In today’s society, we often hear the term OCD used to signify someone who gets upset if things aren’t lined up “just right” or someone who is a germaphobe. We may think of someone being “extra” when it comes to neatness or cleanliness. While these things can, in part, be true, Obsessive Compulsive Disorder is just like the name- a disorder that involves obsessive intrusive thoughts that compulse a person to feel like they have no choice but to do certain rituals or behaviors as a way to find relief from the obsession. The obsessive thoughts involve extreme fears such as causing harm to oneself or others, extreme discomfort, or spiritual condemnation. The thoughts are often intrusive, meaning that they are uninvited and can pop in at any moment, leaving someone feeling exhausted and in fear of the next mental attack. Often the behaviors can become debilitating, making it so that someone is spending extreme amounts of time performing rituals or mentally checking to try and find some relief or prevent the fear from occurring.
Although the variety of obsessions that can pop up with OCD may feel endless, they can usually be categorized into four main groups.
The first is a fear of contamination, germs or uncleanliness. For example, excessive hand washing for fear of catching a germ that could cause a deadly illness, or excessive cleaning. The fear leads to a cycle of hand washing, face washing, or cleaning, which makes the person feel better temporarily, but then the discomfort, doubt, or fear returns and the person feels compelled to wash or clean again.
Second is the need for things to be in order, or “just right.” Often this is associated with spending a lot of time organizing or arranging things. There can be extreme discomfort when things are not in the right place, and there can also be a fear of something unconnected (sort of like a superstition), such as if things are not in the right place, something bad will happen to someone I care about.
Next is called moral/scrupulosity OCD, which has to do more with thoughts and fears that you have done something or thought something that makes you “bad.” For some, there is a fear that those thoughts make God angry with you and you question your salvation or ability to call yourself a Christian or a good person. This type includes the compulsion to check and review, causing the need for constant affirmation that they are okay.
Lastly, the fear of doing harm to others. An example of this might be a fear that you have harmed someone without knowing it, or a fear that you might accidentally cause someone to be injured, get sick, or be poisoned in some way.
Most people with OCD experience a combination of the four types, but they tend to battle more with one than the others. All OCD types have a few things in common. There is a doubt about something (examples- did I wash well enough? Did I accidentally think of something I shouldn’t have? Did something get touched or moved without me noticing?) These doubts trigger fear, anxiety, and discomfort and cause the person to first mentally check and often ruminate over the doubt. There can also be a compulsion to do something to “make sure” or to keep the fear from coming true. OCD doubts make a person doubt their senses, question reality, and get wrapped up in stories of negative possibilities. OCD can also make a person feel that they have more control or responsibility than what is reasonable.
OCD can feel like a very dark place. I have noticed that one of the hardest parts of OCD is that the person experiencing the intrusive thoughts knows that the thoughts are not rational. They know that they don’t need to wash their hands 5 times after touching a doorknob, or they know that they don’t have to turn around in their car and drive back to make sure they didn’t hit someone and not notice. But the obsession does not let them be, and they are compelled to go and check. This awareness that their thoughts are not rational, and a feeling of not being able to control their behavior creates a cycle of embarrassment and shame for people who struggle with OCD. Because of that shame cycle, many people with OCD try to mask their behaviors and hide them so that no one notices how much they are struggling. Keeping their struggles in the dark can lead to feelings of hopelessness and depression.
I have heard many times when I work with someone who struggles with OCD, how therapy can help almost immediately with their feelings of hopelessness because it gives them a space where they can be open and honest about their struggles. It takes that shame away and shines a light on what is really happening, and it allows a person to hear that they are not crazy, and that OCD is a real disorder that can rob people of their peace. There is also so much hope- there are some great evidence-based (which means it has been researched and shown to be helpful) therapies that can help people with OCD find relief and freedom from the obsessive-compulsive spiral. I have seen people who feel completely controlled by their OCD thoughts and compulsions learn new skills that help them feel more grounded and able to face their obsessive thoughts and respond differently than giving in to the compulsions. It can take work, but over time, people learn that their anxiety is not going to be unmanageable, and they can move forward with their life. They can learn to trust their senses again and feel safer trusting in reality. It is amazing to see someone come out of that pit of darkness and step into the light of freedom from the control that OCD can have over them.
Comments