The Deconstruction of OCD

“I am such a weirdo. I have strange OCDs.”

“I am so like Sheldon from The Big Bang Theory.”

“Oh, I can’t keep the TV volume on an odd number. I HAVE AN OCD!”

We come from a generation where the word OCD is thrown around with almost little or no thought put into the context surrounding the reference to this term. Part of why this is so can be attributed to the popular yet grossly misinformed portrayal of this and many other mental disorders in media. In fact, the media portrayal of OCD has almost reduced it to a funny illness that is not to be taken seriously. For instance, when you see Sheldon Cooper knock on Penny’s door 3 times in a row with a monotonous “Penny” following each knock, it first makes you laugh and then (maybe) consider this behavior as problematic. But only when we move beyond laughs will we truly understand this psychological disorder and stop trivializing every other quirk of ours as “a full blown OCD.”

OCD—what does it mean?

Obsessive Compulsive Disorder aka OCD is an anxiety disorder characterized by  time consuming and recurring obsessions and compulsions. An obsession is an unwanted thought, word, phrase or image that due to its repeated and persistent presence in a person’s mind causes unease and distress. These unwanted thoughts feel extremely intrusive to the person experiencing them. They drive individuals to engage in some repetitive acts or thoughts which at the first glance may seem quite purposeful but in fact are compulsions that a person performs in order to reduce or neutralize the anxiety generated from the overwhelming fixation on obsessive thoughts. These compulsions are ritualistic or rule based acts and thoughts which have somehow come to be associated with a particular obsession and exclusively hold the power to help regain control over one’s anxiety ridden mind.

Let’s explain the above highlighted keywords with the help of an example. The most commonly heard OCD is related to the need for cleanliness. A person with this OCD may experience an obsession with the idea of that touching any uninspected surface with bare hands poses a serious health hazard. In order to bury the worry that this thought arouses, s/he may wash hands EVERY time they touch a wall or a stool or a window pane. This can be understood as the compulsion that occurs in response to the overwhelming obsession concerned with hygiene needs. In fact, s/he may persist in their behavior even when their skin becomes all raw due to repeated hand washing. Also, we should note here that the distress caused due to the recurring obsession is so huge that it overshadows the distress coming from the physical pain arising due to the irrational, compulsive act of washing. This can be an indicator that the OCD has reached a clinical level of diagnosis wherein it has started interfering with an individual’s everyday functioning and well being.

OCDs—have your pick of the type

The obsession for cleanliness and hygiene coupled with the compulsion for washing is only one type of the many kinds of OCDs that one may suffer from. The need for order and symmetry is another kind which is often followed by the compulsion of putting things in picture-perfect order. Some individuals are overcome by checking compulsions whereby they often fear that they have committed some error that needs to be checked several times. This kind of OCD may not only involve compulsively checking the stove 5 times before you leave the house but may also involve constantly seeking reassurance from someone else about whether the stove was put off before leaving home.

Also, it is not necessary that a compulsion has to be a physical act. Compulsions can also involve mental rituals like counting up to a certain number or reciting a short prayer each time a threatening thought occurs. Although compulsive picking of skin (excoriation), hair pulling (trichotillomania), hoarding compulsions and preoccupation with perceived bodily defects (Body Dysmorphia) are conditions related to OCD and may in fact show similar patterns of expression; they are often diagnosed as separate disorders.

OCD—how does it sustain?

Individuals with OCD are hyper vigilant to danger detection. At the same time, their nervous system is often slow at recognizing that a threat has passed. When combined, this results in extremely high levels of long-lasting anxiety. Since the automatic danger/safety detection system is malfunctional in individuals with OCD, they try to gain control over their paralyzing fears by manually interfering in the form of compulsions. OCDs sustain due to negative reinforcement of the compulsive acts. In simple terms, negative reinforcement refers to an action that is strengthened as it supposedly removes some form of unpleasant stimuli from the said circumstance. For example, if taking a pain killer calms down your terrible headache then the act of ‘popping the pill when in pain’ is strengthened as it removes the unpleasantness experienced due to the said headache.

Thus, the negative reinforcer of hand-washing is strengthened as it illogically gets paired with the idea that it cleans the germs you contact on touching a wall thereby providing relief. However, over time the act of washing almost becomes an addictive behavior that you are dependent on to get rid of your obsessive thoughts and instead of something that helps you deal with the feelings of threat, it becomes something that makes space for you to experience more obsessive images. Instead of serving as a means to an end, the compulsion then becomes an end in itself.

Dealing with OCD: Exposure Response Prevention Therapy

Although several methods of dealing with OCD exist, the one that has most popular use is the Exposure Response Prevention Therapy. This technique seeks to restructure problematic behaviors and thoughts that drive the OCD. It involves gradual exposure to feared obsessions followed by restrictions on performance of the associated compulsion. A hierarchy of least to most anxiety producing thoughts is created and the person is encouraged to test the waters at a comfortable pace. So, a person excessively concerned about hygiene may start out by purposely touching a glass window and wash hands only after a delay of 10 minutes, then 20 minutes, then 45 minutes then an hour and eventually working up to not washing hands at all in response to such minor anxiety provoking situations. After the touching of this one threatening surface is mastered, one can move on to the next in the hierarchy and so on till a total disconnect is established between the obsession and the compulsion.

This technique and many others are easier said than done. Professional support in diagnosis and treatment is always recommended. OCD is much more than a “funny illness”. It is a very real clinical diagnosis that has the potential to reduce one’s potential drastically. Don’t let the unnecessary obsessions and compulsions take up the mental space that can otherwise be utilized to live a life that is worth it.