So, About OCD
Simon-Peter Brown LMHC
As a person with Obsessive Compulsive Disorder, I often find myself “stuck.” Maybe I’m stuck in my obsessive thoughts, or agonizing over how I’m going to organize the words in a blog post in order to make something as inoffensive as possible. I’m sure some of my people with this particular constellation of symptoms have similar experiences, but perhaps not all; I wouldn’t want to assume. However, as I work through my stuckness a few thoughts come to mind as I am reminded of the uniqueness of OCD.
I always found it interesting and even a little frustrating that so much literature and the perspectives of my colleagues seem to contextualize obsessive compulsive disorder as something just adjacent to anxiety. As I sit with my experience I see so many other emotions as they add tension and encourage compulsive behavior while anxiety seems to be a byproduct of mounting distress. Anxiety might be a common character, but at most it plays a background role while any number of other thoughts and feelings are leading the cast. Of course I’m speaking exclusively from my experience, although it may be worthwhile to look at other feelings if we’re trying to understand OCD a bit more.
The first thing I like to point out when discussing OCD is that in the DSM 5, it no longer shares a class with anxiety disorders, rather it is in a class called “Obsessive-Compulsive and Related Disorders.” But what does that mean? Well, it seems to mean quite a lot. OCD in some cases can be tic related and identified by a need to experience something as “just right” without strong recognizable obsessions; compulsions can also be triggered by a rigidly held ruleset that directs conduct. Furthermore, OCD is distributed between about 5 different dimensions; contamination, harm related, acceptability, symmetry, and hoarding all of which illustrate the type of obsession and compulsive behavior. To clarify, as illustrated in the linked table, an individual with the acceptability dimension might have recurrent intrusive thoughts of a grotesque or violent nature and therefore pray or do other mental rituals in order to correct or atone for their misdeeds.
It’s not simply anxiety. That said about two thirds of people with OCD have another comorbid disorder with Major Depressive Disorder being very high in prevalence. And according to the previously linked study, individuals with an OCD diagnosis are indeed more likely to have an anxiety disorder in childhood, however prevalence decreases with age. This post could get bogged down in the intricacies of OCD and comorbidity; but it’s important to note that yes there is a higher rate of anxiety disorder among some folks with OCD as well. But what are the defining characteristics of OCD? With the data available to us we can see that it is different from anxiety, but what makes it distinct? Well…
According to NIMH “OCD is a common, long-lasting disorder characterized by uncontrollable, recurring thoughts (obsessions) that can lead people to engage in repetitive behaviors (compulsions).” Let’s break that down.Firstly “uncontrollable recurring thoughts.” To paraphrase the International OCD Foundation, these thoughts, feelings, images, and impulses happen outside of a person’s control; they are also time consuming and interfere with functioning to an extent that is well beyond that of what one might expect from the casual use of the term “Obsessive.”Secondly those “repetitive behaviors.” The same article defines compulsions as repetitive behaviors that are used to address the obsessive thought content by neutralizing or counter acting them; these acts can be time consuming and distressing. Further, a person with OCD is often aware that these behaviors and thoughts are irrational or not based in reality, but will still feel compelled to perform them or be distressed by the thought content.
Unwanted thoughts, feelings, and even mental images contribute to an experience of distress that compels an individual to behave in a certain way. While the compulsion is intended to somehow address the distress caused by the obsessive experience, compulsions are distressing on their own. From where I’m sitting the “involuntary” aspect of OCD is something that seems to set it apart. We don’t want intrusive obsessive thoughts or compulsions, but despite our protests they come, even if we know they are unreasonable, irrational, or just plain wrong.
So what’s the point of all this? Why is it important to better understand OCD? Less than a third of people with OCD get appropriate psychiatric care and even fewer get appropriate psychotherapy treatment. Hence, having these conversations with clinicians is important to improving treatment. But in the social context, you may have very well come across someone with these symptoms and it may be valuable to remember that they did not choose this, and they may be suffering. I can’t speak for all of us and I would never try, but my guess is that many of us would like to be understood a bit better. I, as a clinician and a person with this diagnosis, am passionate about helping folks with OCD. If you or someone you know struggles with these symptoms or this condition then please reach out for support. I am here for you!
