There is a lot of confusion around Obsessive Compulsive Disorder, and a great many inaccurate portrayals of OCD in the media have led to thousands of people thinking they have OCD when they don’t.
Many people will describe themselves as ‘a bit OCD’ if they like things done in a certain order or they like to keep their homes clean and tidy. This is not OCD. It is perfectly normal to have preferences for order and routine, and cleanliness works on a sliding scale with some people being very particular and other people being a lot more relaxed about their cleaning routines.
The difference between liking things a certain way and having OCD is the level of distress felt by the individual. Those suffering from OCD will experience highly distressing thoughts and will develop rituals or ‘compulsions’ that they need to carry out. There are two main components to obsessive compulsive disorder: ‘obsessions’ and ‘compulsions’.
What are obsessions?
Obsessions are recurrent and persistent thoughts, impulses or images that are intrusive, inappropriate and cause anxiety or distress. They pop into your mind and are not easily dismissed, meaning that even if you manage to distract yourself from the thoughts for a short while, they will return. The thoughts, impulses or images are not simply excessive worries about real-life problems.
For example, these won’t be everyday worries about finances or illness that may be related to real-life events. Instead, these will be worries about things that may never happen or things that those without OCD would never think to worry about.
Often, the person having these obsessions will attempt to ignore or suppress such thoughts or to neutralize them with some other thought or action (a compulsion). The person recognizes that the obsessional thoughts, impulses or images are a product of his or her own mind (not imposed from someone or something else).
A person with OCD will, on some level, have insight into their problem and situation. Often, people will say to me ‘I know nothing bad will happen, I know this is just in my head…but I do these things just in case’. This is classic OCD thinking.
What are compulsions?
Compulsions are repetitive behaviours (e.g. hand washing, ordering, checking) or mental acts (e.g. praying, counting, repeating words silently) that the person feels driven to perform in response to an obsession (intrusive thought), or according to rules that must be applied rigidly.
People who carry out these compulsions will often have a set way of doing things e.g. there will be a ‘correct’ way to drive to work and so on. If the compulsion is disturbed or interrupted then the person may feel they need to start again. This often means that people carry out their compulsions in secret, or develop ways of ensuring they can carry them out without other people knowing or being interrupted.
Sometimes the behaviours or mental acts are aimed at reducing distress or preventing some dreaded event or situation. However, these behaviours or mental acts may not be connected in a realistic way with what they are designed to neutralize or prevent, or could be clearly excessive.
For example, a mother may worry about accidentally poisoning her children and so may wash her hands repeatedly throughout the day whenever she touches anything, even if it is clean, for example, washing her hands in-between unloading items from the dishwasher.
Who has intrusive thoughts?
Everyone has intrusive thoughts. We all have had an experience of driving along the motorway and having a thought about crashing the car. We’ve all held our new-born baby and have had intrusive thoughts about dropping them. We have all experienced embarrassing, inappropriate, violent, sexual or distorted thoughts.
Therefore those of you with OCD who think that there is something ‘wrong’ with you for having the thoughts that you have, need to start letting that idea go. You have exactly the same thoughts as someone without OCD.
The only difference in this thinking is that someone with OCD will give the thought a meaning. For example, if I’m holding my baby and I have a thought of throwing him down the stairs, without OCD I probably wouldn’t register that thought, or if I did it would come and go very quickly (known as a ‘fleeting thought’).
However, if I had that same thought and I had OCD, I would immediately assume that that meant something about me as a person e.g. ‘I’m a dangerous person’, ‘I’m going to harm my baby’, ‘I’m a terrible mother’, ‘I’m not safe to be around him anymore’.
This may then lead to a great deal of angst and anxiety and possibly some avoidance or checking behaviours. So the thought itself is not different, rather it is the meaning that we apply to that thought that defines something as OCD or not. The meaning that is given to the thought is often quite alarming or shocking and that in itself can cause a lot of anxiety and worry, as well as the thoughts and worries that may follow.
How does OCD work?
OCD is a bully. It stands over your shoulder making unhelpful comments about what you are doing or thinking and starts to put doubt in your mind about the simplest things that you have never questioned before.
You will just be minding your own business, trying to get on with your day, but this is made more difficult because you have OCD next to you saying ‘have you done that right?’. ‘Are you sure you turned that off?’ ‘Should you be thinking that?’ ‘What if this terrible thing happens and it’s your fault?’. It is exhausting and belittling and mean.
However, OCD tricks us into thinking that it has a nicer side. It does this because when we feel extremely anxious or wound up OCD offers us a ‘solution’. OCD will say ‘I know you’re scared – just go and check that and then you can relax’. In this way, OCD offers us a way out of our anxiety, and it is easy to forget that it’s anxiety we only have because OCD gave it to us in the first place! In this way OCD is similar to smoking cigarettes. Smoking seems to satisfy a craving for nicotine but that craving for nicotine only exists in the first place because you smoke – it’s a vicious circle!