Why OCD is a lot worse than you thought

The phrase “I’m a little OCD” demonstrates brilliantly the poor understanding we have of obsessive compulsive disorder. The phrase connotes someone who’s a bit overenthusiastic about neatness and order. This has absolutely nothing to do with OCD. In fact, the kinds of ‘orderly behaviours’ that might be seen in cases of OCD comprise only a tiny number of the symptoms. Of course, no one can be expected to list off all the characteristics of something this complex. But we can be a little better informed. So instead of overgeneralising OCD as a desire to keep things tidy, let’s approach OCD from another overgeneralisation, but this time a more useful one. OCD as a form of anxiety. In this case, anxiety about intrusive, involuntary, and troubling thoughts.

Anxiety is a normal healthy emotion. It’s thought to be a function of evolution that is rather beneficial in many cases. When we become anxious, our entire body gets a little more active and so certain types of anxiety actually increase our performance in certain situations. We become more alert and focused, and are likely therefore to perform better in sporting or test-like situations. This is best represented by the Yerkes-Dodson law. The more pressure, the better we perform. But only to a point. Too much pressure and our performance begins to decline until we become paralysed.

And, for one in five of us, every year, will slide down the wrong side of the Yerkes-Dodson law so severely that they will meet clinical criteria for an anxiety disorder. OCD is one of the forms this might take.

¶Obsessive Compulsive Disorder (OCD): an anxiety about intrusive thoughts

OCD is characterised primarily by what are called obsessions: repetitive and intrusive thoughts that of something very specific and troubling. These thoughts might be different from person to person, but they are generally the same within people. That is to say, a person with OCD will suffer one particular kind of thought, image or impulse that happens in the same way and of the same thing each time it appears.

These thoughts aren’t just irritating. They’re extremely distressing. It might be the persistent notion that your carelessness will lead the house to burn down, killing everyone inside. Or perhaps a new parent who repeatedly experiences images of stabbing the newborn infant. We have no particularly promising leads on why these thoughts begin, except that there is almost certainly some genetic component. But it’s easy to see how someone suffering these mental images might consider themselves some kind of monstrous person, rather than the sufferer of some unusual malfunction.

And despite the fact that these obsessions have absolutely no bearing on the behaviour of the sufferer, the sufferer will seek to avoid it desperately, terrified that the thought might come true. This leads us to the second constellation of symptoms: the compulsions.

¶Compulsions help the obsessions subside

When someone with OCD has an obsessive thought, they might try various things to distract themselves. When a particular distraction works, whether by design or by accident, the relief can be extraordinary. As such, those with OCD are likely to repeat the sequence of events or actions that led to the relief the next time the obsession returns. This is why compulsions are often so specific. The person concerned with disease from his hands infecting and killing his family was distracted the fifth time he washed his hands. So the next time the obsession appears, he washes his hands five times. The person concerned with a burglar slipping in and violating the home felt relief after checking the lock sixteen times, so the next time the obsession intrudes, they check the lock sixteen times. It becomes a ritual, almost a superstition.

The superstitious nature of these compulsions are not lost on most sufferers either. People with OCD are just as aware as you are that what they’re doing seems unlikely to help. Unfortunately, just like many superstitions, knowing they’re a bit silly is not the same as being free of the compulsion to do them.

Certain obsessions, of course, are more common than others. Those related to ‘symmetry’ account for the most: more than a quarter. These obsessions relate to doing something in a specific way. Creating symmetry with the time of relief through action or event. These often lead to the classic ‘neat and tidy’ compulsions we often think about. The world needs to be arranged just so, because it was that way when they felt relief.

The runner up would comprise ‘forbidden thoughts or actions’ obsessions–fears of doing something aggressive and taboo, or leading to violence. They might worry they are going to strike a nearby stranger, or do something overtly sexual on the bus. Although these actions are completely unlikely to happen, they often lead the person to compulsive checking habits. Mostly, these are logical extensions of the obsession. Checking your fly is done up, or your hands are where they should be. But sometimes, they can be completely illogical, like checking behind you every few steps, or turning your head in a particular direction. Whatever they associated with relief is likely to become part of the compulsion.

The third most common are cleaning and contamination obsessions (with obvious compulsions) and following those, hoarding compulsions which are peculiar enough in their own right to spark debate as to whether they should be considered a seperate phenomenon.

¶Why

The cause of OCD is unknown, but we know that it appears to have a strong biological basis. Studies exploring the condition in (near) ‘identical’ (monozygotic) and non-identical twins find that identical twins are substantially more likely to share the disorder. But it doesn’t seem to be particularly hereditary. Only about 10% of parents will Share the disorder. This suggests it’s a kind of build up of unfortunate genes, likely similar to those involved in more general anxiety disorders.

This biological mix appears to result in a peculiar use of the brain chemical seratonin (involved in mood, social behaviour and memory among other things) as well as a strangely hyperactive loop in the brain that generates an excess of ‘worry inputs’ alongside a lack of (subconscious) control over over the process. Essentially, the brain is behaving decidedly oddly and in such a complicated way that we’re not really sure what’s going on, except OCD sufferers, like all those with excessive anxiety, are neurologically inclined to worry.

Fortunately, because it’s biological, it lends itself well to drug-related treatment. As Stanford carefully put it a modest proportion of patients will achieve freedom from significant symptoms. Reading between the lines, though not curable, it can become manageable.

What would help, though, is if we stopped treating it as though it were a trivial problem. People who are excessively orderly are not necessarily suffering OCD. In fact, it’s unlikely. As we learned, only about a quarter of OCD sufferers have symmetry obsessions, and not all symmetry obsessions are about the position of ‘stuff’. People who are super neat are more likely to have traits of obessive compulsive personality disorder. Unlike those with OCD, those with OCPD think this kind of attention to detail and orderliness are completely rational and desirable. Control, even excessive control, is a good thing. For those with OCD, the compulsions are not simply annoying and unwanted, but they can be as distressing and stressful as the obsessions that sparked them.

So, you’re not a bit ‘OCD’ about things. You’re just a bit retentive. Unless you have a near paralysing fear of intrusive and distressing thoughts that pop unbidden into your head with the kind of regularity that it causes you to engage in strange, time-consuming, and stressful behaviour. In that case, you might be a little ‘OCD’.