OCD: When thoughts and actions are out of control

When does one become too obsessive about something? When does one become too compulsive about something? Everyone has experienced repetitive actions from time to time, such as double checking to insure their car or home doors are locked; and everyone has experienced frequent and repetitive thoughts about something. It is only when these thoughts and actions are taken to the extreme that they become a problem.

When an individual continuously experiences upsetting and frequent unwanted and intrusive thoughts about something it is called an obsession. When a person feels an overwhelming need to repeat certain routines and rituals it is called compulsions. Put the troublesome obsessions and compulsions together you have Obsessive-Compulsive Disorder, or OCD; a diagnostic anxiety mental disorder. OCD affects over 2.2 Adult American , about 1 in 40; and affects 1 in 100 children as well. Clearly 1/3 of adults with OCD develop symptoms as a child, and research indicates that OCD may run in families.

People with OCD generally have repeated thoughts concerning a number of different things. They may have “germaphobia,” fear of being dirty, afraid of violence directed at them, or being overly neat and tidy. Because of these fears, they may repeat ritualistic behaviors over and over, such as consistent hand washing; counting before they perform an action, locking and unlocking their doors, touching things in sequence, hoarding unneeded items, and repeating other actions over and over. These thoughts and behaviors are uncontrollable and unwanted, and most certainly un-pleasurable to the person experiencing them; albeit they do provide temporary anxiety relief for the individual, but they do impede a person’s daily living.

Although the symptoms may come and go through the course of one’s life, they may progress to the most severe point of not being able to work or carry out responsibilities at home or interaction with others. Severe OCD may involve persons avoiding altogether situations which are triggers for their obsessive thoughts and compulsions. They may turn to alcohol or illicit drug substances to help calm their anxieties. OCD may be associated with eating disorders, other anxiety disorders, and depression as well.

Of all the mental illnesses, none has been so widely publicized as OCD; and most often in comedy TV shows and movies. We most often find humor with people with OCD, with their obsessive thinking and their compulsive behaviors. In the TV shoe Monk we find the major character, Adrian Monk, depicted as a genius detective with chronic OCD. Monk must have symmetry, neatness, and cleanliness in all that he does. We see him having to touch lampposts and automobile antennas as he walks down the street, insuring that everything is arranged in a most specific way in his home, sterilizing his tooth brush prior to brushing his teeth, insuring different foods on his plate do not touch each other, insuring that items are presented in even numbers only, and a myriad of other compulsive behaviors.

We find humor in his behaviors, but also become witnesses to the pain and suffering he endures with his OCD as he presents in his therapy sessions with his psychiatrist. In the TV show The Big Bang Theory we are presented with the character Dr. Sheldon Cooper, and experimental physicist. As with Monk, Sheldon is characterized as a person with chronic OCD with many fears, obsessive thinking, and compulsive behaviors; all compensated with by his genius, work ethic, and disregard for others opinions and feelings. In one episode of the Show we find Sheldon’s “girlfriend” attempting to help Sheldon overcome his obsessive thinking and compulsive acting by not allowing him to finish a particular task; for example not allowing him to blow out the last candle on a birthday cake, not being allowed to sing the last stanza of the Star Spangled Banner, not allowing him to complete a game of Tic-Tac-Toe, etc.

We watch as Sheldon manifests complete frustration and anxiety at not being able to complete the task at hand. Yes, we find humor in this program as well, but also being cognizant of the pain and suffering that Sheldon actually endures with his condition.

As a therapist working in psychiatric facilities I often encountered individuals with OCD, some often most extreme and chronic. I shall never forget Mary (not her real name) and the disorder she had been battling since age 15. Now, in her late 30’s, her disorder had become most debilitating. Her fears of many things, and her compensating compulsions took on many forms; such as having to do things in multiples of seven; taking no more than 7 steps at a time in her home, brushing her hair and teeth in multiples of 7, counting to 7 before answering a door, etc. She constantly washed her hands, so much so that they were rough and raw appearing. She had difficulty eating if she did not prepare the food herself, which consequently led to an eating disorder. Before she began a task she would have to recite certain phrases and sentences. She had terrible intrusive thoughts about the harm she could do to herself and others if certain compulsive behaviors were not performed.

The treatment for OCD can become most extensive and time consuming. As in the case of Mary, Cognitive therapy which taught her different ways of thinking, behaving, and reacting to situations that helped her feel less anxious or fearful without the unwanted obsessive thoughts or acting compulsively. Medication was also provided to help with her anxiety. She was afforded Exposure-Based psychotherapy wherein she was faced with situations that caused her fear and anxiety until she became less sensitive to them. There was hope for Mary as there is hope for anyone with this debilitating illness. If you, a family member, or other loved one is suffering from the effects of OCD, I encourage you to seek out help. You just have to reach out.

Until next time, Stay Healthy my Friends!