Jenny stops by Amanda’s locker to borrow a pencil before the homeroom bell. “Ugh,” Jenny scoffs, eyeing Amanda’s perfectly stacked books and variety of office supplies, all arranged by size and color. “You’re sooo OCD.”
Unlike many mental illnesses, which still carry some degree of social stigma, OCD — obsessive compulsive disorder — has gained such popular acceptance that it is often dropped casually into conversation to punch up a joke or as a pithy synonym for “neat freak.” Pop culture is rife with representations of OCD, ranging from the exaggerated and the absurd (e.g. the signature Sheldon Cooper door knock that shows up in almost every episode of “The Big Bang Theory”) to the relatively true-to-life, like Jack Nicholson counting how many times he turns the door lock in “As Good As It Gets.”
What is OCD?
True OCD, however, is no laughing matter. OCD is a condition characterized by troubling thoughts, images, or feelings — obsessions — which produce intense anxiety that patients feel they can alleviate only by performing ritualistic behaviors, or compulsions. OCD affects people of all ages, including children, and expresses itself differently in every patient, but some hallmarks of the disorder are as follows:
● Obsessive thoughts are intrusive, persistent and — and this is important to recognize — unwanted. Obsessions can range from perverse sexual images to fear that harm will come to a family member to an unshakable suspicion that every surface one touches contains germs and contaminants. OCD patients recognize that the thoughts are irrational, and while they desperately want them to stop, patients cannot simply talk themselves out of repetitive thought patterns.
● Compulsions are routines and rituals that patients use to soothe the anxiety produced by their obsessions. Like the obsessions themselves, compulsions can take many forms, from repeated movements or actions to habitual counting. Sometimes, compulsions are logically linked to a patient’s obsession, like a stock trader who washes his hands dozens of times a day because he is sure he has picked up a deadly virus. Often, however, the compulsion has nothing to do with the obsession, as in the case of a college student who can’t fall asleep until she has counted all the ceiling tiles in her dorm room three times.
● The obsessions and resultant compulsions get in the way of the patient’s daily life. For instance, Richard is often late to work because he feels he can’t leave the house until he has checked five times that the stove burners are turned off and that all the windows are locked. Bonnie makes her friends uncomfortable when she rides with them in the car because she will only listen to radio stations that end in even numbers.
● Patients are well aware that their thoughts and behaviors are illogical, and they want to put a stop to them. However, OCD is extremely difficult to treat on one’s own, even with the support of friends and family members.
● Both obsessions and compulsions can evolve over time. Richard might once have checked the stove compulsively before leaving home, but after a few years, he started thinking something terrible would happen if he didn’t check all the windows as well. Then he had the feeling the house would be burglarized if he didn’t check the stove and all the windows in a particular sequence. Later, he couldn’t bring himself to step out his front door until he had repeated the sequence a comfortable number of times; twice didn’t feel like enough and three times felt unlucky, but for some reason Richard couldn’t put into words, five felt “right.”
What isn’t OCD?
In the locker scenario, Amanda is clearly a put-together young lady; her friend Jenny might think Amanda is rigid or even neurotic in her degree of organization. But Amanda is simply a neatnik, not someone suffering from OCD.
If Amanda were battling OCD, she wouldn’t keep a tidy locker just because she likes things neat and orderly. She might keep a tidy locker because lining her books up by height is the only way she can stop herself from worrying that her mother will be diagnosed with a dire illness. She might keep a tidy locker because pointing all her binders in the same direction reassures her that she will not fail all of her classes and be unable to find a job or get into a good college. She might keep a tidy locker because grouping her pens together in sets of three alleviates the guilt she feels over the disturbing daydreams she’s been having.
And if Amanda were battling OCD, it is possible that Amanda’s attention to locker organization would interfere with other parts of her life, for example if Amanda were late to homeroom because she couldn’t stop counting her markers.
Symptoms of OCD can overlap with those of related disorders, like Obsessive Compulsive Personality Disorder (OCPD) or Body Focused Repetitive Behaviors (BFRB) such as picking or hair-pulling. In order to receive the right treatment, those who suspect they might have OCD should work with a psychologist to ensure they receive the proper diagnosis and care.
How is OCD treated?
Some antidepressants have been shown to reduce OCD patients’ anxiety, thus making it easier to curb both obsessions and compulsions. However, most mental health professionals agree OCD cannot be treated with drugs alone and should, if used at all, be combined with therapy.
Some Cognitive-Behavioral approaches to OCD include:
● Cognitive Restructuring – This refers to a range of techniques that can include talking through one’s obsessive thoughts with a mental health professional and examining the evidence for those thoughts so the patient can rewrite the thoughts in a more appropriate or accurate way. CBT can also hone in one other aspects of a patient’s life to reduce focus on obsessions and compulsions.
● Exposure Therapy – With the help of a mental health professional, patients purposely put themselves in situations that trigger their obsessive thoughts, either by imagining a scenario or actually seeking out a trigger experience. Therapists often start with low-anxiety scenarios and build to ones that fully agitate a patient’s obsessive compulsive condition. The idea is to desensitize the patient to the anxiety-producing situation, to break the cycle that produces compulsions.
● Response Prevention – Often used in combination with exposure therapy, response prevention asks patients to experience an obsessive thought without performing the usual compulsion. The goal is for patients to become more comfortable with their anxiety and find ways to cope with it other than through compulsions.
● Family Treatment: Families can often exacerbate or enable OCD patients’ conditions, even when they are trying to be helpful or supportive. By meeting with a therapist, OCD patients’ loved ones can learn the best way to encourage recovery.
While there is no quick fix for OCD, with appropriate therapy patients can learn to reduce their obsessions and compulsions, so that they no longer interfere with everyday life. They can also learn to manage normal life stresses so that their OCD is not exacerbated by those events.
For more information, or if you suspect that you or a loved one may be suffering from OCD, contact Dr. Alison Block at the Health Psychology Center by calling 732-933-1333 or via her website www.dralisonblock.com.