Mental Health Matters: Obsessive-compulsive disorder

Obsessive-compulsive disorder (OCD) may be one of the most misunderstood conditions by the general public and even by mental health professionals. Evidence for this is that, on average, it takes more than 12 years for someone to be diagnosed and then additional years before they receive adequate treatment. OCD can start in childhood or adulthood and affects men and women equally. It can be mild, taking up about an hour a day, or so severe every waking moment is filled with symptoms.

Before discussing what OCD is, I want to first say what it is not. OCD is not being a very neat and tidy person. It is not disliking dirt or germs. It is not putting things in order or keeping doors locked. It is not repeating behaviors over and over. Lots and lots of people do all these things and yet do not have OCD.

At its core, OCD is fear. Often, it is gut-wrenching, mind-racing terror. When a person has OCD, they fear the consequences of their thoughts and actions. But even deeper than that, they fear the type of person they may be or may become.

Obsessions in OCD are doubts which are rooted in fears and lead to more fear. For example, “What if I did something that contributed to a house fire?” “What if I hit someone and didn’t know it?” “What if I am a bad person?” Compulsions are the things people do when attempting to get rid of fear and all the sensations that come with fear. An observer may never see evidence of compulsions because they are not always overt behaviors, and overt behaviors are not always done repeatedly.

As a person performs compulsions, trying to manage the fear and potential bad outcomes, they are teaching their brain that fear is reasonable. Because of this, their brain becomes vigilant, looking for any sign of unease anxiety, or evidence of their fears. This vigilance can increase the amount and type of obsessions a person has because the brain does not want to mistakenly ignore a potential signal of danger. For example, if you were going hiking and were very afraid of a dangerous, brown animal, you would want to be absolutely sure you noticed everything that could be this animal. As a result, you would wrongly identify many things as harmful and spend much of your hike scared.

OCD is a broad and adaptable condition. About 2-3% of the population has it. For this reason, it is important to remember that OCD can turn any fear into an obsession and any behavior or thought into a compulsion. Rather than try to explain this, I am going to present some examples.

Imagine two people at work writing emails and editing them before sending them. Person A likes to make sure words are spelled correctly and ideas are clear because she wants to be professional. She can finish an email in about 10 minutes. Meanwhile, person B has been working on his email for an hour, going over every paragraph, sentence and word multiple times. While he wants to be professional, his compulsive editing comes from a strong fear that he could really be a careless person, and by being careless, he could lose his job, resulting in losing everything important in his life.

Now imagine people going to a pot-luck dinner party. Person C likes to be reasonably clean but doesn’t have OCD so he may or may not use hand sanitizer before eating. Person D has contamination OCD with fears of getting other people sick. She worries that she may have harmful germs on her hands and does not trust the hand sanitizer will kill it all, so she spends five minutes washing her hands. She makes every effort to not touch serving spoons, cups, food or anything that may spread her germs. After the party, she mentally reviews, over and over, everything she touched. A couple of days later, she calls the host to make sure no one has reported being sick. Her fear is that she is selfish and she worries she was selfish to try to go to the party when she knew she could be contaminated.

Persons E and F both have babies they love and want to protect. Person E has tried to be informed about infant safety. Person F has Harm OCD and is terrified he will hurt his baby son. He has been reluctant to hold the baby and refuses to be left alone with him. He is a loving man, but he fears he could have an unknown evil lurking that would make him get out of control. He worries repeatedly about scenarios in which he could suddenly, without warning, do something terrible like drop his son on purpose. To keep his son safe, the father must do everything in multiples of three. He washes the bottles three times, hangs his son’s clothes in groupings of three, puts the baby monitor volume on 3, 6 or 9, and opens and closes his son’s bedroom door three times.

Keep in mind that these are basic examples of types of obsessions and compulsions people suffer with on a daily basis. OCD can spread or hop from one area of concern to another. For example, the father’s fear of harming his son may fade and be replaced by a fear he will shout obscenities. Contamination fears may linger and be joined by fears of things not being “just right.” Stress, hunger, fatigue and other things that sap us of resilience can result in worsening symptoms. The fluidity of OCD can, itself, cause anxiety as people grapple with trying to find certainty about life.

How OCD is treated will be presented in another column. To learn more about OCD, you can go to www.iocdf.org.

Nora Sinclair is a licensed professional counselor and national certified counselor based in Lexington, S.C.