OCD

OCD (Obsessive-Compulsive Disorder) can be a crippling disorder for many individuals. Like many disorders, there tends to be a spectrum that individuals find themselves on that “run” from mild, moderate, to severe.

OCD is near to my heart, because I have moderate OCD. This is something I have lived with for nearly five decades. It can be awful at times, time consuming, and very tiring. This is why it is imperative to navigate through OCD with sound, proven skills. There is a fair measure of hope.

When people ask, “Does having OCD mean I’m ‘crazy’ or something?” I tell them no. It’s a struggle that many learn to navigate through.

What are the symptoms of OCD? Having OCD means one struggles with intrusive thoughts (obsessions) and repetitive behaviors (compulsions) where they try to neutralize/minimize the intrusive thoughts. Intrusive thoughts can produce great fear and anxiety. For example, a person can be slicing up bell peppers for dinner and, out-of-the-blue, a thought comes to mind to stab themselves. The person may even get a vivid picture in their thinking to do so. This produces immediate fear and anxiety, because the person with OCD feels like they are going crazy, that they are unsafe, and therefore, they can feel a type of self-hatred for themselves. To neutralize these automatic, disturbing thoughts, they may resort to a lot of counting, praying, or cleaning to neutralize/minimize these automatic, disturbing thoughts.

Other signs or symptoms of OCD are excessive, repetitive checking (like the stove, the doors, windows, etc.), excessive hand washing due to fear of contamination, excessive ordering, excessive rules one places on themselves and life, following a strict routine, ruminating, or fixating. Sometimes it can manifest as a strict, over-adherence to religious rules one places on themselves and a strong sense of control.

OCD is an anxiety- based disorder. We’re not exactly sure what causes OCD; however, there are a few theories that I think are good.

Theory number one says OCD originates in the brain. The cingulate to be exact. S.P.E.C.T. studies, which show the firing of the brain, show that those who have OCD, have an enlarged cingulate. It is believed that there is an extra amount of blood flow to this part of the brain, according to Dr. Daniel Amen (Change Your Brain Change Your Life).  The cingulate is responsible for “shifting gears” from one thing to another to another. Those with OCD have a difficult time shifting gears from one thing to another, which is believed to be because of the extra amount of blood flow in the cingulate. This is why people with OCD ruminate, or fixate, on things, like maybe checking the stove four, five, or six times in a row.

Theory number two says that OCD can be brought on by trauma. The idea is that life happens fast and hard for many. It can cause trauma. Since we cannot control what, where, how, and when life throws traumatic events at us, our subconscious drives us to “control what we can;” hence, OCD.

If you have ever watched the TV show Hoarders, you will discover that an overwhelming majority of those suffering with hoarding have experienced a significant trauma. Therefore, the subconscious drives them to control what they can without them even knowing it.

Theory number three is that OCD is hereditary (in the genes) and is caused by chemical deficiencies in the brain. If mom or dad has it, Johnny and/or Sally have a chance of inheriting OCD as well.

Okay…which theory is true? Ready for this? All of them. For one person it can be theory number one. For another theory number two. For another it can be theory number two and three. Sometimes disorders, or struggles as I would rather call them, don’t come in neat little packages with easy explanations. Many times, struggles are complicated.

Now that we see some of the potential causes of OCD, the magic question is “how do we cure it?” Well, I’m not sure OCD is ever cured; however, it can be managed fairly well. The following are ways we “OCDers” can eventually manage our symptoms. For the sake of time, I’ll keep “the ways” simplified. Further in-depth counseling, to “piggy back” off these, may be helpful.

CBT.  This stands for Cognitive Behavioral Therapy. In essence, it’s “thinking about what you’re thinking about,” because not all thoughts are correct.

I remember I had a compulsive behavior of organizing my wife’s and my vitamins so all the labels faced forward. I would take my morning vitamins, then put them back with all the labels neatly facing forward. Well, my wife, bless her heart, didn’t share that behavior. She would take her vitamins, and, when finished, put them back “any which way but loose.” The next day I’d go to take my vitamins, and, behold, all the labels are all over the place! I’d secretly get frustrated. This went on and on and on.

One day I went to take my vitamins and, again, I got frustrated because the labels weren’t perfectly facing forward! The thought hit me, “Earl, do you want to do this the rest of your life?” It took five seconds for me to say, “Heck no!” So, on that day I purposely put the vitamins back with the labels facing north, south, east, and west. I changed my thinking. That’s been five years ago. My vitamins face “whatever way the wind blows” to this day. It’s so nice to not have to have them perfectly facing the front anymore. It’s a freedom and a lack of frustration.

Now, I realize this is probably an “easier” thing to do, since they are just vitamin labels. Over time, certain behaviors can be managed with this approach.

Exposure and Response Prevention. Here is a good definition of ERP from OCD-UK: it “is a therapy that encourages you to face your fears and let obsessive thoughts occur without ‘putting them right’ or ‘neutralizing’ them with compulsions.”

Here is a word picture: Let’s say you’re petting your beloved dog, Henry. There are OCDers that must wash their hands immediately afterward due to germ issues they feel. ERP would say, “Wait a little bit. Yes, you will feel the anxiety of ‘contamination.’ Sit in that for a bit. Ask yourself what’s the worst that can happen? Will this kill you or make you sick? Is Henry really contaminated?” It’s right to say “no.” Believe this. Maybe after ten minutes or so, go wash your hands. Next time, push washing your hands to twenty minutes out. Next time maybe thirty-five. And so on. You’ll see that you are just fine after all.

Behavioral Therapy. Begin to change your behaviors over time. For example, if you always put your right shoe on first…put your left shoe on first sometimes. If you always put your pants on first…put your shirt on first sometimes. If you always take the same route to work…try different routes sometimes.

Yes, this is easier said than done. I get it. I’m not minimizing the fears. As a person with OCD, I do know we have to fight back to regain our lives.

Therapy. Talk to a therapist who understands OCD, the dynamics, and who can help you navigate through it with a fair measure of success.

Medication. There are certain antidepressants that actually target anxiety as well, and are helpful in treating OCD. Talk to your Doctor or Psychiatrist to see if medications would be something that would help you. In many cases, those with moderate to severe OCD do greatly benefit from medication.

Understand OCD. Remember I discussed those automatic thoughts that “pop” into your head that can cause very disturbing feelings? These thoughts can be a violent act, vulgar words, or a plethora of other things. Understand that these thoughts are not you. These are not premeditated thoughts. These are automatic thoughts out of nowhere. They are not you, and they do not define you. If this can be understood, it takes the power away from these thoughts. It helps you know that these are out-of-the-blue, automatic thoughts that are not coming from you, and they will pass.

One last point to remember: we OCDers give into compulsive behaviors in order to control our fears and anxiety. However, this makes the situation worse. Trying to control life actually controls us. As we OCDers begin to give up aspects of our control we actually become free-er.

Fellow OCDers, you have my deepest compassion. I get it. I understand. We are not defective! We just have a struggle that we will be managing the rest of our lives. There is hope!

Written by: Earl Hocquard
MA, LLP
Oakland Psychological Clinic