Obsessive Compulsive Disorder (OCD)
The Merriam-Webster Dictionary defines Obsessive Compulsive Disorder (OCD) as “an anxiety disorder characterized by recurrent obsessions or compulsions or both that cause significant distress, are time-consuming or interfere with normal daily functioning, and are recognized by the individual affected as excessive or unreasonable.”
OCD is often referred to as the “doubting disorder” or “doubting disease.” The doubt fuels the ‘need’ for certainty and so the problem begins.
- What if I left the iron on and the house burns down?
- What if I get infected with a strange virus?
- What if the chef at the restaurant has HIV and it gets into my food?
- What if I become aroused over inappropriate sexual thoughts?
- What if my children get hit by a car on their way home from school?
Common Compulsions or Rituals
- Checking things
- Counting things
- Washing hands or other body parts
- Repeatedly asking for reassurance
- Making sure everyone is ‘safe’
- Rigidly sticking to a schedule
- Repeating phrases or sayings
- Arranging items in a perfectionistic manner
Can you see the doubtful mindset going on here? A person who obsesses over these thoughts might feel the need to clean obsessively, to constantly check the stove is off, to avoid eating at restaurants, to count in patterns to 'feel right' or to ‘avoid a catastrophe’, or perhaps they might go to church every Sunday to confess their ‘sinful thoughts’. These behavioural patterns can cause chaos in people’s lives and can persist for years unless something is done. If we want a different result in life then we have to go about things differently, right?
The Paradox of Obsessive Compulsive Disorder
People experiencing OCD believe that if they can just think ‘this’ or do ‘that’ then the problem will go away. The reality is that this is the problem. But it is only part of the problem. Why do people become so obsessed with trying to control their thoughts in the first place? The answer is because they perceive these thoughts as being dangerous. If an animal was about to attack us, we sense danger, and our bodies quickly fill up with adrenaline and other powerful stress hormones. This would prime us to either fight the animal or to run away from it. These survival responses help to keep us alive in this way. The problem with OCD is that individuals have unintentionally conditioned themselves to fear their thoughts in the same way that they would fear a wild animal. When these intrusive obsessive thoughts come about, instead of fighting or running away, they perform rituals in an attempt to ‘get rid’ of the anxiety. These rituals may start as a way of distracting themselves from dealing with the underlying feelings of anxiety.
Obsessive Compulsive Disorder is linked to intrusive thoughts but with OCD the individual becomes convinced that they need to perform some type of action or ritual in order to stop the thoughts, or to prevent them from occurring in the future. The ritual itself might also be thought based. For example, an individual may believe that if they do not repeatedly count to 99 in multiples of three that their children might not make it home alive. A person who is worried about germs might avoid touching objects and feel compelled to wash their hands. The individual will feel some short-term relief, but the rituals performed ultimately serve to maintain and reinforce the problem.
Feeling 'Just Right'
Many OCD sufferers when asked about what motivates them to perform certain actions or rituals will report that if they do not that they will feel an extreme discomfort or that they will not feel 'right'. These feelings can be so powerful that the person feels as though they must perform the rituals in order to alleviate their discomfort or to feel 'just right'. They will often tell themselves or others that they have to perform the rituals. This is what keeps the person stuck. Although the person may feel like they 'have to' perform certain rituals, the reality is that they do not have to. They may not feel 'just right' if they do not, and they may feel strongly compelled to, but they do not 'have to'.
A person experiencing OCD will opt for short term relief by performing these rituals. Unfortunately, this serves to reinforce and maintain the OCD, inadvertently creating long term suffering. In therapy, the individual will learn that short term suffering for long term freedom is the goal.
Treatment for Obsessive Compulsive Disorder
Education is always the best form of treatment when it comes to any anxiety disorder and Obsessive Compulsive Disorder is no different. Once you know how anxiety works and once you learn the necessary skills, OCD will have less of a hold over you. I would always advise working with an experienced therapist who specialises specifically in anxiety disorders to help guide you on your road to recovery.
Acceptance and Commitment Therapy (ACT) will be a valuable part of your treatment plan. ACT can help you to accept the anxiety rather than resist it. It is important to understand what acceptance is as many people believe that acceptance is akin to giving up. Nothing could be further from the truth. Acceptance is not about resigning yourself to a life of anxiety. Acceptance is about giving up your struggle with the anxiety. Some will say, "But if I stop struggling and stop fighting my anxiety, wont’ it consume me?" Or they might ask, "If I do that, aren’t I letting the anxiety win?" No, this is the paradox of anxiety. The more you struggle with it, the worse it gets. The issue is that people become so entrenched in their struggle that they do not know how to stop.
Exposure therapy will also be an incredibly important component to recovery. The trap that anxiety sufferers fall into is believing that they must do something to get rid of their anxiety in order to ‘solve the problem’. In reality, trying to get rid of the anxiety is the problem. Exposure therapy trains a person to gradually increase their tolerance towards the sensations and symptoms of anxiety and panic. For example, a person’s instinct will be to check the stove if they think they have left it on, or to wash their hands if they have touched an object or surface. Usually, a person will feel incredibly anxious until they perform their ritual/s. Part of the therapy will involve postponing the performance of these rituals so the individual can acclimatise themselves to their uncertainty and feelings of anxiety instead of resisting them. This is better known as Exposure and Response Prevention (ERP). Over time the feelings of anxiety hold less power over the person and subsequently the need to act out their compulsions or rituals fade over time.
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