example, a person might experience the suggestion to commit a violent act. Some varieties include: violent thoughts, sexual thoughts, religious or moral thoughts, or magical thoughts, which suggest a connection between a person’s behavior and good or bad fortune. For example, a person who struggles with magical thinking might believe that if he steps on a crack in the sidewalk that something terrible will happen.
A final category of OCD is meant for obsessions that concern non-visual compulsions or imagery. Musical thinking, for example, is similar to intrusive thoughts, however the thoughts do not arrive in the form of words. If a person hears a certain song in certain circumstances, then that person might have thoughts or behavior that arise as a result. Or, a person might have a certain song stuck playing in his or her mind unceasingly, or arising at random times.
Identifying the cause of OCD is different from identifying its triggers. Generally, genetics are seen as the cause of the condition. However, not everyone develops OCD that is genetically predisposed to do so. Those who do develop it can sometimes trace it back to a traumatic event, an illness, or stress brought on by a significant loss or an ongoing difficult situation.
Recent neurological research reveals differences in the brains of people with chronic OCD.
In such individuals, the parts of the brain involved in sending information for processing operate differently and never allow the brain to come to a conclusion. So thoughts continue to re-enter the cortex for re-processing. Think of the times when you sort through a problem or a series of issues in your own mind. When you finally come to a decision, you have a sense of relief and conclusion, and you can put it behind you and move on. Many people with OCD never have that sense of relief and conclusion.
Another key difference in people with OCD is that they can never be comfortable with uncertainty. Many of the obsessions and compulsions involve seeking a sense of absolute certainty, which is impossible in life. A critical piece of providing relief for those who suffer from OCD is enabling them to accept a certain amount of uncertainty.
For someone with OCD, anxiety, stress, or certain negative thinking or behavior can trigger a resurgence of symptoms. Each patient is different. Certain triggers might cause no reaction in one person, however if a different patient were to experience them, they might have a severe reaction.
OCD is a disorder with both a learned and a neurobiological basis that results in obsessions and compulsive behaviors. Treatment generally involves Exposure Therapy and it may also involve medication. To be effective over the long term, treatment will enable the patient to develop new neural pathways that serve as an alternative to those that tie the obsession or trigger to the compulsive behavior. The good news is that our brains are malleable, and with the right strategies, we can rewire them.
How can you tell if someone has OCD?
OCD does not have a specific set of indicators that warrant a diagnosis. The most effective way to diagnose it is for a licensed mental health professional to perform a thorough evaluation of the individual. With proper understanding of the patient’s behavior and triggers, an accurate diagnosis is not difficult.
How do you break the cycles of OCD?
Excellent question! For an individual suffering from OCD, therapy involves the process of helping the patient identify triggers and learn how to face them in real time. Armed with sound practice and effective coping strategies, the person can pass through challenges without elevated stress, and thus improve their confidence and quality of life.
Jim Brillon has been diagnosing and treating OCD in Orange County residents for years. With his training and experience, he makes it easier for you to do the work of identifying your triggers and managing your disorder. If you think you might have some of the symptoms of OCD, call our office to schedule an appointment.
We are happy to get you diagnosed and help you begin your journey to recovery.