Saturday, August 31, 2013

Anxiety: OCD

Reminder of Scenario #1:
You leave the house to go take an exam. On the way, you don't see a pedestrian crossing the street and have to slam on your brakes. "Oh no! Did I hit her?!" But it's okay. You missed her by about a foot. No one was hurt.

Here's what this scenario might look like if you have been diagnosed with
Do-Over -- Scenario #1:
You leave the house to go take an exam. On the way, you don't see a pedestrian crossing the street and have to slam on your brakes. "Oh no! Did I hit her?!" But it's okay. You missed her by about a foot. No one was hurt. Or was she? Did I really miss her? I'd better go back and check.

No one's here. No cops. No ambulance. No onlookers. Okay. We're good. Exam time.

But what if I went to the wrong intersection. Oh dear. I'd better go back and check. (Drives around a few intersections) Nothing. Okay. I'm really good this time. On to the exam. Oh no! I'm barely going to get there on time to take it.

But what if I hit the person and she didn't actually stay on the road? There was a field next to that intersection. What if she's in the field bleeding to death and no one knows because the brush is so high. No. This is ridiculous. I've already gone back and checked twice.

But what if she is there and I'm the only one who knows? I have to go back.

:: sigh :: I know no one's in here. Oh shoot. Here comes a cop.

"Hey man, you okay?"

'Oh yeah, I'm perfectly alright, officer. I just have OCD and I'm having an episode right now. I just missed an exam because I'm looking for someone that I know isn't actually here, but I feel compelled to look anyway. Don't mind me.'

"Um...Yeah, I'm okay. Just got a little car sick and needed some air. Sorry to worry you, officer."

Obsessive-Compulsive Disorder (OCD) can be a disorder of both the body's fear and anxiety systems. It's name gives away how it works:
  • A thought occurs in your mind. But not just once. It repeats itself so much that you start to obsess over it. It's not a good thought, either. The thought is intrusive and sometimes, inappropriate. It causes a great amount of anxiety and distress to the person. 
    • Did I hit someone?
  • You do everything possible to ignore it/avoid acting on it.  
    • No, I didn't. I was at least a foot away from her. I know I saw her walk away.
  • Ignoring it doesn't work, so you have to do something about it. The goal in doing this is to suppress the effect(s) that the thought is having on you, but the behavior becomes uncontrollably repetitive and compulsive. 
    • I'll go back and check, just to be sure.
    • I'll drive around the intersection, just to be sure.
    • What if she's in that field...I've got to go check, just to be sure.
  • Many times, the compulsions --> relief part in the image usually looks more like compulsions <--> relief for a while.

There are a few different types of OCD that one can have. Among them are these:

Contamination OCD
These are your germophobes. The real germophobes. They fear contamination, dirt, and disease, be it getting one or giving one someone else one. The example that most people are familiar with is that of those who, because of this fear, are compelled to wash their hands to the point of cracking and bleeding...and then they keep washing. Some refuse to touch others or anything outside of their own homes because of this fear. Some cope by touching things outside with a tissue that they can just throw away after. Those who muster enough courage to touch someone can usually be found in the bathroom soon after...washing their hands.
Those who say "I'm a germophobe" usually aren't really. They may not necessarily like germs; they may carry a bottle of sanitizer all the time; they may not like to get dirty; they may scrub their dishes in super-hot water; but they aren't going to experience any type of significant distress or anxiety if someone sneezes too close to them. 
Doubting OCD
This is based on fear of (1) causing harm to either themselves or others (this includes their/others property) and/or (2) not appearing to be a responsible person. To compensate/suppress these thoughts, they'll check everything related to the situation that might cause distress:
    • My exam notes:
      • They're not just notes. You basically re-wrote the entire textbook on a couple of 3x5 cards. You can't miss a question just because you weren't responsible enough to write everything down.  
    • The gas gauge: 
      • You don't want to run out of gas and look like an idiot (even though you won't be driving for more than a mile).
    • The door locks: 
      • Safety is important. You need to check every door to make sure the locks work and are being used. After doing this three, maybe four times, you're satisfied...for about an hour.
    • Their wallet/purse: 
      • You need to be sure that everything you could possibly need is in there, even if you won't be anywhere near that type of circumstance today.
    • In the example that I gave earlier (Did I cause harm to someone?):
      • You check everything around the area that could be linked to the problem.
There's nothing wrong with making sure the tank's got gas in it or going back home to make sure the front door's locked if you're not sure. But it becomes very intrusive in your life when you feel overwhelmingly compelled to re-check multiple times, even after being reassured that everything's alright.

Order, Precision, and Symmetry OCD
It's one thing to prefer organization and keep things organized. There's also nothing weird about wanting others to respect your stuff and keep it looking decent and orderly. It's another thing altogether to experience great distress and even get seriously annoyed at yourself when perfection isn't attained.
          Those who are OCD perfectionists have their own personal rituals to make sure that everything's in order:

    • Perhaps they'll shower the same way every day--not because it's just what they do, but because if they don't, something bad will happen.
    • When studying, they may feel that it's necessary to make    x    number of notes in their notebook for every two paragraphs read. If they don't, they missed something crucial.
    • When getting dressed, they may feel compelled to put their clothes on in a certain way. If something wasn't put on just right, he/she will take it off and put it on until it does.

Living with OCD is not easy. Part of the problem with really being able to take full advantage of CBT (talked about here) for treatment is that they have to face their fear(s). For example, a person with Contamination OCD may be afraid of getting sick. During treatment, he tries to stop washing his hands. Then he gets sick, thus seeing his fear come to light. This causes great distress and can scare him into extreme hand-washing again.

You can see the problem. But overcoming it is possible. It just takes time and patience.

1 comment:

  1. Thank you for the info! I have doubting and order OCD, but over time I have learned to use it to be an asset and also to subdue it when needed. I'm not perfect (no one is right ?), but I am working on it :)


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