Obsessive Compulsive Disorder (OCD) is one of the more well-known disorders, made popular, among many other portrayals, by Jack Nicholson in the movie “As Good as it Gets” as Melvin Udall, a misanthropic author with OCD. If you’ve seen the movie, you may recall Melvin turning the lock repeatedly after closing his front door.As with all mental disorders, it is important not to self-diagnose based on information we have gathered from pop culture or the internet. OCD can cover a broad range of behaviors and thought patterns, and it is perhaps best evaluated in the context of how disruptive or distressing it is in your life. If you are concerned you have any mental disorder, see a mental health professional and get a diagnosis.
What is OCD?
The DSM-V Manual defines obsessions as (1) “recurrent and persistent thoughts, urges, or images that are experienced, at some time during the disturbance, as intrusive and unwanted, and that in most individuals cause marked anxiety or distress,” and (2) “The individual attempts to ignore or suppress such thoughts, urges, or images, or to neutralize them with some other thought or action (i.e., by performing a compulsion).”
The manual goes on to define compulsions as:
1. “Repetitive behaviors (e.g., hand washing, ordering, checking) or mental acts (e.g., praying, counting, repeating words silently) that the individual feels driven to perform in response to an obsession or according to rules that must be applied rigidly,” and
2. “The behaviors or mental acts are aimed at preventing or reducing anxiety or distress, or preventing some dreaded event or situation; however, these behaviors or mental acts are not connected in a realistic way with what they are designed to neutralize or prevent, or are clearly excessive. Note: Young children may not be able to articulate the aims of these behaviors or mental acts.”
Please notice that concern for your children, or songs that get stuck in your mind, or situational awareness in a strange parking lot at night, are not OCD. If your concern for your children causes you to quit your job and follow them everywhere, or the song plays in your head all night and you can’t sleep, or your situational awareness of potential danger keeps you from leaving the house, that would be worth getting a diagnosis from a professional.
The manual specifies, “The obsessions or compulsions are time-consuming (e.g. more than 1 hour per day) or cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. The obsessive-compulsive symptoms are not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition.
The disturbance is not better explained by the symptoms of another mental disorder…” then goes on to list a host of mental disorders that may present with OCD-like behaviors. Again, if you are concerned you have any mental disorder, get a diagnosis from a mental health professional.
What Causes OCD
Sometimes OCD has an organic cause. People on the autism spectrum may demonstrate OCD behaviors, along with people with brain injuries and other structural abnormalities. Most often, OCD is a reaction to defensive structures that have been erected around our traumatic narratives.
It is a coping mechanism for a mind that feels overwhelmed by internal and/or external circumstance. Depending on the depth and complexity of the structures at work, OCD can be treated by effective therapy, and sometimes overcome completely.
Danielle works at a marketing agency. Without realizing it, she has gotten into the habit of clicking her retractable ballpoint pen open and closed when she’s thinking, working or talking. One day her supervisor takes her aside and mentions that the habit is a little distracting and asks if she would mind too much finding something else to do. She assures him she will.
Back at her desk, she sets the pen aside and gets to work, only to discover she can’t concentrate. She starts tapping her leg, but that’s more distracting than the pen. She tells herself this is ridiculous, it’s just mind over matter. She tries a number of substitutes, worrying a coin, bending and unbending a paper clip, but nothing works.
Finally, she dismantles her retractable pen and takes the mechanism out that causes the click. Now she can press the button over and over under the table and it makes no sound. By this point, she has spent over an hour of work time trying to solve her problem but feels like it’s going to be okay.
She gets to her meeting that afternoon, a meeting in which she will have to present something, and just as the meeting starts, she realizes she doesn’t have the right pen. Now all she can think about is the pen and is unable to function. Before it’s her turn to speak, she has to excuse herself because the anxiety is intolerable.
What Danielle didn’t realize, and what a therapist could help her see, was that she was in the grip of a compulsion (clicking the pen) in response to an obsession (pressure to perform) layered on an emotion (anxiety) that likely has its roots in trauma narratives from her childhood. When our acting out behaviors are based on early trauma, they often seem both bizarre and insurmountable at first.
These defensive structures that allow us to survive, which eventually become obstacles to our growth and health, are formed at a time when we literally cannot think about them. We don’t have the neocortical, reasoning portion of the brain sufficiently developed to understand and craft a healthy response to our trauma. So when these behaviors emerge they may seem to come out of nowhere and it isn’t until we engage the help of a mental health professional that we begin to understand the underlying processes that are at work.
Mike works for the city as a tollbooth operator at a subway station. Two years into the job, one of his coworkers is mugged on the way home. There were no injuries and the mugger got away with a few dollars, so he shrugs it off and moves on with his life. A few weeks later, he’s cycling on thoughts of being unsafe.
He tries to tell himself everything is okay, but he starts coming up with reasons to leave work early so it’s still light out. The following week, he buys an extra lock for his front door.
Over the weekend, he watches a movie where someone gets blown up in a car. The next day, he checks under his car for explosive devices. This becomes part of his routine. The next week he puts another lock on his door.
His wife starts to get concerned that he’s stuck in his thoughts and suggests counseling. A month later, he quits his job and is unable to leave the house. With his wife’s encouragement, he checks in for a 72-hour evaluation at the local mental health unit.
After a week of stabilization, Mike returned to work, with tools for disrupting his negative thinking and a plan to see a therapist once a week to enhance and develop those tools and understand his underlying emotional triggers more clearly.
It may seem obvious, Mike was in a downward spiral of anxiety and catastrophic ideation after the mugging suffered by his coworker, resulting in a compulsion (safety checks), in response to an obsession (protecting against all harm), layered on an emotion (anxiety), once again likely with roots in childhood trauma.
Instead of pausing to reflect on the impact of the mugging, he shoved his feelings aside and tried to soldier on. By ignoring his devolving emotional world, he trapped himself in a prison of his own making and it wasn’t until he admitted he needed help that he began to overcome the issues that were driving his thinking and behavior.
Crystal was raised in a home by an abusive mother and distant father. For as long as she could remember, she had a habit of touching people, even strangers, when she first came up to them. Though she occasionally got scolded for it, she became adept at apologizing quickly, like it had been an accident.
In high school, her friends told her it was weird, but despite numerous attempts, she wasn’t able to stop the behavior. During this time, she also developed a habit of keeping everything on her desk in straight lines and being very uncomfortable if something was out of place.
Her senior year, facing the daunting task of taking off to college and the unknown, she was in tears at her best friend’s house and the friend suggested she see a counselor. That summer, Crystal started seeing a therapist.
After a few sessions, she began to understand that she was suffering from a compulsion (touching people) in response to an obsession (deep-seated need for connection, missing from her childhood) and layered on an emotion (fear of abandonment).
With the therapist’s help, Crystal developed deep breathing techniques to help her manage her anxiety and mindfulness to help her stay in the here and now, let the past be the past and the future be the future, and deal with the reality of the moment. Over time, the compulsion began to fade.
As we see with Crystal, OCD is often treatable by processing underlying traumatic narratives, replacing undesirable actions with neutral or desirable ones, managing anxiety, and learning to locate oneself in the present. The work is not usually easy and may take months or years, and as always should be under the care of a licensed mental health provider.
There are a lot of quizzes out there to help us self-diagnose a multitude of physical and mental ailments. The quiz that follows is only intended to provide the reader with some sense of whether or not there may be an issue with OCD in their life.
Any actual diagnosis should be provided by a mental health professional. Having said that, here are some questions to begin to scope out the presence of OCD in your day to day activities. Some of the questions involve thought patterns, particularly thought patterns that seem ingrained and resist attempts to alter them.
An example would be the difference between concern about being assaulted while in a strange parking lot at night, versus lying awake at night unable to stop worrying about it, even though you’re not there.
If the latter describes your experience, you would circle “Y” on the OCD test. After taking the quiz, if you score high enough to be concerned, schedule an appointment with a therapist to get a professional diagnosis.
HAVE YOU BEEN DISTRESSED BY, AND HAD DIFFICULTY CHANGING, REPETITIVE, AND/OR UNPLEASANT THOUGHTS OR ACTIONS AROUND:
Contamination (dirt, disease, germs, chemicals, radiation) Y N
Catching/spreading illness (AIDS, MRSA, Ebola, other diseases) Y N
Excessive examining of body for signs of illness Y N
Keeping objects (pens, pencils, tools, other) in perfect order Y N
Repeating actions (going through doorway, in/out of chair, etc.) Y N
Robbery/assault (mugging, pickpocketing, home invasion) Y N
Forgetting to (lock the door, turn off the oven, other) Y N
Afraid of losing something important Y N
Excessive cleaning (hands, floors, teeth, clothes, other) Y N
Locking your doors Y N
Guarding your things Y N
Hoarding your things Y N
Preoccupation with a person Y N
Preoccupation with someone’s words Y N
Calamity (floods, fire, volcano, earthquake, etc.) Y N
Losing control of your car (accidents, hurting others) Y N
Unacceptable religious or sexual thoughts Y N
Harm coming to loved ones from your own lack of knowledge Y N
Acting on a senseless impulse to harm someone Y N
Add your own: _______________________________________________________
Now look at the list above and ask yourself:
How much of my time is taken up by these actions?
Not much Some A lot
How much do these actions bother me?
Not much Some A lot
How much does this interfere with my work, social or family life?
Not much Some A lot
How much does this make me avoid being with others?
Not much Some A lot
Based on your answers, you should have the beginnings of a picture of this part of your life. If you have any concerns, as mentioned before, please schedule time with a mental health professional and see if there is a diagnosis. Our best opportunity to get better is when we ask for help.
“In Order”, Courtesy of Dustin Kirkpatrick, Unsplash.com, CC0 License; “Woman Crying”, Courtesy of Abigail Keenan, Unsplash.com, CC0 License; “Anxious Man”,Courtesy of Jessica Oliveira, Unsplash.com, CC0 License; “Look”, Courtesy of Joshua Rawson Harris, Unsplash.com, CC0 License