A Brief Text About OCD
Anxiety disorders affect around 12% of the global population. This figures for more than 2.9 million Canadians (Wood, Wood, Boyd, Wood and Desmarais, 2017). Among them, Obsessive-Compulsive Disorder is the one I found more interesting, because it may be useful, and decided to take a closer look at for now.
What is OCD?
After studying a bit about OCD and a byte about programming, I would summarize Obsessive-Compulsive Disorder as an infinite loop of distress where people find themselves stuck and that makes them act in weird ways. Of course, since I am no PhD in any of those subjects, I will leave some reliable definitions I found.
1. “a disorder in which a person is plagued by unwanted thoughts, called obsessions, or feel that they must carry out actions, termed compulsions, against their will” (Feldman, Catney, Cavanagh and Dinardo, 2016) ;
2. “a disorder in which intruding thoughts that occur again and again are followed by some repetitive, ritualistic behaviour meant to lower the anxiety caused by the thought” (Ciccarelli, White, Fritzley and Harrigan, 2013);
3. “an anxiety disorder in which a person feels trapped in repetitive, persistent thoughts (obsessions) and repetitive, ritualized behaviors (compulsions) designed to reduce anxiety” (Wade and Tavris, 2000).
Note that persistence and repetitiveness are the keys here. Since those thoughts hardly go off, they are always causing anxiety, hence my comparison with an infinite loop. In other words, thoughts lead to anxiety that leads to behaviours. However, we all have anxiety in a certain level. So, how does it become a disorder? Let us see what experts have to say about this sense.
According to Wood et al. (2017), anxiety is “a vague, general uneasiness or feeling that something bad is about to happen”. These authors also state it may be linked to a situation, an object, or even have no link with anything at all. Anxiety is bad, or rather abnormal, when it grows out of proportion and control, forcing a person behave in a way he or she believes will lower that feeling. The problem happens when those behaviours prevent one from having a normal life, especially regarding social interactions (American Psychology Association, 2015).
Symptoms and Behaviours
People with OCD may have a frequent thinking (obsession) linked or not to an action (compulsion). It is curious to note that near 80% of people with OCD have both (Carter and Seifert, 2013). That said, it is important to know what is obsession and what compulsion is.
“Obsession: a thought that is an unwanted, intrusive, and distressing;
Compulsion: a condition (behaviors or mental actions) in which a person feels compelled to perform behaviors or mental actions in response to an obsession” (Carter et al., 2013).
It is necessary to emphasize that very commonly those obsessions are terrible and disgusting like thoughts related to the death or harm of another (Wade et al., 2000). Moreover, please note that compulsion is there to relieve anxiety caused by the obsessive thoughts (Ciccarelli et al., 2013).
According to the BeyondOCD (2016), which cites the DSM-V (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition), the diagnosis for an OCD may contain:
- The presence of obsessions;
- The attempt to ignore or suppress the obsession;
- The presence of compulsions;
- Both obsessions and compulsions are time-consuming, taking more than one hour per day, and;
- The symptoms are not related to the use of drugs or medicine, and;
- The disturbance is not related to another mental disorder that can cause stress or anxiety.
That said, the most common symptoms of OCD are:
- washing hands repeatedly, and excessive cleaning;
- constantly checking if a recently closed door is really closed/locked;
- feelings that something was left undone;
- need for symmetry.
Nevertheless, I just found out the same apply to gamers, in which their OCD is also expressed as a deep need to beat every game they play, as well as collecting every item of a dungeon, or meticulously adjusting settings or inventory. As a result, they end up taking too much time and practically playing each stage twice, and even the same game countless times just because there is an urge to fulfill, to complete, it.
In order to know more about it, on December 12 I asked a friend, Thiago Araujo, that had passed through OCD to share how hard it was to live with this disorder. Please find below his answer (freely translated from Portuguese).
“I took clomipramine for some years. I think for three years. I did group therapy for 6 months, but I didn’t see much improvement. I felt better with medicine.
I used to feel a lot of anxiety and I had those called intrusive thoughts, thoughts that cause stress and anxiety, usually fear that something will happen, like fear of contamination. Therefore, I prevented myself from doing many things to avoid having to face these situations. I also had misophonia, which is the fear of contamination, then, everything I had to do involved that fear.
And I had some rituals to face anxiety. For instance, when I had to go to school I knew I would have to touch the doorknob of the class’ door, and that was when those thoughts would come. Thus, I had to clean my hand right away or do something else to lower anxiety. However, this process grew with time, so I saw myself having to do a lot of things in order not to go through the anxiety attacks.
I felt something (I do not recall the name right now), but for me it was like a noise inside my head. There were several thoughts and a lot of anxiety that disturbed me. Just like a noise, you know?
When I took the medicine for the first time, all of this vanished completely. I felt like new.
As time passed by, some things came back, but I can manage them pretty well. I know how to deal with anxiety now. Also, misophonia disappeared. Now I have other feelings, like anxiety to deal with people, but way less intensive than before.
Oh, and I was very very shy. I couldn’t speak to any stranger. I was shy just to go ask for some copies to the photocopy guy at college. Since I had to talk to him, I kept rehearsing for hours and hours how I was going to do it, what I was going to ask.
By the way, this thing of rehearsing before talking to people was worse, too. It was too stressful, but now I am ok with it. :)
And so, deep down I knew perfectly well all this was nonsense, but I could not stop thinking about these things.
These things started when I entered high school, so I should have been about 15 years-old. The shyness I’ve had since I was little. I was diagnosed with OCD at around 23 years of age, when I started to treat myself. I think that’s why it took me so long to graduate, too. Only after I began to treat myself that I was able to graduate”.
As the last example, I would like to show this video about Samantha Pena that as able to get strength from her symmetric OCD. She did therapy Cognitive Behavior Therapy (CPT) to help understand and overcome the unwanted behaviours, and now she uses it as a way to improve her balance in life.
Types of Treatment
As we saw above, there are two types of treatment: medicine and therapy. As we also saw above, people will respond better to one or to the other.
Regarding medicine, the most prescribed may be benzodiazepines like Xanax and Valium, as well as with SSRI (Selective Serotonin Reuptake Inhibitor) antidepressants such as clomipramine (Kosslyn and Rosenberg, 2003), the one my friend took for 3 years. Antidepressants are also used to treat depression, anxiety, and phobias (Wade and Tavris, 2000).
As per therapy, CPT — Cognitive Behavior Therapy, which was the type chosen by Samantha Pena, consists in using two techniques: ERP (Exposure and Response Prevention), and Cognitive Therapy.
According to BeyondOCD (2016), in ERP the patient is presented to the circumstances that cause obsessive thoughts and compulsive behaviours. Since a professional is controlling the environment and monitoring the patient, he or she learns to cope with those triggers and slowly takes control over the situation.
Cognitive Therapy, in turn, allows the person to determine and change patterns of thought that originate anxiety (BeyondOCD, 2016). It helps one to understand that thoughts — even those harmful ones — may appear from nowhere, totally out of control, and that there is no need to focus on them. By thinking in more flexible, adaptive, ways one can change maladjusted cognitions about life itself (Feldman et al., 2016).
Overall, it is clear that it is difficult to deal with OCD (and with any mental disorder). People have a hard time whenever they see themselves having unwanted thoughts. However, there are ways to overcome it, or at least to reduce the amount of stress involved, and live a better life. Depending on the circumstances, it is also possible to take advantage of the disorder, like Ms. Pena did. It is always important to know more about ourselves so that we can prevent diseases, or leastwise, work to improve with it.