Collecting, Organizing, Checking, Washing…. Obsessive Compulsive Disorder (OCD)
Obsessive Compulsive Disorder (OCD) is a type of anxiety disorder.
It is composed of two parts: Obsession and Compulsion. Obsession is the portion of OCD that occupies your thoughts such as excessive concerns about cleanliness (my kids call this germophobia), extreme social fear, fear of harming someone, preoccupation with organization or other intrusive thoughts that create anxiety. Compulsion is the physical manifestation of needing to do something about the obsessions. Compulsion results in behaviors such as ritualistic behaviors like excessive hand washing, repeatedly checking to make sure the stove is off, counting steps and other extreme behaviors such as hoarding.
OCD the Good
Once I while participating in a wedding, I was attending the rehearsal dinner at the home of the bride whose mother made the appetizers for over 200 people. I was amazed at her management skills that made her capable of preparing appetizers from a single kitchen – right up until the time that when looking for the restroom adjacent to the laundry, I opened the pantry door.
There, staring at me were over 100 spice containers, of all the same brand, all the same size and all angled at a precise 45-degree angle so that the labels were all pointed exactly at my head. I was so dumbfounded that I continued to stare and found that on the other shelves there were precise pyramids of 5 cans each of various vegetables – all the same brand, all the same size, with all the labels facing exactly the same direction.
Lining the floor were plastic bins, spaced 2 inches apart…exactly, containing 3 bags each of a variety of pasta, flour, rice…. all of course the same brand, carefully placed in the bin, with the label in exactly the same location.
This is OCD at its best – at least for others. She had an obsession and a compulsion that created this superbly organized pantry. Likely though, even this “good” OCD manifestation took up a lot of her time – and had a negative impact on her daily life and that of her family’s.
OCD is not always at its best however and can result in the opposite – hoarding. I don’t have to go into this but if you haven’t seen it, you should watch “Hoarders” or “Hoarding, Buried Alive” for some insight.
OCD the Bad
In addition to situations like hoarding, OCD can also interfere with life in other ways. I have a cousin with OCD, who before he was medicated, found himself unable to leave his driveway due to fears that he would back over a child with his car. This caused him to spend hours – literally hours every morning starting the car, looking in the rear view mirror, getting out of the car to look behind it, getting back in the car, looking in the rear view mirror, getting out of the car…. He eventually found himself unable to work.
Others have found that OCD has limited their lives in similar ways. Howie Mandel, a well-known comic, has talked about his Obsessive Compulsive Disorder. It prevented him from appearing in public for many years, in part due to social fear but also due to fear of infection. Even today, while his disease is “under control,” he does not ever shake hands or allow others to touch him.
How do I know if I have OCD?
A lot of people have rituals – such as specific routines before bed. A lot of people have extreme concerns which may consume thoughts for a while – such as excessive concerns over money. The difference in “normal” rituals and “normal” concerns is that they don’t typically impair normal life and they don’t become paralyzing.
Thoughts and behaviors that might indicate OCD:
• Repeated thoughts or mental pictures about things such as
o Hurting others
o Religious beliefs
• Repeated behaviors such as:
o Washing hands
o Disinfecting surfaces
o Locking and unlocking doors
o Repeating steps over and over
o Keeping unneeded things
o Excessive grooming
• Lack of ability to control or stop unwanted thoughts and behaviors
• Repeated behaviors provide temporary relief from anxiety that is caused by obsessive thoughts
• Repeated behaviors don’t provide any pleasure other than temporary relief
• Spending at least 1 hour a day on thoughts and behaviors, creating a negative impact on daily life
The International OCD foundation reports that it takes around 15 years for most people to be diagnosed. This may be due to hiding of symptoms – but it may also be due to lack of awareness of both the public and health professionals.
What can be done about OCD?
OCD can be treated – it usually cannot be cured but can be controlled. First line treatment for OCD includes working with a properly trained therapist – most beneficially, one who is trained in cognitive behavioral therapy (CBT). CBT uses “exposure to” unpleasant stimuli, carried on to the “what if” stage. “What if” I touch that faucet without disinfecting it? “What if” I get into the elevator without opening the door 10 times? The “exposure” period is followed by “response prevention” where the patient chooses NOT to perform the behavior that the “exposure” usually causes. Over time, the obsession and compulsive thoughts and behaviors become more manageable.
In other cases, medication may be needed – usually given in combination with CBT. Some antidepressants (not all) will help with OCD. Anti-depressants that have been shown to help include:
o Luvox (fluvoxamine)
o Prozac (fluoxetine)
o Zoloft (sertraline)
o Paxil (paroxetine)
o Celexa (citalopram)
o Lexapro (escitalopram)
o Effexor (venlafaxine)
Other medications may also help but have not been “approved” to treat OCD. Doctors who have found them helpful may use them regardless of whether they are officially approved to treat OCD. Medications such as Cymbalta (duloxetine) have been reported to be helpful – and some patients may benefit from short-term use of anti-anxiety agents.
It is important to know that all medications may cause side effects and you should tell your doctor about any other medications you are taking.
Obsessive Compulsive Disorder (OCD) is a mental disorder characterized by intrusive thoughts that produce anxiety and by repetitive behaviors aimed at reducing that anxiety.