Understanding_Obsessive_Compulsive_Disorder.pdf

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Understanding
obsessive-compulsive disorder
'When I was four years old I contracted a terrible case of
impetigo... The doctor told my mother that I probably got the
impetigo from putting dirty things such as toys or unwashed
fruit in my mouth, so from that day forward she washed
everything I came in contact with – everything. She washed
my pencils and my crayons; she washed my dolls and my doll's
tea set (just in case); she washed my food... And most of all
she washed me. When I came in from playing outside, after I
used the toilet, after playing with the dog, or just because I
was standing around and hadn't been washed for a while....
When my hands were dirty, or I thought they were, they had
a special feel about them. They felt huge and as though they
were vibrating. I tended to hold them away from myself. Along
with the sensation in my hands came a gripping feeling in my
stomach. My thoughts were, "I can't feel right until I wash my
hands. I must feel right immediately or something bad will
happen." The issue shifted from the dirt on the hands to the
feeling in the stomach and the vibrating feelings I felt in my
hands... My head was saying, "Not dirty – no danger", but
my stomach was still saying, "Danger, danger, do something
quick!”’
The Sky is Falling
Raeann Dumont (W. W. Norton 1996)
'He felt compelled to check that "everything was right", so
would go back over almost everything he did. The most serious
doubts he had were about doors, windows and gas taps, which
he checked several times before leaving the house in the
morning... and at night. He could not put anything in an
envelope or a file, drawer or cabinet without repeatedly
checking that he had written exactly the right things. (This
man had an exaggerated sense of responsibility and felt he
had to prevent errors or disasters).’
Obsessive-compulsive Disorder – The facts
Padmal de Silva and
Stanley Rachman (OUP 1996)
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The symptoms of obsessive-compulsive disorder (OCD) can
be very distressing and may seriously disrupt normal life.
This booklet is for anyone who wants to understand more
about OCD. It provides an outline of possible treatments, looks
at what support is available and at the ways that people can
learn to help themselves.
What is OCD?
OCD stands for obsessive-compulsive disorder. People who have this
problem feel they have no control over certain thoughts or ideas,
which seem to force themselves into consciousness. These repeated
thoughts – obsessions – are usually very frightening or distressing, or
can seem so unacceptable that they can't be shared with others.
One very important underlying feature of these thoughts is the
person’s fear that harm may somehow come to them or to other
people, and that they must try to prevent this.
Whatever the particular obsessions, even if they seem absurd or
unrealistic, they can't be dismissed or reasoned away. They create
unbearable anxiety that often makes people feel quite helpless. The
only way to relieve the anxiety is to perform the particular ritual that
neutralises the devastating thought. This could be something like
repeatedly opening and closing a door, washing ones hands, repeating
a litany, or counting. In other words, exaggerated elements of everyday
actions and routines. The irresistible urge to carry out such rituals is
known as a 'compulsion'. But the relief from the anxiety is only
temporary.
Some people have obsessive thoughts without having any compulsions.
Others have compulsions without knowing why they feel the need
to do them.
OCD is an anxiety disorder and is called a ‘neurosis’ because anyone
with OCD knows that the thoughts bothering them are their own.
This is unlike schizophrenia, which is a ‘psychosis’. (Someone who
has been diagnosed with a psychosis may feel that thoughts come
from somewhere outside themselves.)
?
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OCD shows similar features to a phobia. Both are to do with a natural
reaction to fear – anxiety and panic – that causes rapid heartbeat,
churning stomach, dizziness, shortness of breath, sweating, trembling
and other symptoms. (See Mind's booklets
Understanding Phobias
and
How to Cope with Panic Attacks,
details on p. 14.) But OCD is
about fears that other people can't necessarily relate to or share. In
addition, someone who has a phobia can avoid the object of that
phobia, whether it be cats, spiders or being away from home. But
this is not possible for someone with OCD, because the devastating
thoughts are always there, ready to emerge. People often suffer
from depression, and this may well be partly a result of the distress
caused by having OCD.
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What are the signs of OCD?
The term 'obsessed' is very much part of everyday language, but the
distinction between OCD and ordinary, everyday behaviour is a matter
of degree. Rituals are part of normal life – bedtime songs and religious
practices, for instance. We all worry occasionally about whether the
gas is turned off or the door locked, and we talk about people being
obsessed with work, football or someone they are in a relationship
with. Many of us indulge in small, everyday rituals without thinking
(throwing salt over our left shoulder, or avoiding the path of a black
cat). We may engage in compulsive behaviour, such as straightening
objects, or cleaning more than is strictly necessary. As many as
four-fifths of the population may experience such minor obsessions
or compulsions from time to time.
Obsessive-compulsive disorder is an extreme form of this behaviour.
During times of stress (a serious illness in the family, for example)
ordinary worries, such as a fear of germs, may increase. But this dies
down once the crisis passes. But with OCD, symptoms like these persist,
or make no sense, or interfere with life, or cause distress. For example,
someone might spend eight to ten hours a day washing, even though
their hands are already red-raw and bleeding. Or they may be
repeating some action over and over again, such as dressing and
undressing, or going up and down stairs.
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People are compelled to do these actions by the unquenchable fear
that they didn't do it properly last time. It is for this reason that OCD
is known as the 'doubting' problem. They may even recognise just
how absurd and damaging the behaviour is – but they are not able
to do anything about it. The behaviour is distressing not only to them,
but also to their family and friends.
OCD symptoms can occur in people of all ages. It's been estimated
that between one and three per cent of the population experience
the symptoms, although only those who are most severely affected
may ask for help. Some research suggests that as many as one per
cent of all children may have OCD at any one time. It seems that
problems may start in children as young as four or five years old,
and may continue into adult life.
The thoughts and rituals themselves seem to vary from culture to
culture, but common examples are:
Common obsessions
Fear of contamination via
germs and dirt
Imagining having harmed
oneself or others
Imagining losing control
of aggressive urges
Intrusive sexual thoughts or urges
Excessive religious or moral doubt
Forbidden thoughts
A need to have things 'just right'
A need to tell, ask or confess
Common compulsions
Washing
Checking
Repeating actions
Touching
Counting
Ordering or arranging
Hoarding or saving
Praying
When doctors make a diagnosis of OCD, they base it on a list of
medical criteria. The diagnosis depends on how many of the criteria
that person meets. This also tells doctor how severe the problem is,
and so what the best treatment might be.
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