What is OCD?

OCD is the acronym for Obsessive Compulsive Disorder. Let’s break it down into it’s component parts:

Obsessions are thoughts/feelings/urges/images that are intrusive and unwanted that won’t go away. They are painful, bothersome and troubling. They are disturbing for sure: often in content, and in persistence.

Disturbing content are things like:

a belief if you buy a dented tin can without noticing it, you may kill your family with botulism
a concern that if touch germs with your palms, you will get deathly ill.
a concern that door knobs have deadly germs on them
a fear that you have not locked the door to your home as you get in your car to leave and that there is huge danger in that
a worry that you have left your curling iron on and the house is at risk of burning
a belief that your chairs need to be placed exactly in the right position around the table or something terrible will happen

The thought is one that won’t go away. It’s persistent. Often a person knows “it’s irrational” or “not logical” but that doesn’t stop the feeling…and the fear behind the thought feels awful. The obsessions create anxiety.

Compulsions are the actions people engage in, in an effort to make the obsessions go away.

avoiding touching things, or having an elaborate hand washing procedure, or both
checking and re-checking for dents in cans, curling irons being off, doors being locked.
adjusting and readjusting chairs, carpet fringes, items on the counter
cleaning and recleaning items/areas of concern
thinking certain mantras or thoughts or various internal mental exercises

Compulsions are done to directly address the anxiety of the obsessions. When a person does not do the compulsion the anxiety around the compulsion can increase. Often the compulsion has to be done until it is “enough” or “feels right”…which means that going back to chef the lock once likely won’t be enough to stop the concern.

Sometimes folks with OCD will have a number that feels like a good one for them…they might need to check something four times, or they might need to say a certain prayer in multiples of three.

Disorder is the last word of “OCD”. The disorder time means it’s not just a cute little gesture, or a quirky affectation…it means it’s a problem. It interferes with normal living. It gets in the way of getting life done.

OCD is often mocked in the media as something that is gimmicky or something to be teased. Folks with OCD don’t find it funny. At all.

What’s it like to have OCD?

It’s gross. It feels like a constant monkey on your back. It’s a heavy burden to be always thinking of that which is uncomfortable, and that which must be done to bring relief. It’s. not. good.

The impact on a person’s life with OCD ranges from very inconvenient to downright crippling.

Hands raw from washing
Being very late from work because of checking something repeatedly
Not being able to do certain things that would be great to do…like hugging your kids

Perhaps the biggest impact that is difficult to measure is the impact on relationships.

People with OCD anticipate that they will be perceived by others as silly or crazy (or both). They know this because there is a part of themselves that is judging themselves that way. It’s hard to explain how a particular fear has taken over your life completely out of proportion to what conventional wisdom would say is appropriate. So…folks with symptoms of OCD not only have the anxiety that comes with the obsessions and compulsions…but also carry a burden of “What will other people think?” and often go to rather significant lengths to avoid being found out. That means figuring out how to cover up and hide behaviours, or express oneself creatively to laugh off something, or create a some misdirection so it won’t look like what it seems. This can be exhausting. Those who struggle often live in fear of being found out…they live with a sense of deep shame.
Often the OCD is discovered because it can’t be completely hidden. Because OCD is often misunderstood, folks who are struggling with it can feel judged or ridiculed. Sufferers can feel “less than” and “not good enough” when others discover the disorder.
Often the rituals of the compulsions impact on relationships. Say, for example, you carpool with your partner who has OCD…but you have to build 30 minutes leeway into your morning…getting into the car a half hour before you need to leave to allow the partner to return to the house to check and recheck an appliance or the lock…and even then, occasionally being late for work because extra checks are required that morning. Because you don’t have the anxiety, these extra behaviours are quite unnecessary from your perspective…it becomes extremely challenging to have ongoing patience for the inconvenience of the compulsions day after day after day.

What makes OCD worse?

Stress.

Stress increases the intensity of the obsessions-the intrusive, upsetting thoughts, which generally increases the intensity of the compulsions–the behaviours designed to make it better. Things like exam time, watching your child struggle at school, tension in the team at work all can increase the impact of OCD.

The lousy part is that when OCD gets worse, the sham of OCD starts to present itself. For example, if leaving your car four times to go check to make sure the door is locked is usually enough, during a stressful time when the symptoms of OCD intensity, it can feel like no amount of checking can assure you that the door is safely locked…a person can feel stuck in the loop, or seemingly unendurable anxiety if they aren’t checking.

What can a person with OCD do?

First…be kind to yourself. To the best of your ability, know that you are not crazy. I’ve known kind, warm, funny, engaging people who have OCD and they are most definitely not crazy. However, they wonder if they are, and benefit from encouragement that they are not. Care about yourself enough to get treatment, to know that you are worth investing in to address these symptoms.

Second…tell your story to those who have earned the right to hear it. People who know that you are more than your OCD…folks who can be compassionate, understanding and supportive. Carrying the secret of OCD creates its own anxiety/stress which (you guessed it), can itself be something that impacts symptoms. Tell a family member, close friend, your family doctor, and perhaps a counsellor. Give yourself the gift of not having to carry the weight of a secret.

Third…consider treatment. Talk to your doctor about medication. This is a choice that can be discussed with your physicians to consider the implications…many find significant relief with medication.

Counselling can also be very helpful. Your therapist will teach you ways in which to control your anxiety in a way that will gradually give you greater control over your obsessions and compulsions with something called “exposure and response” therapy. You will learn breathing techniques and other strategies that help you gain more control over your body’s response to the triggers. This can be of significant help to about 75% of those who suffer with OCD.

It likely will not be something that will ever disappear completely, but it often can be well controlled.

What does a family member do?

First…recognize OCD for what it is. It is a disorder that is real and is a problem. In all likelihood, the person struggling with OCD understands that “it doesn’t make any sense” and so attempting convincing him/her of that is insulting and futile. Telling a person with OCD to stop is no more effective than telling a person with an asthma attack to start breathing normally.

Become informed about how to helpfully support a loved one with OCD. It involves compassionately being supportive to the sufferer, and to oneself, and to the entire family. The International OCD foundation has a great page on family support.

Learn to compassionately work at decline in participating in Family Accommodation Behaviors which can help increase the intensity of the disorder. This would include participating in the behaviours (e.g. washing your hands also), helping the sufferer to avoid activities (e.g. by doing the laundry for him/her, or driving him/her around to places you wouldn’t ordinarily go to so they can avoid the driving), making changes in your leisure activities (you stay home with him/her and don’t go out with friends to avoid the fear of contamination). On “tough days” you may do some accommodating and “back off”. Setting limits and being clear about boundaries are best done in advance, when everybody is calm.

Recognize that OCD creates true suffering…and when small gains are made, there is great cause for celebration. Recognize that there will be good days and bad days…and that being critical and frustrated on bad days is adding fuel to the fire. Allow for bad days with compassion and patience and understanding.

Find ways to gang up on the OCD with the OCD sufferer…not gang up on the OCD sufferer.