Obsessive-Compulsive Experiences (Neuropsychoidiology)
SAMPLE CHAPTER from Section: Mental Health
I was very superstitious as a kid, which would generally wax and wane. During one period of my life — probably high school — I was tortured by the compulsive practice of “knock on wood.” Knocking on wood (also referred to as “touch wood”) comes from a Celtic/Pagan tradition of invoking the spirits that were thought to live in trees in order to avoid tempting fate. For example, if I thought “I haven’t gotten sick in a while” I would need to knock on wood right after so that I would avoid that coming true. These are the types of thoughts that make us think, “shit”, I wish I didn’t think that! Or that we just jinxed ourselves being well.
Many people can let the thoughts go and be done with them. But when these kinds of thoughts emerged for me, I would be filled with anxiety. Then I would need to rid myself of that feeling by knocking on wood! Wood is generally not that hard to find so it was relatively benign to just knock on wood. But then it started happening while I lay in bed at night trying to fall asleep. Except, my bed was a metal-framed bed. I would inevitably have to get out of bed and walk across my room to my wooden dresser. This became so disruptive to my sleep that I started sleeping with a piece of wood!
With obsessive-compulsive disorder, two things are at play. First, are the obsessions, which are the worrisome thoughts that creep into our mind. Compulsions, on the other hand, are the behaviours that we do to alleviate the anxiety associated with those obsessive thoughts. Obsessive-compulsive disorder (OCD) is when all of that becomes so bad that it is disruptive to normal functioning. I was never diagnosed with OCD but these obsessive-compulsive experiences (OCE) as I now refer to them would wax and wane throughout my life. To learn more about OCD and the diagnosis of such, please refer to the readings at the end of this chapter.
Driving over train tracks was another bad superstition for me, particularly growing up in Winnipeg, a prairie city with trains everywhere. The superstition was that you had to lift your feet up over the tracks or it would be 7 years bad luck. Being a very superstitious kid, this caused me serious concern. So generally, I got good at lifting my feet up, even while driving a standard transmission car. But then there would be those times that I missed it and my feet would remain on the ground while I drove over train tracks. That would haunt me because I had no compulsion (i.e., behaviour) to alleviate the anxiety from my obsession. Eventually, it was so anxiety-provoking that I made up a new rule. The rule was: every time I lifted my feet up, I incurred 7 years of good luck. Smart! Eventually I incurred so much good luck that I began to feel comfortable if I left my feet on the ground without any anxiety. Overtime — I’m talking years — I lost track of how much I incurred and found that my feet would just be on the floor over tracks and I was not worried. Later, as I pursued formal studies in psychology, I realized that what I had inadvertently done was apply a strategy known as Exposure and Prevention Therapy combined with Cognitive Therapy to my obsessive-compulsive experiences! On the one hand, I used cognitive therapy to alter my experience with obsessive thoughts. I essentially reframed what would happen if I lifted my feet: I incurred 7 years of good luck. Having lost track of the balance over time allowed me to leave my feet on the ground, i.e., having exposure to the train tracks (the obsessive thought) and preventing my response of lifting my feet (the compulsion). Although to this day, I don’t worry if I do leave my feet on the ground over train tracks, I also don’t actively leave them there if I do realize we are coming up to train tracks. I do lift them up!
There was another time when OCE reared its head in my life. It was when I was pregnant. During this time,I had developed an intense fear of germs and this was very novel to me. It was the first time in my life where I had actually begun carrying hand sanitizers (this was years before COVID, FYI!). The obsessive thought was that I would get sick and cause health problems for my baby. The compulsive way of relieving that anxiety was to a) use hand-sanitizers, b) wash my hands a lot, c) avoid touching things, d) keep away from sick people, and e) avoid touching my face with my fingers. All of those are fine as general precautions and strategies I learned working in a research laboratory for years. They are also great precautions during COVID-19 times. These strategies do reduce our statistical chance of contracting contagious illnesses through mouth, nose, eyes, etc. The problem isn’t that act of doing any of these. The problem is what happens when these practices become a compulsive behaviour intended to relieve extreme anxiety associated with an obsessive thought if we are prevented from doing any of these. I remember one time being on the subway and having to hold the handrail because there were no seats (and I wasn’t pregnant enough yet for people to give up their seats for me). I grabbed the handrail and immediately felt the rush of anxious nausea seep into me… and then it lingered all the way until I got home and washed my hands. Walking home from the subway, I was so incredibly conscious of my hand. My hand was buzzing with energy. It felt like it was growing and growing as my somatosensory brain cells devoted more and more attention (and neural architecture) to it. It was as though I could feel each germ the size of a quarter walking over my throbbing hand. It was excruciating. (Growing somatosensory brain cells is a concept associated with “Neuroplasticity”. It’s an important concept related to how we learn and change and the way the brain supports that learning and changing. To learn more, check out the further reading section.
If I hadn’t been able to get to a handwashing station, I honestly felt like my hand would have exploded. Today, I’m back to my baseline state. The obsessive-compulsions associated with my pregnancy vanished a couple of months after I had my baby, which made me think it was very hormonally-based. I don’t love germs today but I don’t worry about them and I certainly don’t avoid them altogether. Up until COVID, I applied the 5-second rule to food that fell on the ground (in our own kitchen or on the grass outside) and would still eat it. And despite the COVID-19 pandemic, my obsession of germs hasn’t really returned. A conscious awareness of germs is there, but not to the level of obsessive compulsive experiences. Others, may not be so lucky. The rise in OCD and general health anxiety is a definite possibility, particularly as the pandemic subsides and people are left with having to recalibrate.
I will add that a different kind of postpartum (i.e., after birth) OCE did emerge, which presented itself as intrusive and unwanted fears of my baby dying or being harmed. This experience is quite common in new moms. It was a horrible experience for me, which at the time, I thought was totally justified. In my mind, of course, I would be obsessing over keeping my baby out of harm, but the visions that would come into my head were unbearable in actuality. In my mind, I would go over all sorts of scenarios of what would happen if… and how would I respond to save my baby? The thoughts of my baby being harmed was the obsession and then thinking about how I would deal with that situation was the compulsion. It was like an imaginary behaviour instead of an actual one but knowing I “figured it out”, was enough to momentarily relieve my worry.
For a scientific review of OCD in pregnancy and postpartum see the further readings section.
Triggers
Sleep deprivation is a HUGE trigger for my OCE. Sleep is a major stressor to the entire nervous system. It causes an elevation in our sympathetic nervous system, the driver of the stress response. Cortisol hormones (the stress hormones) rise and so does adrenaline (also known as epinephrine). Both of those hormones are associated with “arousal” states. With sleep deprivation we have this odd complex experience where we are both exhausted and aroused. Because of cortisol and adrenaline we are aroused but we also have an accumulation of adenosine, which is trying to tell our body to sleep. It’s a recipe for disaster, both in terms of physical performance (e.g., driving a car, operating heavy machinery) and also in terms of mental performance (e.g., remembering things, emotional regulation, and the cognitive control required to keep obsessive thoughts at bay). We also know that OCD and depression both have altered Hypothalamic-Pituitary Adrenal Axis dysregulation. The HPA axis is what regulates the release of cortisol and adrenaline during the stress response.
There is also scientific evidence that OCD does fluctuate with menstrual hormones. My OCE were heightened when I was in puberty, when I was pregnant, when I was postpartum, and during different points during my cycle. These all point to estrogen and progesterone as two of the many reproductive hormones. We do know that anxiety is dampened by progesterone and heightened with estrogen.
It’s also worth noting here two other conditions: 1) Pediatric Acute-onset Neuropsychiatric Syndrome (PANS) and 2) Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS). Briefly, these two conditions are associated with the onset of neuropsychiatric disorders, of which OCD is one manifestation. PANDAS is related to a streptococcus infection and an auto-immune condition. Changes to the immune system can trigger a host of consequences including changes to the gut-brain relationship and the gut-brain relationship is involved in cognitive-emotional experiences like depression and quite possibly obsessive-compulsive experiences. We’ll talk more about PANDAS and autism in the chapter on Sensitivities and the Gut-Brain Relationship.
Benefits of OCE
Like many double-edged swords in life, we may be able to reap benefits from our innate or learned ways of being that could also be to our detriment. My OCE experiences have also benefited me and they can benefit others as well. Obsessive-compulsive traits can be used to refine methods into something that does or approaches perfection. This can be adaptive in industries that require a great deal of expertise. For example, elite athletes working tirelessly to perfect a stroke, shot, cut, or play or a musician who has to perfect a piece they are playing or writing. The obsession emerges over something not sounding perfect and the compulsive behaviour is working to get it just right in order to stop the agony of the cacophony they are experiencing. I have seen these types of OCE when I have been training hard during some of my elite athletic years, particularly in ultimate frisbee, and then recently when I started practicing aerial circus (trapeze). There is an obsessive trait that certainly drives me toward a higher level of performance. I also obsess over “knowing” an attempt to learn and understand as much as I can, not feeling able to rest without knowing. The desire to know is the agony (obsession) and the information seeking behaviour is the compulsion I engage in. This also happened when I got pregnant. I thought I could know all that I should about pregnancy. That was futile. At moderate levels these are manageable and can drive development and performance. I also found help for myself after 3 years of suffering with challenges of being a new mom. I only found that help, I think, because I didn’t quit. My obsessions drove me… and helped me. But they can lead to dysfunction and a paralysis of sorts when levels are too high. That’s when it can turn into a disorder. The balance is delicate and I have to be constantly vigilant.
Conclusion
From a neuropsychoidiology perspective, I have been able to identify patterns in my own behaviours throughout my years that helped me identify my own triggers for these very disruptive obsessive compulsive experiences. Bringing a piece of wood to bed might seem relatively benign but worrying about my child being harmed when I was postpartum was not. Whenever we have intrusive thoughts that are disturbing, it is really challenging to live with them. I would also like to comment on the possible benefits of mindfulness-based strategies for working with OCD and OCE. In my experience, having a strong background in mindfulness training is helpful in relatively normal circumstances but when circumstances become too grandiose (e.g., significant sleep deprivation and possibly in combination with hormonal fluctuations), it feels too much for my mindfulness practice to circumvent.
Courses on Neuropsychoidiology available through the Centre for Applied Neuroscience: https://www.knowyourbrain.ca/courses/neuropsychoidiology
