The Obsessive-Compulsive Trap

Resources

Introduction

While most people have heard of Obsessive-Compulsive Disorder (OCD), few people really understand it. In the movie, As Good As It Gets, Jack Nicholson portrayed a man who suffers from OCD. Audiences laughed as Nicholson’s character washed his hands compulsively, stepped over cracks in the sidewalk, and used his own cutlery in a restaurant to avoid possible germs. The television show Monk showcases a brilliant but quirky investigator who suffers from OCD. In fact, his illness is one of the main themes of the show. Recently, I’ve heard many people jokingly comment on a friend’s fastidious behavior by calling them Monk. However, to individuals suffering from OCD, the symptoms are no laughing matter.

It is estimated that 1 in 40 people in the United States suffer from OCD. Many of these individuals suffer in relative silence and are unaware that this is a very treatable condition. Because of the nature of the symptoms, OCD also affects people closely associated with the person suffering from the disorder. Consider the following facts about OCD:

1. OCD is a biological condition that results primarily from a deficiency in the neurotransmitter serotonin in the brain.

2. OCD tends to run in families. Therefore, people probably have a genetic predisposition toward the disorder.

3. According to the Obsessive-Compulsive Disorder Foundation, approximately 1 in 40 people in the United States is diagnosed with OCD. As many as twice that number may have suffered from OCD at some point in their lifetime.

4. OCD can begin in childhood and often manifests in children of preschool age.

5. The average person sees 3-4 doctors and spends over 9 years seeking treatment before receiving a correct diagnosis.

6. Some studies have found that it takes an average of 17 years from the time OCD begins for people to obtain appropriate treatment.

7. With proper diagnosis and treatment, most people who suffer with OCD can find significant relief from the disorder.

8. It is believed that many famous historical figures probably showed significant symptoms of OCD (e.g., John Bunyan, Winston Churchill, and Martin Luther).

If you or someone you know suffers from OCD, this book was written for you. This book is designed for patients and families affected by OCD as a resource that can be read relatively quickly. It is hoped that after reading this book, the reader will have a good understanding of what OCD is and what OCD is not. It is also my desire to educate the reader about the very effective treatments that are available for OCD.

The first two chapters of this book explain the two basic symptoms of OCD: obsessions and compulsions. Chapter 3 discusses the biological causes of the disorder. Chapter 4 describes how OCD manifests in children and teenagers. OCD in children is often overlooked or misdiagnosed as attention or behavior problems. Chapter 5 is designed to clarify the confusion that many Christians have about the symptoms of OCD and spiritual issues. Chapter 6 discusses disorders associated with OCD (Obsessive-compulsive spectrum disorders and co-morbid disorders). Chapters 7 and 8 discuss treatment options. Finally, Chapter 9 describes some actual cases from my practice to illustrate how OCD manifests and is treated. My hope is that this book will help the reader understand OCD and realize that help is available in order to alleviate the tremendous suffering this disorder causes for millions of people.

ONE

Obsessions

Obsessive-compulsive disorder is characterized by two main categories of symptoms: obsessive thoughts and compulsive behaviors. The terms obsessive and obsession are used in everyday conversation to suggest a preoccupation. For example, a person may be described as being obsessed with money. The term obsession is frequently used to describe a passion or strong interest. For example, Golf is Howard’s current obsession. However, in discussing OCD, the term obsession is used differently. Obsessions refer to intense thoughts, worries, or images that are experienced as intrusive and unwanted. These obsessions cause great anxiety for an individual and often lead to the development of compulsive behaviors or rituals designed to decrease anxiety. I’ll discuss compulsive behaviors more in Chapter 2. One of the simplest ways to describe an obsession is an unrealistic or overexaggerated worry or concern about something. The person experiencing an obsessive worry will frequently describe a thought or concern that sounds magnified or catastrophized to others. In other words, they will talk about a fear or worry that is far beyond what most people consider normal. In fact a person with OCD can sometimes tell you that they realize that their fears or worries are irrational or illogical. However, the anxiety is very real and overpowering. I’ve talked with many patients who tell me that they know their worries are irrational; however, they can’t control the overwhelming fear and anxiety that these obsessive thoughts produce. Obsessions usually fall into one of several categories.

Contamination Obsessions

These types of obsessions frequently involve excessive concern over germs, diseases, and other contaminants.

Tammy was a young girl who was fourteen years old when her parents brought her to me. Her parents indicated that they felt Tammy worried too much. Worry is a common presenting problem for people who suffer from OCD. Tammy’s worries included fears that something may happen to her parents; fears that something may happen to her sister; and worry about germs. Tammy was so concerned about germs, she was unable to use any restroom outside of her home. Traveling was terrifying for her. Even family vacations that were designed to be fun and stress free became a source of tremendous anxiety and stress for Tammy and her family. If the family had to stay in hotels, Tammy would make sure that she brought several cans of Lysol spray with which she would immediately disinfect the entire hotel room upon arrival. This would enable her to feel safe enough to at least be able to use the restroom. At home, Tammy simply could not use any public restroom. If she went out with friends to a movie, she made sure that she would use the restroom just before leaving. During an outing with friends, she was always careful not to drink too much liquid so she would not have to urinate. She timed her outings to make sure that she would never be out longer than she could wait to use the safe restroom of her own home. The biggest challenge she faced was from Monday through Friday at school. While Tammy did use the restroom before leaving home and restricted her fluid intake, she could not make it through the entire school day before she had to yield to the call of nature. Since she could not use the school restroom, she would actually leave school and return home to use the bathroom. Needless to say, Tammy missed most of her afternoon classes. In fact, she missed so many of these classes she actually failed two of them.

While people who suffer from OCD often have a general fear of germs, some people with OCD have specific fears related to a particular disease. For example, many people with OCD report a specific fear of contracting AIDS. Most of the time, these individuals are not in any high risk group for contracting HIV (the virus that leads to the development of AIDS). However, their fear and anxiety is extraordinary. This fear often causes them to ruminate endlessly that they may be HIV positive. They are not comforted by reassurance that there is no reason to believe they should be concerned (e.g., no unprotected sexual encounters; no blood transfusions; etc.). They begin to describe irrational fears such as believing that they might have had an undetected cut on their skin (the hand, for example) and they wonder if they may have shaken hands with someone who was infected with HIV thus resulting in the transmission of the disease. This example illustrates the type of thought processes characteristic of obsessive thinking. Probabilities are greatly exaggerated and logic is stretched to arrive at the ultimate conclusions. Many of these people will have multiple medical tests to make sure that they aren’t infected. However, a negative test may lead to further rumination and obsession. They may begin to wonder, What if the test was wrong; after all, they aren’t 100 percent accurate. Perhaps I should be retested. Some OCD patients will receive repeated tests for a disease that they are at virtually zero risk of contracting. Others will do the opposite: they are so terrified that they may have the disease they will refuse to receive a test to assuage their fears. They reason, If I am HIV positive and find out, I won’t be able to carry on. It’s better to not know. While HIV isn’t the only specific disease OCD sufferers worry about, it is a common one.

Another frequent obsessive worry is that of getting cancer. Jeff was a young man who read an article about testicular cancer and became terrified that he would develop this disease. Consequently, he worried almost incessantly about having the disease. This was a bright young man who functioned at a very high level. He was at the top of his graduate school class in his studies, and everyone found him fun to be around. However, he was almost constantly tormented by obsessive thoughts that he had testicular cancer. He described experiencing sensations in his scrotum. He read that while the disease is often symptom free in the initial stages, there may be a heavy feeling in that area. He began to imagine that he felt a heaviness in this area which further fueled his anxiety and concern. At times, obsessions can involve an imagined physical sensation. These are known as somatic obsessions. The only time he was not assaulted by these thoughts and fears was when he was mentally engaged in a task, or when he was distracted by something he thoroughly enjoyed. He found that he was almost anxiety free when he drank alcohol. Consequently, he began to drink more. OCD can be a precipitant to abuse of substances. Many OCD patients described using alcohol, marijuana, or other drugs to self-medicate, or to decrease the anxiety caused by the obsessive thoughts.

People who suffer from OCD are particularly at risk of developing obsessive worries that they may have a disease after reading about the symptoms of a particular disease. Some OCD sufferers will see a television show or read an article about an obscure disease or illness and begin to worry that they may have the symptoms of that malady.

For some people with OCD, the obsessive worry is not of contracting a specific disease, but rather a pervasive fear of any germs that they may come in contact with. This may become so extreme that they fear touching doorknobs (because myriad other people have touched them) or handling money. Their persistent worry about germs causes anxiety in almost any public arena. Efforts to avoid being contaminated with germs can lead to the development of significant compulsive behaviors (discussed in Chapter 2).

While some individuals obsess about contracting an illness, others may obsess about contaminating others. These concerns range from mild (a man who worries excessively that he will spread germs if he coughs in public) to more severe (a woman who fears that her past sexual indiscretion may have caused her to contract a sexually transmitted disease that she will pass on to innocent others by simply rubbing against them).

Some individuals worry about being contaminated not by germs, but by other contaminants. Many individuals report a fear of being harmed by ordinary household cleaners. Bobby was a teenage boy who was terrified of household cleaners. When his mother would spray the kitchen counters with a normal household product, he would experience severe anxiety (bordering on a panic attack). He avoided all cabinets and rooms where cleaning supplies were stored.

Other individuals report anxiety over the possibility of environmental contaminants. These may include chemicals such as pollutants and pesticides. Some individuals refuse to allow their homes to be sprayed for pests or their lawns to be sprayed for weeds for fear of being harmed by the toxins used in these types of treatments.

The Need for Symmetry or Exactness

Many people with OCD describe the need for things to be evened up. This refers to the need for things to be symmetrical. For example, some people go to great extremes to make sure things in their environment are even on each side. They may arrange their rooms or offices