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An Understanding of Obsessive Compulsive Disorder

Mary Jane Amato breaks down the behaviours associated with OCD, how sufferers can harness these traits to their advantage, and the support that is available.

Photo by Rumman Amin


There are many misconceptions and cliches that still surround obsessive-compulsive disorder (OCD). Many continue to associate this condition only with fixation on order and/or cleanliness. In actuality, OCD is a highly complex and often debilitating disorder. However, with the correct understanding and attention, OCD can be handled and, in certain cases, almost completely subdued.


OCD: A brief history and description of the disorder


OCD is a chronic mental health disorder that implicates obsessions and compulsions, often simultaneous and present in all forms of OCD. Compulsions are repeated physical or mental behaviours carried out to alleviate distress and anxiety, whereas obsessions are unwanted and intrusive thoughts, feelings, urges and doubts.

The World Health Organization states that OCD is among the top ten most disabling illnesses. People affected by this condition typically experience persistent and unwelcome thoughts, known as ‘intrusive thoughts’, which cause unwanted feelings and trigger specific compulsive and ritualistic behaviours that often fall within the following behavioural categories:

  • Organisation, Symmetry and Order

  • Contamination

  • Checking

  • Rumination

  • Hoarding


1. Organisation, Symmetry and Order

This behavioural category for OCD is most common and refers to obsessions with objects being in exact locations, symmetrical or ordered in very specific manners. Someone affected by this form of OCD often feels heavy pressure to maintain said order. Disorganisation can cause great discomfort or pain, leading some to believe disorganisation will hurt them or their loved ones indirectly if compulsions and order are unfulfilled.


2. Contamination

Ritualised washing and cleaning are also widely acknowledged OCD symptoms, being compulsive actions of purification. Sufferers may be worried about physically harming or contaminating others, or may feel uneasy or contaminated by substances. Sufferers may be concerned about contracting or spreading diseases or ailments from contamination. In these cases, ritual washing will be carried out as prevention.


Perceived contamination can also be mental, with less clearly defined obsessions; cleaning compulsively to alleviate the discomfort of feeling soiled or unclean. In this case, human interaction (rather than an external contaminant like blood or dirt) is the source of the discomfort. Degradation, humiliation, severe criticism and betrayal are examples of emotional violations that can lead to mental contamination.  


3. Checking

Checking compulsions are intentional and performed repeatedly to lessen the anxiety created by the certain thoughts and beliefs, though often resulting in the opposite effect. Some checking rituals include repeatedly checking to see if windows and doors are locked, ensuring all appliances are turned off or repeatedly scanning the road for accidents.

Other manifestations of checking behaviour are even more subtle and mentally draining. Some re-read or re-write words, sentences or entire paragraphs repeatedly. Some think the same thought while completing a different action, such as looking at oneself in the mirror or exiting a door until the feeling is “just right” – or turning light switches on and off, continually.

4. Rumination

Rumination is a compulsion based in the mind, generally understood as compulsive and repetitive thinking about a particular matter to the extent that suffers may loop and spend excessive amounts of time engaged with such thoughts without demonstrating any visible external behaviours.


Rumination may occur as an attempt to relieve anxiety or uncertainty, or to find answers to evasive questions – to explain something. However, sufferers often find themselves exhausted after the behaviour is habituated and control is lost.


5. Hoarding

The hoarding behavioural category covers the struggle to dispose of belongings. Sufferers accumulate things continually across time, storing them (typically in an unkempt manner) leading to clutter or unhealthy or dangerous environments. 

Although some people gather and store a lot of expensive artefacts, the goods are almost invariably of little or no monetary value. Sufferers typically feel an emotional connection to each object, attributing sentimental value to them, experiencing extreme anxiety about being separated from them.



The impacts of compulsion


OCD compulsions usually follow patterns that tend to be repeated precisely and consistently. Such rituals can impact lives in ways that can become extremely impairing. Compulsions are physical and mental, consuming a lot of time and affecting social lives. Knowing you might be performing rituals that could be perceived as highly unusual may prevent you from attending social scenarios to avoid judgement or anxiety.


Did you know? It takes the average OCD sufferer over seven years to reach a diagnosis. - Made of Millions.com

Relationships

Relationships for people affected by OCD can become very challenging. OCD sufferers may often feel anxious or insecure, requiring frequent assurance in relationships. Compulsion in relationships can be challenging, demanding, exhausting and require patience.

Taking care of duties that OCD sufferers are unable to may also be difficult for some families or partners. It takes resilience and understanding to support a loved one as an ally, rather than an enabler. Many engage in the therapeutic process as a family, to understand what they are going through and to receive the appropriate support.

The other side of OCD


Though OCD can cause much hardship, especially on the more severe end of the spectrum, it is important to remember, during the initial phases of recognising symptoms and the subsequent assessments, that looking solely from a medical perspective gives us only half of the picture.  

From a more holistic standpoint, traits that fall under the OCD bracket, though sometimes impairing in everyday life, are also well-defined characteristics that accompany the artistic and creative minds.  

In the words of Rose Cartwright, an OCD advocate and member of the Made of Millions team:

“Many experts have observed that people with OCD often possess a range of positive character traits, such as inquisitiveness, creativity, and empathy. I like that idea: the brain which gives you misery is the same brain which can give you great joy”. 

Attention to detail, creativity and a great deal of resilience, related to a single task, are traits that can be harnessed. Well-known individuals affected by OCD include David Beckham, Jessica Alba and Daniel Radcliffe. Sufferers are found in creative industries, using hyperattention to their advantage.  



Support and treatment


Those recognising compulsive behaviours affecting their lives often consult a healthcare professional to be referred for diagnosis.

The most common treatment is Cognitive Behavioural Therapy (CBT), involving the alteration of thought processes and behavioural patterns. Another type of therapy is called Exposure and Response Prevention (ERP), pushing clients to confront obsessions whilst resisting the urge of acting on compulsions.

In more persistent cases, Selective Serotonin Reuptake Inhibitors (SSRIs) are prescribed. Acting on chemicals of the brain, SSRIs have proven effective in cases of OCD-induced depression.


Concluding comments


Complex conditions like OCD can be scary, strenuous and isolating, but we are experiencing a shift toward further understanding of and lesser stigma around the mental health. Overcoming fear of judgement and actively seeking help are steps toward a more sustainable and richer quality of life.



Useful links:


Mental health support charities: Mind, Rethink Mental Illness, OCD UK. 

Diagnosis support: NHS, Awakn Clinics. 

Psychological support: Better Help, List of CBT Therapists.  



Researched by Alexandra Kenny / Edited by Mia Caisley / Online Editor: Harry Hetherington

 

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