What is OCD?
Dec
14
2007
14
2007
Obsessive-Compulsive Disorder (OCD) is an anxiety disorder. This is something often not understood or appreciated by the sufferer. It is often a very disabling disorder in that the sufferer finds it difficult to do routine things day-by-day. Obsessions and compulsions take up much of the available time, for example, excessive cleaning.
Obsessions are recurrent and persistent thoughts, impulses, or images that are experienced as intrusive, unwanted, inappropriate and mostly as irrational in the cold light of day. I say mostly because of the doubt element that many of my clients experience, for example, 'How though can I be sure that this thought is not the case?' and 'Isn't is possible that my sore arm could be caused by cancer?' The thoughts, impulses, and images of obsessive ideation as it is called cause marked anxiety and distress and are not simply excessive worries about real - life problems. The sufferer often attempts to ignore or to suppress the obsessions, or to neutralize them with some other thought or action (here control is the problem which is something we will return to later) . For example, in thinking something deemed unacceptable having to blink both eyes in a certain sequence in order to 'put matters right' (i.e. to relieve the felt anxiety and distress of the obsessional thoughts).
Obsessions are viewed by the sufferer as the product of his or her's own mind (they are not imposed from without as a thought insertion).
Compulsions in turn are what I call the 'putting matters right' component in response - the things the person feels compelled to perform in response to the obsessions, often according to rigid rules developed over time (for example, doing things in particular multiples). Compulsions include repetitive behaviours (e.g. hand washing, checking) and/or mental acts (counting, repeating words or actions). Many sufferers check things after the event by running what I call movies in their head about what exactly happened. A sufferer can have an obsessive thought that they may have offended someone in a conversation and then feel compelled to call the person to 'check out' in a round about way that they had not been responsible. Compulsive behaviours or mental acts are designed to reduce distress or prevent some dreaded event or situation.
In some cases compulsions can take on a mind of their own and are performed in what is called a functionally autonomous fashion (a bit like learning to take a headache pill before and in case that you do get a headache). There is mostly no realistic relationship between the compulsive part and the obsessional part that triggered it in the first place and the compulsive behaviour is clearly excessive, e.g. hand washing.
While a sufferer may clearly see that the obsessions and compulsions are excessive and/or unreasonable, they may resist giving them up because they are viewed as offering some control over the situation, no matter how time consuming. Having to deal with the sheer terror of living with the uncertainty of obsessive ideas can be an overwhelming prospect, particularly if the neutralizing compulsive behaviour has been around for a long time.
At work, compulsions may have to be hidden to avoid detection. This can become another sourse of anxiety in itself. For example, while undertaking a business assignment a young accountant was found to be repetitively re-working and checking the accounts of clients but could not legitimately bill for this time. The partners of her small accounting firm were at a loss to comprehend and to understand just what was going on. OCD was the last thing that came to their minds. The sufferer's day-by-day attempt to control and live with the disorder may be largely invisible to the casual observer or family friend (despite the presence of much repetitive behaviour).
The sufferers of OCD often experience the following: poor self-esteem; mood flucuations which are particularly evident to close family members; guilt all the time; anger problems, and difficulties in relationships.
Also, many sufferers seek to avoid the sources of their problems through avoidance. For example, avoiding places that trigger off obsessions about being contaminated. Avoiding people who create problems. Avoiding certain rooms in the house so as not to feel contaminated.
The sufferer can also feel OK if someone else can take the responsibility for checking something. Research has demonstrated that obsessive ideas and compulsive behaviours are all commonly experienced, for example, who hasn't been convinced that they had their airline tickets but then felt compelled to check just one more time on the way to the airport (you could see this as caused by the stress of travelling). Who has not had the thought that the gas might have been left on and then felt the need to quickily returm just to check it out for a final time. I used to have a neighbour that after going on holidays would always send a postcard asking me to check if his front door had been left open. Both in terms of these everyday examples, and in the case of OCD, stressful life events puts more pressure on and then your vulnerability to anxiety gets activated.
In the next postings I am going to deal with how to get help, what to ask and to look for, and I will discuss what psychological treatment will generally involve.
Obsessions are recurrent and persistent thoughts, impulses, or images that are experienced as intrusive, unwanted, inappropriate and mostly as irrational in the cold light of day. I say mostly because of the doubt element that many of my clients experience, for example, 'How though can I be sure that this thought is not the case?' and 'Isn't is possible that my sore arm could be caused by cancer?' The thoughts, impulses, and images of obsessive ideation as it is called cause marked anxiety and distress and are not simply excessive worries about real - life problems. The sufferer often attempts to ignore or to suppress the obsessions, or to neutralize them with some other thought or action (here control is the problem which is something we will return to later) . For example, in thinking something deemed unacceptable having to blink both eyes in a certain sequence in order to 'put matters right' (i.e. to relieve the felt anxiety and distress of the obsessional thoughts).
Obsessions are viewed by the sufferer as the product of his or her's own mind (they are not imposed from without as a thought insertion).
Compulsions in turn are what I call the 'putting matters right' component in response - the things the person feels compelled to perform in response to the obsessions, often according to rigid rules developed over time (for example, doing things in particular multiples). Compulsions include repetitive behaviours (e.g. hand washing, checking) and/or mental acts (counting, repeating words or actions). Many sufferers check things after the event by running what I call movies in their head about what exactly happened. A sufferer can have an obsessive thought that they may have offended someone in a conversation and then feel compelled to call the person to 'check out' in a round about way that they had not been responsible. Compulsive behaviours or mental acts are designed to reduce distress or prevent some dreaded event or situation.
In some cases compulsions can take on a mind of their own and are performed in what is called a functionally autonomous fashion (a bit like learning to take a headache pill before and in case that you do get a headache). There is mostly no realistic relationship between the compulsive part and the obsessional part that triggered it in the first place and the compulsive behaviour is clearly excessive, e.g. hand washing.
While a sufferer may clearly see that the obsessions and compulsions are excessive and/or unreasonable, they may resist giving them up because they are viewed as offering some control over the situation, no matter how time consuming. Having to deal with the sheer terror of living with the uncertainty of obsessive ideas can be an overwhelming prospect, particularly if the neutralizing compulsive behaviour has been around for a long time.
At work, compulsions may have to be hidden to avoid detection. This can become another sourse of anxiety in itself. For example, while undertaking a business assignment a young accountant was found to be repetitively re-working and checking the accounts of clients but could not legitimately bill for this time. The partners of her small accounting firm were at a loss to comprehend and to understand just what was going on. OCD was the last thing that came to their minds. The sufferer's day-by-day attempt to control and live with the disorder may be largely invisible to the casual observer or family friend (despite the presence of much repetitive behaviour).
The sufferers of OCD often experience the following: poor self-esteem; mood flucuations which are particularly evident to close family members; guilt all the time; anger problems, and difficulties in relationships.
Also, many sufferers seek to avoid the sources of their problems through avoidance. For example, avoiding places that trigger off obsessions about being contaminated. Avoiding people who create problems. Avoiding certain rooms in the house so as not to feel contaminated.
The sufferer can also feel OK if someone else can take the responsibility for checking something. Research has demonstrated that obsessive ideas and compulsive behaviours are all commonly experienced, for example, who hasn't been convinced that they had their airline tickets but then felt compelled to check just one more time on the way to the airport (you could see this as caused by the stress of travelling). Who has not had the thought that the gas might have been left on and then felt the need to quickily returm just to check it out for a final time. I used to have a neighbour that after going on holidays would always send a postcard asking me to check if his front door had been left open. Both in terms of these everyday examples, and in the case of OCD, stressful life events puts more pressure on and then your vulnerability to anxiety gets activated.
In the next postings I am going to deal with how to get help, what to ask and to look for, and I will discuss what psychological treatment will generally involve.
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