“I’m OCD!,” “he’s so OCD!” We hear that often today. Everyone today is “an expert” or at least conversant in psychology and this is just one of the many terms in psychology that is used freely to describe ourselves and others. Obsessive-compulsive disorder is a classifiable mental disorder that is found in roughly two to three percent of adults and one percent of children, possibly higher. Yet we use the term often too loosely to refer to certain behaviors that roughly fit the description and thus create confusion about the true meaning of the clinical disorder.
What is OCD?
Strictly speaking, OCD (Obessive Compulsive Disorder) is classified as an anxiety disorder. As the name implies, it has two parts to it, obsessive and compulsive. Some people who suffer from the disorder have one part, others may have the other part, and some have both. Let’s take a look at these parts.
Obsessions represent thoughts that one cannot get out of one’s mind, like an annoying song that gets stuck in our heads. The more annoying the song is the more it won’t go away. Some professionals refer to this as “intrusive “ thoughts. I like to call them “sticky” thoughts because like flypaper it is hard to get rid of them.
Compulsions are behaviors that one can’t resist, such as washing one’s hands repeatedly, checking over and again whether the door is locked, or symmetry compulsions where everything must be done in even numbers. Compulsions are often confused with impulsive behaviors, such as gambling, overeating, and smoking addictions, behaviors that are inherently pleasurable even though they can be destructive when they get excessive or out of control. Compulsive behaviors on the other hand are not inherently pleasurable. They may be inherently value-neutral such as hand washing that becomes unpleasant because repetition cannot be resisted or inherently painful or unpleasant, such as giving in to the irresistible urge to pull one’s hair out repeatedly.
Likewise, an intrusive thought, or “obsession,” is distinctive by its unpleasant content. Often these thoughts are distinguishable from “ordinary” obsessive thoughts in that they seem “out of character,” such as engaging in some immoral act one would never even remotely consider doing. An example of an intrusive thought would be imagining a loved one being harmed, hitting a pedestrian while driving, sexual thoughts that are unwelcome, etc. Intrusive thoughts are obsessive in the sense that they occur repeatedly even though they are unwelcome, like the unpleasant song that won’t go away.
Obsessive thoughts and compulsive behaviors can be annoying, embarrassing, and even frightening. The prevalence of this disorder is probably underestimated because many who suffer from it are too embarrassed to admit it. An intrusive thought can be frightening because it is sometimes mistakenly believed that these thoughts represent intentions or inclinations even though this is never the case.
OCD is often confused with OCPD, obsessive-compulsive personality disorder. Years ago there was a movie, “As good as it gets,” starring Jack Nicholson, Helen Hunt, and Greg Kinnear, that added to this confusion by conflating these two separate disorders which statistically are only mildly correlated. OCPD represents what we usually mean when we say facetiously or disparagingly that someone is “anal” because certain features of personality such as rigidity, punctuality, and stinginess, were believed by Freud and his followers to arise from a fixation that presumably were associated with a specific stage of psychological development in childhood. OCD and OCPD are not the same and only occasionally are they manifest together in the same person.
What causes OCD?
As with most mental disorders, no one knows for certain. Epidemiological studies evidence a hereditary contribution to most mental disorders and OCD is no exception. OCD is not curable but its symptoms are treatable to help people better manage the disorder and diminish its effects. My experience in clinical practice suggests that symptoms wax and wane and are most likely to resurface during stressful life situations.
How can someone who has OCD be treated in clinical practice for this disorder?
Obsessive-compulsive disorder (OCD) is treated with a combination of cognitive and behavior therapies and in some cases I might also refer a patient for a psychiatric evaluation when a combination of psychotherapy and psychiatric medication is indicated. For intrusive thoughts I reassure my patients that their thoughts do not reflect their intentions or tendencies. To the contrary, they represent ideas and images that are abhorrent so it is fear, not desire or intention, that produces these symptoms. In some instances an intrusive thought may represent an idea that may symbolically serve some useful purpose to that patient at that time in their life which may stimulate discussion about what that may be. Autogenic training, a meditative exercise I teach many of my patients, helps them to let go of these thoughts more readily.
For compulsions, exposure therapy in combination with response prevention helps a patient to gradually gain control over these behaviors. This is used in conjunction with coping skills training that includes meditative exercise. I help normalize by reinterpreting these symptoms as a remnant of magical thinking that once long ago served an adaptive purpose in human history before science helped us better understand how and why things happen in life.
Compulsions, as with superstitions, act under the principle of negative reinforcement which means that it is rewarding to avoid something that is feared. People who suffer from these symptoms act out of a fear of what might happen if they resist even though they know their behavior is irrational. They might not even know what it is exactly that they fear might happen if they resist. It is the emotion of fear, not reason, that produces this behavior because it is an anxiety disorder. These are difficult behaviors to change because avoidance prevents one from challenging the expectation, however irrational it might be, that its imagined outcomes won’t occur.
If you or someone you know is suffering from obsessive-compulsive disorder it is encouraging to know there are steps you can take and resources you may rely on to remedy the effects of this problem. The International Obsessive Compulsive Disorder Foundation publishes a newsletter at www.iocdf.org with information about the latest OCD research and support groups in your area.
Posted by Robert Hamm, Ph.D.
Robert Hamm Ph.D