Do You Wonder, “What is OCD and Do I Have It?”

David Hodel, MA, LMHCA, EMDR

You walk into a coffee shop and place your order. As you wait patiently for the barista to conjure up your double-decaffeinated half-caff with a single shot of sugar-free vanilla and light foam, you glance over to the side and notice a woman apparently set up to take some notes on a notepad.

Beside the pad are three identical pencils and a retractable pen. While you watch, she takes a second pen out of her purse and carefully disassembles it, placing all the pieces on the table in perfect rows. Once stripped down to the ink cartridge, she takes it and holds it close to the point, then draws with three sharp strokes on the paper to make sure it writes.

Mission accomplished, she painstakingly puts the pen back together and places it in perfect alignment beside the first one. As you watch incredulously, she takes out a third identical pen and proceeds to disassemble it in the same fashion. Before you can be caught staring, your order is up and you go merrily, if somewhat bewildered, on your way.

A quick stop at the restroom reveals a line. Further inspection reveals there is a traffic jam because a man is standing in front of the sink, which effectively blocks the door. At first glance, he appears to be washing his hands, but as you watch, you notice he’s being very methodical.

He turns on the water, scrubs his hands under the water, adds soap, scrubs his hands under the water, adds soap, scrubs hands under the water, adds soap, scrubs hands under the water, grabs a paper towel, turns off the water, grabs another paper towel, scrubs hands, grabs another paper towel, scrubs hands, grabs another paper towel, turns the water on and starts all over again.

Leaving this unusual scene, you head outside to your car. As you are about to get inside, you notice a woman in the next row with her key in the lock, frozen, staring at the key with a look of distressed confusion. Afraid you will regret it, you overcome your resistance and move a little closer.

“Are you all right?”
“Not really, no.”
“What seems to be the problem?”
“I’m afraid to get in the car.”
“Why?”
“I’m afraid I’m going to hit an animal?”
“Here, in the parking lot?”
“While I’m backing up.”
“You managed to get here okay.”
“Oh, I’m fine once I’m going. Just as soon as I put it in reverse, I know some small, helpless creature is going to dart out of the shadows and right under my wheels.”
“But you can go forward.”
“Yes.”
“Why didn’t you back into the space?”
“I’m always afraid someone is going to come out of their space while I’m getting turned around.”
“But you’re fine once you get going?”
“Not really, no.”
“But you said…”
“People really can’t be trusted. They signal one way then turn another or stop suddenly without any warning. Or don’t signal at all.”
“I see. Well, good luck.”

You get quietly into your car and drive away.

These are only a couple of examples of what OCD can look like out in the world. The extraordinary complexities of the human mind and vagaries of human interaction with others and their environment mean that there are countless millions more.

What is OCD?

Have you ever wondered, “What is OCD?” Obsessive-Compulsive Disorder (OCD) is described in the DSM-5 as “the presence of obsessions, compulsions, or both.”

Obsessions are defined as:

  • Recurrent and persistent thoughts, urges, or impulses that are experienced, at some time during the disturbance, as intrusive and unwanted, and that in most individuals cause marked anxiety or distress.
  • The individual attempts to ignore or suppress such thoughts, urges, or images, or to neutralize them with some other thought or action (i.e., by performing a compulsion).

Compulsions are defined by:

Repetitive behaviors (e.g., hand washing, ordering, checking) or mental acts (e.g., praying, counting, repeating words silently) that the individual feels driven to perform in response to an obsession or according to rules that must be applied rigidly.

The behaviors or mental acts are aimed at preventing or reducing anxiety or distress, or preventing some dreaded event or situation; however, these behaviors or mental acts are not connected in a realistic way with what they are designed to neutralize or prevent, or are clearly excessive. Note: Young children may not be able to articulate the aims of these behaviors or mental acts.

The obsessions or compulsions are time-consuming (e.g., take more than 1 hour per day) or cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

The obsessive-compulsive symptoms are not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition.

The disturbance is not better explained by the symptoms of another mental disorder (e.g., excessive worries, as in generalized anxiety disorder; preoccupation with appearance, as in body dysmorphic disorder; difficulty discarding or parting with possessions, as in hoarding disorder; hair pulling, as in trichotillomania [hair-pulling disorder]; skin picking, as in excoriation [skin-picking] disorder; stereotypies, as in stereotypic movement disorder; ritualized eating behavior, as in eating disorders; preoccupation with substances or gambling, as in substance-related and addictive disorders; preoccupation with having an illness, as in illness anxiety disorder; sexual urges or fantasies, as in paraphilic disorders; impulses, as in disruptive, impulse-control, and conduct disorders; guilty ruminations, as in major depressive disorder; thought insertion or delusional preoccupations, as in schizophrenia spectrum and other psychotic disorders; or repetitive patterns of behavior, as in autism spectrum disorder).

Specify if:

With good or fair insight: The individual recognizes that obsessive-compulsive disorder beliefs are definitely or probably not true or that they may or may not be true.

With poor insight: The individual thinks obsessive-compulsive disorder beliefs are probably true.

With absent insight/delusional beliefs: The individual is completely convinced that obsessive-compulsive disorder beliefs are true.

Specify if:

Tic-related: The individual has a current or past history of a tic disorder.

As you can see from the list of qualifying behaviors, there are a lot of things that may fall under the umbrella of OCD. As with all such things, if you think you may suffer from this disorder, make arrangements to see a mental health professional in order to get a proper diagnosis.

Probably the most common “little p” pathology we regularly encounter involves our patterns of thinking and how they interact with our anxiety. Most people have a circus of anxieties playing in their head a fair amount of the time.

Over the space a few seconds, our thoughts may bounce from one concern to another – running out of money, viral outbreak, home invasion, death, losing a loved one, failing at work, car breakdown, health issues – any of these and more can be sideshows at our internal circus.

It can feel like we are worried about nine things at the same time, but this is not the case. The human mind can only think about one thing at a time, so what is really happening is you are thinking about nine things in quick succession. When we find ourselves preoccupied with distressing thoughts, there are steps we can take to relieve those symptoms.

Tools For Managing Preoccupation

When we catch ourselves thinking obsessively about something, there are some things we can do to stop it:

Assess: Is my mind preoccupied with something I can affect right now? Does it need to be done right away? Does it need to be done by me, or is my mind ruminating on it simply because ruminating feels like doing something? If there’s nothing to be done right now, I can permit myself to let go of this line of thinking, knowing that I can pick it up again if need be.

Redirection: When we’re preoccupied (usually with something negative) job one is noticing that we are in a negative thought pattern cycle. Once we notice we are dwelling on the negative, one technique we can use to disrupt the cycle is redirection. This is simply taking the mind down a different path.

Suppose I’m sitting in my office chair during a break and my mind wanders to thoughts of my child who is struggling in school. I start by worrying about her grades, then about the people she’s hanging out with, then whether she’s using drugs, then whether she’s going to die.

In very short order, my mind is locked in a downward spiral. As soon as I notice it, I can shake it off, take a deep breath and let it out, and remind myself there’s nothing I can do about it right now. I’ve broken the cycle, but to keep it from starting back up again, I need to find something else to think about. It doesn’t matter what it is – grocery list, household chores, creative thoughts, something positive – as long as it isn’t another negative thought.

Mindfulness: So many of our negative thought patterns are rooted in something that happened to us in the past, or something we are afraid will happen to us in the future. The interesting thing about things past and future are that none of them, not one, are actually happening now.

If your mind is racing, or you can’t get yourself to stop thinking about something mildly to moderately distressing, try the following steps:

  • Take a moment and sit down comfortably
  • Notice your breathing – in through the nose, out through the mouth
  • As you breathe, repeat to yourself, “The past is the past, it’s not happening now. The future is not written, it is not happening now. All I have is now. Now is all there is.”
  • Notice if there is tension in your body, and when you find it, see if you can release it

Some people like to imaging closing a door to the past, and closing a door to the future when trying to locate themselves in the present. Naming objects in the room can be helpful. Kinesthetic awareness is an excellent distraction:

  • Pick up something, like a smooth stone or paperweight
  • Notice how heavy it is
  • Notice the texture, run your thumb or fingers over it
  • Wonder what it looks like on the inside
  • Notice how warm or cool it is

Again, we can only think about one thing at a time. By training our focus on the particulars of an object, we give our minds an occupation. If the smooth stone is playing in the theater of your mind, it’s the only show playing.

That doesn’t mean a prior preoccupation won’t commandeer the stage loudly and abruptly, but even then, the technique is the same. Once a negative thought pattern is disrupted by any of these techniques, you are free to redirect your mind to something else.

Workarounds

OCD is only incapacitating if you are unable to do anything else. Repeatedly locking and unlocking the deadbolt on your front door every time you come or go may be a nuisance and a waste of time, but it isn’t harmful. Dwelling on how attractive your coworker is to the exclusion of all else is likely to lead to trouble.

Sometimes we can deal with these kinds of distractions by making the effort to avoid them, such as not going to the coffee shop if someone with whom we are obsessed works there. When we can’t find a way to avoid the trigger for our obsessive thinking, it is on us to begin the process of taking each thought captive.

The tools described above can help with this, but it can be exhausting and disruptive, and at some point, it may be time to connect with someone who can help. A mental health professional gives us a person to connect with, so we aren’t alone in the battle to effect positive change in our lives.

Most of our emotional growth happens in relationships with other people, and mental challenges are no different. If we can have the courage to reach out and get help when we need it, we improve our chances of moving toward growth and health.

Photos:
“Shoe Rack”, Courtesy of Alev Takil, Unsplash.com, CC0 License; “Fear”, Courtesy of Juliet Furst, Unsplash.com, CC0 License; “Plates”, Courtesy of Chance Anderson, Unsplash.com, CC0 License; “Corrugated”, Courtesy of Alfonso Navarro, Unsplash.com, CC0 License

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By |2020-03-25T20:10:39+00:00March 23rd, 2020|Featured, Individual Counseling, OCD|