What is OCD?

A black-and-white photo of a boy looking down, tears streaming down his face.  OCD is a painful anxiety disorder that causes major disruption and stress.
OCD is an anxiety disorder that causes major disruption and stress into a person’s life. Children, adolescents, and adults can develop OCD.
Photo by Kat Jayne from Pexels

Today I offer my understanding of OCD, Obsessive Compulsive Disorder. I am a lay person who does not have OCD. Hardly an expert. But I’d like to offer the other side to my previous post, What OCD is not . . .

Obsessions: persistent unwanted thoughts, images, or urges that intrude into a person’s thinking and cause excessive worry and anxiety.

Compulsions: hidden mental acts or overt behaviors performed repetitively to relieve or prevent the worry or anxiety generated by the obsession. Compulsions often have the intent of magically preventing some dreaded event or misfortune.

Some forms of OCD: checking, washing and cleaning, ordering and repeating, scrupulosity, hoarding, are common. Some compulsions can be completely internal. The person may have to visualize very specific things in a specific order to “neutralize” an obsessive thought or image. Some people may have rituals that they feel compelled to repeat to prevent a terrible disaster or even death.

To take an example that many people misunderstand– organization and symmetry. A person who loves organization and symmetry, like me, may keep their home and personal belongings well organized. They may set their table “just so.” They may have a specific way they load the dishwasher. They may line up their shoes in their closet in a special way.

If a person does these things because a neat and orderly home gives them pleasure and a messy and disorganized home makes them feel agitated, that is not OCD. It is difficult for me to go to bed with a messy kitchen because I hate waking up to a mess. No matter how tired I am, 99% of the time I clean my kitchen before I go to bed. But not because I am afraid I or someone else will die if I don’t.

A person with OCD may have an unwanted thought– “If my drawers are disorganized, my mother will die.” And then s/he will organize and re-organize their drawers, possibly for hours, until their brain tell them it’s enough, their mother is safe.

What does the organization of drawers have to do with their mother’s life? Nothing. And usually person with OCD knows this. Yet they cannot make the thought go away, nor can they resist the compulsion to act on it without very specific help.

Many people with OCD actually have quite messy homes because their compulsions take up so much time that they cannot complete what are known as the Activities of Daily Living (ADLs). They cannot move on from re-organizing their drawers, for example, to doing the dishes and brushing their teeth. Their day may be so full of hand washing and outfit changing, in an attempt to quiet down the thought that they will get sick from dirty hands and dirty clothes, that do not have time to shop for and prepare healthy food. They may not be able to exercise or spend time with friends. They may not get a good night’s sleep because they have to get up from bed thirty times to check that their doors are locked. And it all starts with unwanted, intrusive thoughts that something horrible will happen if they don’t. OCD tells them “you must do this to keep yourself and others safe,” but it is actually getting in the way of them having a safe, healthy life. And it often hurts the other people in their lives, too.

Some people with OCD become very skilled at hiding their symptoms. They are fully aware of how irrational their obsessions and compulsions are. They realize that everyone they know washes their hands a few times a day and doesn’t get sick and die. But they cannot stop the thoughts, they cannot stop themselves from washing their hands, over and over. They can see the cracks in their skin and see their hands bleed. They know that the cracks in their skin actually increase their risk of infection. And then they will continue to wash because the thoughts will not stop.

Someone who is trying to hide OCD may have excuses for no longer engaging in activities they used to enjoy. They may claim to be too tired, too busy, or trying to save money. They may openly exhibit symptoms of depression rather than symptoms of OCD. Depression can often be present, also, but the symptoms of depression can mask the symptoms of OCD, if the person is ashamed, as almost all sufferers of OCD are. Thus the mantra of everyone who loves someone with a mental illness, End the Stigma.

Most people with intrusive thoughts experience great shame associated with those thoughts. They are terrified to tell anyone the extent that these thoughts pervade their lives and the extreme nature of their thoughts. Some people have what is known pure obsessional OCD, sometimes known as Pure O. These are intrusive thoughts do not have an outward behavioral compulsion associated with them. Often the obsessions are socially and/or morally unacceptable. The person would never act on these thoughts and may come up with mental rituals to try and neutralize the thoughts. It take tremendous strength and courage to decide to get professional help. It takes even more courage for a person suffering from OCD to be completely honest with their therapist about their intrusive thoughts.

Of course OCD can range from mild to severe. Some people may have little OCD quirks. They seem inconsequential to the people around them. “Joe always checks his door three times before leaving.” What is happening in their mind is almost always more serious than the behavior appears, though. Just like any condition, getting help when OCD is mild is preferable to waiting until is has caused a major disruption in a person’s life. OCD rarely goes away on it’s own although it can wax and wane throughout a person’s lifetime. It tends to become more severe with major stress events (even positive ones, like getting married or getting a promotion) and hormonal changes.

Someone with OCD may “lack insight” and believe that their intrusive thoughts and compulsive behaviors are rational. This is a subset of OCD that I am less familiar with but it does exist.

I am so excited that my son will finally be getting help from a program specifically designed to meet his needs. They work with people like him every day. They’ve seen people set free! Once we are there, I will do my best to share our days as they happen. I want others to know help is available and I want to help alleviate any fears about what to expect. I’m not sure exactly what to expect, myself. I don’t know how intense the therapy will be. I don’t know how my son will react. But we will take it one day at a time.

Please comment below if you have any insight or personal experience to share that may help me or others understand OCD.

Talk with you soon.

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