Understanding OCD

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Obsessive Compulsive Disorder (OCD) is one of the least understood and most personally destabilizing mental health concerns. People who have OCD often express how frustrating it is to be misunderstood and mischaracterized by others, which often leads to them feeling unsupported or even rejected by their loved ones, just when they need them most.

Even when loved ones do make an effort to be supportive, they still may not really understand. This lack of knowledge could lead to making the mistake of enabling irrational behaviors, or speaking in well-meant but invalidating ways. Making their best efforts and yet not being able to truly help may leave them feeling frustrated and helpless as well. Unfortunately, this perpetuates a difficult cycle which could exacerbate the symptoms of OCD. And tragically, this could lead to others giving up on trying to help, avoidance of the problem or the person suffering with OCD, or denial of that person’s valid needs.

Having OCD can be extremely frustrating, as even though you are aware that your thoughts and compulsions are often irrational, you are unable to stop them. The disorder is characterized by:

1. Obsessions: Intrusive & disturbing thoughts, images, & feelings that continuously preoccupy the mind and heighten the body’s anxiety response.

2. Compulsions or Timed Rituals: Persistent uncontrollable urges to behave in a certain way, even against one’s conscious wishes. Compulsions and rituals are sometimes used to relieve the anxiety that arises from the aforementioned obsessions.

There are costs related to acting on one’s compulsions. These can include interruptions and challenges in school, employment, and interpersonal relationships.

There are many subtypes of OCD and its related disorders:

Contamination OCD:​ The strong fear of being contaminated by germs and bacteria, through contact with or proximity to anything that the sufferer feels is threateningly unclean.

Emotional Contamination OCD:​ The strong ​fear that contact with a person or place which has been associated with negative past experiences will somehow contaminate and therefore endanger them.

Relationship OCD:​ The harboring of strongly-held doubts about the suitability of a partner or a relationship. Sometimes associated with the inability to make confident decisions in relationships.

Health & Body-Focused OCD:​ ​Distressing preoccupations with bodily processes and sensations, such as one’s pulse, blinking, breath regulation, swallowing, twitching, and focus on the positioning, appearance or feeling of particular body parts.

Existential OCD:​ All-consuming obsessions with unanswerable questions such as the meaning of life, the purpose or fact of existence, other philosophical conundrums, etc.

Perfectionistic or Symmetry OCD:​ The need to be perfectly right, competent, or to have objects or thoughts in perfect order or “symmetry”. One feels that everything must be said and done perfectly. Behaviors and objects must sound, look, or be thought of as “just right.” Mistakes are felt to be catastrophic.

Scrupulosity or Morality OCD​: Obsessions and severe guilt involving religious issues such as unworthiness, sin, sexual impurity, irreverence, dishonesty, blasphemy, and the fear of hell. Extreme concerns about one’s character, integrity, punishment, good vs evil, etc.

Harm or Danger OCD:​ Extreme fear of severely hurting someone else, a loved one, or yourself, through your images, thoughts, or actions.

Morbid or Violence OCD:​ Intense fear of killing or injuring self or others with actions or thoughts. Fear of acting or thinking violently. Unwanted and intrusive violent images and thoughts.

Sexual OCD:​ Severe and unrelenting doubts around sexuality, orientation, or what is thought of as forbidden or perverse. Unwanted and intrusive sexual images and thoughts. Fear of being driven to commit heinous sexual acts.

Superstitious OCD: o​verly concerned with good or bad luck. Preoccupations can include lucky or unlucky numbers, colors, objects, names, words, or images. The belief that these things can cause bad things to happen. The fear that just thinking of bad events can make them reoccur.

Other Types of OCD Related Disorders

1. Compulsive Hoarding Disorder

2. Skin Picking Disorder

3. Hair Pulling Disorder

4. Body Dysmorphic Disorder

5. Eating Disorders – OCD about food, weight, body image, etc.

Unrelenting shame and fear both feed and drive OCD. OCD can also spring from severe and unbearable doubt, and not being able to tolerate uncertainty. It can be absolutely debilitating as the intrusive thoughts lead to intense fears. These fears are most often irrational and will never come to fruition. People with OCD suffer greatly and often in isolation.

Many people lightheartedly express that they “are OCD.” Perhaps to a small extent this could be true, however, this can minimize and invalidate the very real and difficult struggles of those with the disorder. People with OCD live with many challenges brought about by the disorder alone, and also have to cope with the stigma and misunderstanding that is fostered by these comments, even when they may not have been unkindly meant.

If someone you care about has OCD, please learn about the disorder from educated and licensed sources. Encourage your loved one to seek out expert help. A good resource to start with is the OCD Foundation at ​www.iocdf.org​.

Exposure and Ritual Prevention Therapy (ERP) is the best known and most-researched intervention for OCD and is effective in reducing obsessions and compulsions. Dialectical Behavioral Therapy (DBT) can be helpful because it teaches valuable coping skills which function to increase affect tolerance, and to resolve developmental deficits in emotional regulation. EMDR therapy is an additional option, especially when the therapist uses specific protocols that block beliefs and work on urge reduction for compulsions. If the OCD or the obsessions began after a traumatic event, targeting those memories using EMDR may bring great relief. Medications can be helpful in reducing intrusive thinking, relieving anxiety, improving sleep, and decreasing depression. Working with a psychiatrist who has experience with OCD is optimal.