..quiet. quiet. Quiet. Quiet. QUIET. LEAVE ME ALONE! This is a common sentiment with Obsessive- Compulsive Disorder, or O C D.
Much like anxiety, OCD is a term that gets thrown around nonchalantly. People often say “ I’m so OCD” when they fixate on details, or need things organized a certain way. As someone that actually has OCD, I WISH those were my only problems. There is so much more involved with OCD than meets the eye.
From my experience, OCD is widely misunderstood, yet simultaneously, rarely discussed, especially in the mental health field. Approximately 2.3% of the U.S population is affected by OCD. However, because of the taboo nature of OCD, those who are afflicted by it often suffer in silence, feeling as though it isn’t something they can talk about. Growing up, I definitely experienced this, and honestly, still do. But the rare, few times I read about OCD or heard someone’s testimony who had it, it helped me to understand that I’m not, in fact, crazy, and I’m definitely not alone. So, if I can offer that same help and hope to someone else, I would be more than happy to do so.
Similar to my blog post on Anxiety, I will give an overview of OCD, categorized by the following sections:
- Defining OCD
- The Causes Of OCD
- Types of OCD
- OCD’s Affect On The Brain and Body
- Experiencing OCD
- Treatment Options
- Coping Strategies
- Faith-Based Perspective
- Conclusion
Honestly, writing this blog post gives me anxiety. So, I hope whoever reads this will extend grace and sympathy, especially if you can’t completely understand what I have to share. I hope that is extended to everyone who struggles with any kind of mental health conditions or disorders. Thank you in advance <3
Without further ado- this is OCD
Defining OCD
OCD is a neurologically based disorder, characterized by unwanted, recurrent thoughts (i.e. obsessions) in which an individual engages in specific repetitive behaviors (i.e. compulsions), in an effort to avoid or eliminate the thoughts. In order to truly understand OCD, it is important to understand what “obsessions” are, and what “compulsions” are.
According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), obsessions are defined as:
1) “Recurrent and persistent thoughts, urges, or images, that are experienced, at some time during the disturbance, as intrusive and unwanted, and that in most individuals cause marked anxiety or distress.”
2) “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).”
Additionally, compulsions are defined as:
1) “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.”
2) “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. Young children may not be able to articulate the aims of these behaviors or mental acts.”
In addition to the presence of obsessions and compulsions, they are either time consuming, lasting more than an hour a day (not necessarily consecutively) and/or significantly interfere with an individual’s daily functioning. Furthermore, These OCD symptoms are deemed not the result of drugs, substances, or medications, and are not the result of another medical or mental health condition.
Below is one example of an OCD cycle:
1) An individual who struggles with a contamination type of OCD, for example, may fear germs.
2) This individual gets their hands dirty with an unidentified sticky substance from a surface. While the average person with a typically functioning brain may perceive this as disgusting, they are usually able to wash or sanitize their hands and move on from the situation. However, an individual with an OCD wired brain may run through a gamut of thoughts: “What was that? Could I contract a virus/ disease from it? How about if I am now carrying a disease and never know it? What if I die from this? Or worse, how about if I touch someone and infect them with this unknown disease? What if I am the cause of their illness and they die? Oh my gosh it would all be my fault, all because I touched this sticky substance!
3) The individual then washes their hands once, but the obsessive thoughts are still taunting them, and anxiety, fear, and dread still lingers. So, the individual washes their hands 10 more times, for 20 seconds- 1 minute each time, deeply scrubbing every crevice of their hands. The obsessive thoughts have now subsided, and the individual feels relief that they took care of the issue and are no longer a threat to themselves or society. Phew, that was a close one!
4) Going forward, this individual has conditioned themselves to always wash their hands at least 10 times following the same exact regimen, to alleviate obsessive thinking, continuing the cycle of compulsions.
5) When this compulsion no longer satisfies, this individual adapts and may add on an additional 10 hand washing cycles, until things feel “just right” and they experience relief. Or relief until the next cycle of obsessive thinking occurs.
See how this cycle could impede on someone’s daily functioning? Can you imagine going through this cycle multiple times a day while at work, school, or at home? How about while at a social event? See, a normal behavior like “hand washing” could be another person’s nightmare.
What OCD is Not
OCD is not the same as anxiety. According to the DSM-5 it does not fall under the umbrella of anxiety disorders and is in it’s own separate category, labeled “Obsessive-Compulsive and Related Disorders.” You can experience anxiety as a symptom, as a result of the OCD, but because OCD also includes the presence of obsessions and compulsion, it is set apart from anxiety disorders. I often find myself telling people that I struggle with anxiety instead of OCD, because this seems to be terminology that most people are familiar with. Although, like I explained in my Anxiety blog post, anxiety is very complex as well. However, what I experience is definitely different, and harder to explain in a general conversation with someone. Thus, why I am laying it all out here lol.
Everyone has random and obscure thoughts from time to time. The difference with OCD is that the thoughts become obsessive, and the individual strongly feels the urge to engage in compulsions to offset the obsessive thoughts. Additionally, OCD causes significant impairment in daily functioning.
Going back to my previous statement, I often hear people cavalierly indicate that they are “so OCD” because they have perfectionist tendencies, need to have things in a particular order/organized in a specific way, or are germaphobes and need to have things clean. We especially see these types of behaviors in a comedic light with characters on T.V. shows, such as Sheldon Cooper from “The Big Bang Theory.” I can’t speak for all people who have OCD, but I will say that this is so annoying to hear. Trust me, if your so-called “OCD” tendencies aren’t falling under the above categories 👆🏼👆🏼👆🏼, uh, then you don’t have OCD! So please, kindly stop using that statement of “oh I’m so OCD today!” Yeah, I wish my OCD only lasted a day and not the last 2 plus decades of my life! Lol
In all seriousness, please just choose your words more carefully if you happen to be one of those people that throw that term around; I know it’s not meant to be said in a demeaning or dismissive way. However, it is similar to when people say “ I’m so ADD, I’m so distracted today.” I’ve heard people who truly have ADD/ADHD, say that they get very irritated when they hear this phrase. Just like I wrote in my previous blog post, Anxiety, these terms become so normalized that they’re devalued, reducing these actual symptoms and disorders to something that is viewed as “not a big deal.” Well, I hope you can begin to see based on the definition of obsessions and compulsions above- that this is a very big deal.
For Your Consideration
Key terms associated with OCD include:
- “Sticky thoughts” or “stuck”- this describes how obsessions linger in ones mind, despite efforts to get rid of them
- “Just right” feeling- typically describes how a compulsion needs to be completed “correctly” in order to alleviate the distress of the obsessive thought. This can only be determined by the individual and their specific compulsion regimen.
- “Boomerang affect”- resisting, avoiding, or fixing obsessive thoughts, especially by way of engaging in compulsive behavior, typically makes the unwanted thoughts come back tenfold. Same dynamic as a person reacting to a bully- it gives the bully satisfaction, which leads them to continue the bullying behavior.
Which is fitting.
Because OCD is a giant BULLY.
The Causes of OCD
It is estimated that about 1 in 40 adults and 1 in 100 children are affected by OCD. However, this is based on what is reported. I believe the number could be higher, but due to fear and misunderstanding of what OCD is and the many ways it may present itself, many individuals, particularly children, may have a difficult time self-reporting symptoms.
How does OCD occur? What contributes to it? Although there does not appear to be a specific or clear cause of OCD, experts believe that it is “the result of of a combination of neurobiological, genetic, behavioral, cognitive, and environmental factors that trigger the disorder in a specific individual at a particular point in time,” (BeyondOCD.org). Below are some of the possible causes of OCD.
Neurobiological
Please see OCD’s Affect On The Brain and Body section
Genetics
Similarly to anxiety disorders and other mental health conditions, OCD can be the result of a genetic predisposition to the disorder, either in the maternal and/or paternal sides of the family. Age of onset may vary between males and females; however, it is suggested that OCD may manifest in males at an earlier age than females. Average age of onset is 19 years old, however it is suggested that children as young as 5 years old can begin to experience OCD. Research suggests that genetics account for about 45-65% of the onset of OCD, with 25% of individuals with OCD having an immediate family member who also has OCD disorder.
Behavioral and Cognitive Components
Some cognitive theorists suggests that OCD sufferers misinterpret their random thoughts, causing the thoughts to have more of a profound meaning or seriousness, than is actually true. Theorists believe that this gross misinterpretation of thoughts, is what’s responsible for obsessions and inevitably compulsions. This type of thinking may be caused by a neurobiological impairment in the brain, when compared to a typically- functioning brain.
In other words, everyone gets random, fleeting, unexplainable thoughts, in which the average person is able to think “huh, that was weird” and move on with their lives. However, someone with an OCD wired brain, may perseverate on the thought (i.e. why did I have that thought? Is there a deeper meaning there? Am I a horrible person? Oh gosh, I’m a monster). Thus the thought is grossly exaggerated, creating the opportunity for obsessive thinking. In my personal life, I find when I compare thoughts with my husband, who I would categorize as an individual with a typically functioning brain when compared to my OCD wired brain, he reassures me that my thoughts are not abnormal and he has had similar random thoughts, but he is able to brush them off, where as I obsess over them, which causes me great distress.
Furthermore, other theorists believe that “behavioral conditioning” is the culprit for compulsive behavior. Basically, at some point an OCD sufferer realized that when they engage in a compulsion it relieves their distress from an obsessive thought. Even if the relief from the obsession was temporary, an OCD sufferer is more inclined to repeat the compulsive behavior, in order to achieve that relief. This continued behavior can become the equivalent of an addiction, and often when the previous compulsion no longer as affective, the OCD sufferer may feel the need to add additional rituals (i.e. specific series of actions) to the compulsion, or complete an entirely new compulsion, in order to achieve that same relief again. This compulsive behavior can become addictive, leading to impaired functioning in an individual’s daily life.
According to BeyondOCD.org here is a list of other false beliefs OCD sufferers struggle with:
- Total control of thoughts- believing that this not only possible but required.
- Inflated responsibility- believing that thoughts can directly cause harm, and it is the individual’s responsibility to prevent harm from occurring (i.e. the role of compulsive behavior is typically perceived as a way to prevent a negative outcome).
- Perfectionism- believing that it’s not okay to make mistakes and a need to have things completed perfectly.
- Overimportance of thoughts- believing that having a negative thought increases the likelihood of harm occurring and/or that having a negative thought is “morally equivalent” to acting on it.
- Intolerance of uncertainty- believing that there is no room for unknowns, and it is possible and important to ensure negatives outcomes won’t occur.
- Overestimation of a threat- believing that negative outcomes are more likely to occur than not, and the consequences will be severe.
Environmental Factors
There are a multitude of environmental factors that have been linked to the onset of OCD. It is suggested that most environmental factors do not cause OCD, but rather may triggers symptoms in individuals, especially during childhood, who have a predisposition to the disorder. These factors include:
- Inconsistent parenting styles- this can create a sense of instability, heightening anxiety and stress.
- Trauma, abuse or distressing events- this may include exposure to inappropriate material/images at a young age. Trauma/abuse/distressing events can create lingering “sticky” thoughts (i.e. obsessive thoughts) about the events, and are unwanted and disturbing to the individual. This may be especially true if the event(s) occurred during childhood, in which the experience is confusing and the child is unable to process the event(s).
- PANDAS- It is suggested that children may experience the onset of OCD or OCD symptoms as a result of severe viral or bacterial infections. This type of OCD onset has specifically been linked to streptococcal infections, which is known as Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (a.k.a. PANDAS).
Types of OCD
There are several subtypes of OCD, each with their own unique set of symptoms. Many of these symptoms are very complex, which makes it difficult for those who suffer from OCD to be able to express and explain their symptoms; many of these symptoms can cause fear, guilt and shame. For these reasons many of those with OCD may suffer in silence if they are unable to understand their symptoms, and also may fear how others, even trained mental health professionals, could perceive them.
Below I will summarize the main subtypes of OCD and give examples of some of the symptoms of each subtype. The most important thing to remember while reading these subtypes and their symptoms, is that these symptoms are experienced as intrusive, disturbing, and unwanted to the OCD sufferer.
Contamination (Cleaning) OCD
Contamination OCD essentially is excessive fear of uncleanliness or germs that could lead to contaminating oneself or others, which could lead to severe consequences (e.g. contracting a illness, disease, or even death). The individual with contamination OCD feels it is their responsibility to prevent these consequences from occurring.
Examples of obsessions for Contamination OCD include fearful thoughts of:
- Public items, such as transportation and door knobs
- Bodily fluids, such as blood, urine, saliva, sweat, semen
- Illness- related associations, such as viruses, diseases, sick people, hospitals, homelessness
Examples of compulsions include:
- Cleaning and washing rituals (e.g. a strict regimen of washing hands a specific number of times, for a specific duration of time)
- Mental checking/reviewing if came in contact with contaminants and if cleaning rituals were completed correctly
- Avoiding contaminants or avoiding clean items or people when feeling contaminated
- Constant reassurance from others that they have not contracted a illness, virus or disease from a contaminant and/ or have not exposed others to these consequences as a result of coming into contact with a contaminant
I’ve heard people with OCD, myself included, say that the current Covid-19 pandemic exposed them to a real-life contamination OCD scenario. It was basically like watching people go into mad hysterics and act as “crazy” on the outside, as some or most of us OCD sufferers feel on the inside lol. So, for people with anxiety and/or OCD, their mental health conditions either prepared them to deal with the pandemic, or their symptoms were heightened due to it. So, if you ever want to have an idea of what a person with contamination OCD might experience on a daily basis- just think back to what you felt or how you saw people react at the beginning of this pandemic 👍
Checking/Responsibility OCD
Checking/Responsibility OCD is experiencing excessive fear that if one acts irresponsibility, whether purposefully or not, their actions could lead to a catastrophic consequence. For example, I often check and touch the stove knobs multiple times before I leave the house, to ensure that the house wouldn’t burn down, especially if I’m leaving my husband and son behind in the house. I rationalize it by telling myself, “If I don’t ‘properly‘ check the stove, and it was left on, and the house burned down with my family inside, their deaths would be my responsibility- all because I didn’t take the time to check the stove.” See the inflated sense of responsibility in that line of thinking? Beginning to understand how this type of thinking could impair someone’s daily functioning? Good. Let’s continue!
Aside from this personal example, below are additional examples of obsessions and compulsions for Checking/Responsibility OCD.
Obsessions include excessive fear of:
- Leaving doors/other things unlocked
- Leaving appliances on
- Safety items not working correctly, such as car brakes
Compulsions include:
- Repeatedly touching/tapping items to make sure they are off or closed (e.g. the stove, refrigerator)
- Returning to home/location to make sure items are properly off or closed
- Needing constant reassurance that items were checked correctly and off/closed.
Symmetry and Ordering OCD (a.k.a Organizational, Perfectionism, or “Just Right” OCD)
Symmetry and Ordering OCD has to do with excessive fear that particular things are not as precise as desired.
Obsessions include:
- Feeling uneasy about an item not being in the correct location
- Sensitivity about the symmetry of behaviors or objects in relation to other behaviors/objects
- Continuously feeling uneasy after finishing a routine
Compulsions include:
- The urge to even out a behavior on both sides of an object (e.g. tapping both side of arms or legs the same amount)
- Positioning objects so they appear “just right” (e.g. making sure items are aligned in a row)
- Repeating an activity or behavior until it feels “just right” (e.g. repeatedly walking in a circle, opening and closing a door or drawer)
Harm OCD (a.k.a “Forbidden Thoughts”, or Taboo OCD)
This subtype of OCD includes unwanted and intrusive thoughts about harming oneself or others. Some of these thoughts may be violent, sexual or religious in nature. Again, for this subtype I think it is very important to highlight that the individual does not experience a desire to harm themselves or others; these thoughts are truly distressing and unwanted by the OCD sufferer, so much so that they will go to great lengths to prevent any possibilities of harm happening (i.e. going back to that false sense of total control and inflated responsibility discussed in the behavior and cognitive components of OCD.
Obsessions include excessive fear of:
- Harming a person, especially a vulnerable person or loved one, such as one’s child
- Not “taking care” of violent thoughts correctly (i.e. through correctly completing compulsions/rituals “just right” to alleviate the thoughts)
- Unconsciously harming someone without any recollection (e.g. doing so in sleep/sleeping walking)
- Past trauma or exposure to inappropriate material during childhood, predetermining you to be an abuser
- Sudden shift in personality causing one to enjoy harmful thoughts
- Specific fear of causing an accidental hit and run, and being unaware of it until you are tracked down by law enforcement
Oh yeah, that last one- weirdly specific and real! Here is a personal example: one time I was driving home late at night, and I ran over a curb accidentally. A pretty common experience that the average person would shrug off. Well, as I continued driving I had a random thought pop in my head- “ what if that wasn’t actually a bump? What if I just ran over a person??” That thought consumed my mind; I instantly thought about how I potentially killed a person, could get prison time for a hit and run, and my life would be over- all because I wasn’t more careful while driving. I scrutinized myself to no end. So naturally I had to circle back to that same spot to make absolutely sure that I did not hit a person and it actually was just a curb (i.e. the compulsion). However, after I checked, I questioned myself relentlessly- “ Did I check the area thoroughly? Am I sure I didn’t see a person? It’s dark, what if I missed the person, had an opportunity to save them and unknowingly left them for dead?? It was as if I couldn’t believe my own eyes and needed constant reassurance. The only problem was there was no one there with me, so the responsibility to reassure myself was on me. Let’s just say I couldn’t fall asleep that night…
I eventually was able to calm down, reorient myself with reality, and truly realize that I simply ran over a curb accidentally, a common experience, and did not harm anyone. I eventually was able to come to terms with this being another wretched OCD episode.
That takes us to compulsions. Some compulsions include:
- Mentally checking/reviewing thoughts to make sure they are all appropriate, especially as it relates to people/loved ones.
- “Thought neutralization“- If there is even a hint of “inappropriateness” in thoughts, the individual may feel the impulse to immediately replace the thought with an irrefutable positive thought
- Avoidance of media/information, people, activities, places that may trigger the unwanted harmful thoughts
- Mentally checking/reviewing memories and thoughts to ensure that you did not accidentally harm someone and reassure yourself that you would not harm someone purposefully.
- ”Compulsive flooding”- Forcing oneself to think about violent thoughts/images, in order to reassure self and prove that they are disgusted by these acts and would never do them
- Needing constant reassurance from others/self that one would never harm themselves or others
I chose to elaborate on this specific OCD subtype, because I feel like it is more likely to be misunderstood. Additionally, any individual who struggles with this type of OCD may feel especially shameful, confused, and imprisoned by their thoughts, to a degree that they feel they could never disclose these thoughts, for fear of being misjudged. I think contamination or symmetry OCD are less challenging for the average person to understand, and are the common forms of OCD that come to mind when one thinks about OCD. So it is very important to shine a light on harm OCD, to provide deeper understanding and strongly emphasize that these thoughts are nothing more than symptoms- not any more than a cough is to a cold.
It is important that those who struggle with harm OCD, and for those who don’t, to understand that these thoughts are truly unwanted, and these individuals do not have a desire to harm anyone; honestly they would go to greater lengths than the average person to ensure the safety and wellbeing of those around them because they so strongly disagree with their OCD thoughts. So, if you are an individual who struggles with harm OCD, I want to reassure you of this: you are not crazy, you are not a bad person, and there is help out there for you, so you don’t have to struggle in silence.
Scrupulosity OCD (a.k.a. Religious OCD)
Scrupulosity OCD has to do with putting extreme importance on morals, religion, or philosophy, and excessive fear of not upholding these values.
Obsessions include excessive fear of:
- Judgement and condemnation for not upholding ones religion perfectly
- Negative, or perceived negative thoughts about religion icons (i.e. God, Jesus, Satan, etc.)
- Misinterpreting religious text
- Specific words, numbers, or events signifying condemnation (e.g. the number 666)
- Uncertainty if behavior is always ethical, and needing it to be perfect at all times
- Being An innately bad person
Compulsions include:
- Mental checking/reviewing of religious thoughts and practices
- Prayers that are ritualistic and repetitive
- Replacing/correcting religious thoughts that are negative or perceived as negative in nature (i.e. thought neutralizing)
- Avoiding or oversensitivity religious triggers (i.e. materials or symbols associated with cruxifixction or Satan)
Hyperawareness OCD
Hyperawareness OCD has to do with being acutely aware of normal things that passively occur, such as feelings and sensations in the body, which causes extreme distress.
Obsessions include acute awareness of:
- Blinking, swallowing, breathing, heart beating, or other bodily sensations
- Positioning of body parts in relation to other parts of the body, or to the environment (e.g. how one is seated; how leg or arm is positioned)
- Normal or disturbing memories or images ( which can include things seen on television, movies, etc.)
- One’s process of thinking (thinking about thinking relentlessly which causes distress)
Compulsions include:
- Avoiding triggering situations where hyperawareness may occur (e.g. social activities)
- Reviewing/checking triggering behaviors (i.e. breathing and other bodily sensations
- Needing reassurance that hyperawareness is not the result of a different condition and will subside within a certain duration of time.
Tic- related OCD
Behavioral tics are believed to alleviate the distress associated with obsessions; ironically, these tics can become apart of compulsive behaviors. It is especially common for children to experience Tic-related OCD, however because children tend to exhibit behavior that is perceived as silly or corky, this may not be obvious to the child or surrounding adults.
Behavioral tics include:
- Blinking
- Clearing the throat
- Sudden vocal noise (e.g. screeching)
- Twitching
- Shrugging
- Clenching (muscle tightening, appearance of bracing self or holding breath)
For Your Consideration
It is possible for individuals to experience multiple subtypes of OCD. Symptoms may look different among children and adults as well. Typically resistance of these OCD symptoms- thoughts, sensations, or images- unfortunately make the symptoms come back stronger. So, although compulsions typically provide some temporary relief, they ultimately perpetuate the OCD cycle. This is why, if deemed appropriate, it is so important to reach out and get professional help from a trained mental health professional, if you are finding that your symptoms are impairing your daily functioning. Please see possible treatment options and coping strategies below.
There are additional OCD subtypes alongside the subtypes listed above , which include Sexual Orientation OCD, Relationship OCD, and Hoarding-related OCD. For more information about the above listed OCD subtypes or the additional subtypes, please refer to The Mindfulness Workbook for OCD, and Healthline and NIH websites, listed below in references.
Remember, everyone has crazy, weird, and obscure thoughts from time to time- the only difference is that these thoughts cause greater distress and are perceived as more profound to the OCD-wired person, making it much harder for the person to let those thoughts go.
OCD’s Affect On The Brain and Body
It is suggested that the parts of the brain most affected by OCD are the orbitofrontal cortex and the anterior cingulate cortex (refer to diagram 1 below) as well as the thalamus and striatum (refer to diagram 2 below). It is also suggested that there is a malfunction in the transmission of certain neurotransmitters- i.e. chemicals such as dopamine, serotonin, norepinephrine, and glutamate which send messages between brain cells. These are some of the same chemicals that are affected in regards to anxiety symptoms/disorders. Additionally, according to BeyondOCD.org, a research study revealed that those who struggle with OCD and related disorders may have a “mutation” in the human serotonin transporter gene (a.k.a. hSERT).
Experiencing OCD
“Hold up my balloons and cover up my face
I can feel them weighing on me every day
I should let ’em go and watch ’em float away
But I’m scared if I do, then I’ll be more afraid
Tell them how I feel, but they don’t want to change
Tell them how I feel, but they remain the same
Loosen up my grip, they say that’s not okay
Quiet, quiet, quiet, quiet, quiet, ay, leave me alone!”
My first experience with OCD occurred between the ages of 7 and 8, although at the time I had no idea what it was. All I knew was that I was having some strange and scary thoughts that would pop into my head. As I got older the urge to engage in other behaviors to make the thoughts and uncomfortable feelings going away (i.e. compulsions) became more prevalent; when I was young this looked a lot like mumbling to myself or praying, sitting a particular way, organizing and putting things away in a particular way as well. As I got older the thoughts worsened and spurred on the need for more and stronger compulsive behavior; everything had to be done perfectly, following a rigid ritual/regimen, otherwise I had to start all over again until it felt just right.
When I was about 12 years old I reached out for help from family because I couldn’t handle it anymore; That took about 5 years to do because I didn’t know how to explain what I was experiencing, because I really didn’t know myself. For this reason I lived in fear that anyone I told would just think I was crazy and I would be locked away in a psychiatric facility. Therefore for a while, I wrestled back and forth with suicidal thoughts, because the weight of whatever this was, was too much to bear.
So, throughout my teen years I was in and out of therapy, ran through the gamut of medications. A lot of my symptoms mirrored high anxiety and bipolar disorder, which can be commorbid (i.e. combined) with OCD, so looking back it was understandable why I was treated for those conditions. It wasn’t until I was in grad school at the University of Michigan, that things clicked. I was taking a mental health diagnostics class and studying the newly published DSM-5 manual. One particular class was about OCD, and literally everything discussed about the disorder- from the obscure thoughts to specific compulsions- I had experienced! It was such a relief to finally be able to put a name on what I was experiencing. I started crying uncontrollably, and immediately met with my professor after class to discuss next steps.
I was 24 years old when I was officially diagnosed with OCD. Even though I had found relief in finally having the correct diagnosis, it was really difficult to share what I was experiencing; it was still hard for me to explain and honestly I wasn’t sure how much I could trust my therapist. Through building a relationship with my therapist, and undergoing a combination of cognitive behavioral therapy (CBT) and exposure and response prevention therapy (ERP), I was definitely able to make progress; I wasn’t just able to feel comfortable sharing about my obsessions and compulsions, but also became better able to manage symptoms on a daily basis.
Since I was 7 years old through the present, I have experienced a multitude of OCD subtypes and symptoms to some degree. The most prevalent subtype I have experienced is the Scrupulosity/Religious OCD. For me, I have a genetic predisposition to OCD. This combined with misunderstandings about God and religion growing up, innately feeling a strong need to care for and protect people, and other environmental factors, have made me a prime target for OCD.
I had my friend, Adam Sally, create the above banner image. In the image, I am resisting and trying to pull away from the shadow figure, as it’s holding me down, forcing me to watch something that I don’t want to. That’s how I experience OCD- a bully holding me down, creating this cycle of constant chaos, resistance, and fighting with it.
Just like the song by NF, specifically the lyrics I quoted at the top of this section, there is that constant push-pull of wanting to let go of the “balloons” (compulsions) because I know deep down they’re making the problem worse. But I feel like if I do, then I will have no defense when the obsessive thoughts come back. So I cling to those balloons- although I know it’s false security. If I had to guess, I’m sure a lot of people with diagnosed and undiagnosed OCD feel the same.
Treatment Options
There are multiple treatment options used to treat OCD. These include Cognitive Behavioral Therapy (CBT), Exposure and Response (Ritual) Prevention (ERP), and in some cases EMDR. I will summarize these treatment models below, as well as include some common medications that can be used to treat OCD.
Cognitive Behavioral Therapy (CBT)
CBT is a treatment model commonly used to treat a variety of mental health conditions, which includes OCD. Just as I wrote in my previous blog post, Anxiety, the most common treatment is Cognitive-Behavioral Therapy (CBT). CBT is a form of psychotherapy (i.e. talk therapy) that helps an individual identify negative behavior and thought patterns. The idea is to help the individual learn problem-solving skills to challenge, reframe and redirect fears and worries that impair daily functioning. CBT is used widely across a range of mental health conditions. Professionally, CBT is a treatment that I am most familiar with, and used often to treat clients who struggled with anxiety, PTSD, and OCD. Personally, I have been treated with the CBT model, which has helped me manage OCD symptoms.
Exposure and Response Ritual Prevention (ERP)
ERP is a treatment model that includes aspects of CBT along with exposure therapy. This treatment helps the individual to manage/minimize obsessions and compulsions by confronting OCD triggers, while also providing skills to not engage in compulsive behaviors (i.e. mental rituals, external behaviors to offset the discomfort of compulsions. The idea is to help the individual face the discomfort of the obsessions without avoidance of triggers or habitually engaging in other compulsive behavior; the compulsions increase the intensity and recurrence of the obsessions, perpetuating the OCD cycle. Thus, this treatment helps the individual realize that obsessive thoughts are not actually a threat, and therefore compulsions are unnecessary because the consequences they fear will not occur.
ERP achieves these goals by:
- Helping the individual identify OCD triggers, obsessions, and compulsions
- Monitor and rate symptoms from most distressing to least
- In vivo exposure- Primarily targets the obsessions. In vivo is real life exposure to external OCD triggers, such as media, images, wording, other external stimuli that causes the individual distress; the idea is to gradually and repeatedly expose the individual to these triggers so that the trigger will lose its significance.
- Imaginal exposure- Primarily targets the compulsions. It’s aim is to have the individual imagine the consequences they fear, if they were not to engage in compulsive behavior when confronted with an obsession, or didn’t avoid OCD triggers. Again, the goal is to decrease the urge to engage compulsive behavior, helping the individual see that compulsions are unnecessary.
Eye Movement Desensitization and Reprocessing (EMDR)
As I explained in my previous blog post, Anxiety, Eye Movement Desensitization and Reprocessing, or EMDR, is a therapy technique that helps individuals process disturbing thoughts and information in a less intense, more adaptive manner. EMDR accomplishes this through strategic eye movements, similar to eye movements that occur during the REM (i.e rapid eye movement) sleep cycle. EMDR has been suggested to have some success with OCD, especially with OCD that is commorbid with PTSD, or where trauma/distressing past events are known to have contributed to the OCD. This appears to be because EMDR primarily addresses an individual’s distressing or traumatic experiences; however EMDR has appeared to show success in targeting feelings of uncertainty as well.
Medication Options
Serotonin antidepressants are generally used to help treat OCD. Some of these serotonin antidepressants include Zoloft (sertraline), Prozac (fluoxetine), and Paxil (paroxetine).
For Your Consideration
The above mentioned treatment options and medications are a selection of options that can be used to treat OCD. As with most mental health conditions, mental health professionals suggest a combination of treatment and medication help individuals find success. However, it is up to the individual if they would like to participate in treatment and/or medication. Since each person is wired differently, what works for one person may not necessarily work for another person. I personally have found great success with the CBT and ERP treatment models. However, I am not diagnosing or suggesting that anyone needs to engage in treatment or take medication. As always, do your own research as well, and definitely reach out either to your physician or a trained mental health professional to develop a plan that will best meet your needs. If you do decide to receive treatment, please be patient with yourself- it can take time to comfortably share about your OCD symptoms, as well as build trust with your clinician.
Coping Strategies
Although treatments and medication each have their benefits, it is also important to have some practical coping strategies in your back pocket, for day to day use. Just as with anxiety, a multitude of cognitive and mindfulness techniques can be used to cope with OCD. Some common coping strategies include grounding techniques (e.g. deep breathing, muscle relaxation, mental exercises), symptom tracking, cognitive reframing and thought postponement. Although beneficial, symptom tracking and thought postponement may be techniques that are best conducted under the guidance of a mental health professional, as these techniques can invoke initial distress.
Grounding techniques
Grounding essential is another term for centering yourself, and refocusing yourself on the present moment. I referred to this technique as “reorienting yourself with the present” in my previous blog post, Anxiety. Grounding helps you to take the focus off of your distressing thoughts and feelings, and refocus on your environment or your body. This can be done by:
- Deep breathing- Taking a few deep inhales, holding breath for a moment or two; then exhaling. Complete this cycle 3-5 times, or more and preferred 🙂
- Muscle relaxation- Gradually tightening and releasing each part of the body, beginning from head to toe, or vice versa
- Other mental exercises- Focus your senses of sight, taste, sound and hearing to observe and describe your environment (e.g. the taste and sound of chewing gum, the colors outside of your window, etc.)
Symptom Tracking
This is typically a technique discussed during treatment. Essentially, this is an opportunity for an individual to track their OCD cycle, by listing:
- The situation that triggered the OCD cycle
- Rating your emotions
- Brief description of the obsessions
- Brief description of the compulsive behavior
- If the individual was able to refrain from engaging in a compulsion
- Duration of the cycle
- Emotions afterward
Symptom tracking can help the OCD sufferer better understand their specific OCD cycle, which is the first step toward symptom alleviation and management.
Cognitive Reframing
Cognitive reframing is a technique often used and taught within therapy. Essentially, it is a way to redirect negative thoughts, by either challenging if the thought is realistic, true, or beneficial, or by replacing it with a positive thought. This is an opportunity for OCD sufferers to “call out” their obsessive thoughts, by saying:
- This isn’t me; this is the OCD
- You’re not real
- You have no power over me
- Go away!
- or other comfortable phrasing
This is an opportunity to put OCD in it’s place, allowing you to separate yourself from the OCD, and letting it know that it’s not welcome in your mind! Show it who’s boss!
Thought Postponement
Again, another strategy discussed during treatment. Initially, this strategy may be more difficult for an individual to do on their own, and may require practice. The idea is that when an individual is triggered and feels an obsessive thought coming into mind, to immediately “postpone” or redirect focus to the present moment. Practicing grounding techniques is definitely key to successfully using this technique. The difficulty is, refusing the urge to engage in a compulsion, as not “attending” to the obsessive thought will cause distress. Personally, I have found success with thought postponement by:
- Saying the word “postpone”- I either say the word “postpone” aloud or mentally. Similarly to cognitive reframing, I am “calling out” the thought and acknowledging it’s existence, however I am disempowering it by not allowing myself to fixate on it.
- Postponing for a few minutes at a time- When first using this technique it may feel impossible to completely postpone your thoughts. So I’ve found that gradually working up to full postponement can be helpful. Thus, when an obsessive thought comes into mind, tell yourself, “I will postpone this thought for 1 minute.” See how that time frame feels, and if possible continue adding time to the postponement. As you continue to practice this technique over time, you may find that you are able to “postpone” your OCD thoughts indefinitely, without the urge to engage in a compulsion. Now, this may not happen every time, but again takes practice. I have had some success with this, and it is definitely a work in progress 🙂
For additional mindfulness and other coping strategies, please see my previous blog post, Anxiety.
Faith-Based Perspective
Just as I wrote in my previous blog post, Anxiety, there are articles and studies suggesting that an individual’s belief in God can help them cope with mental health conditions. It is suggested that faith that advocates for compassion, forgiveness, and trust in God’s plan, helps the brain build patterns of positive thinking, which minimizes stress hormones and anxiety. These beliefs can help individuals make meaning and purpose out of negative circumstances in life.
On the flip side, however, I do understand how religious beliefs can contribute to anxiety too, especially if they believe that God has abandoned them or is punishing them, loved ones or others. Sometimes this thinking can add to anxiety and stress. I can firsthand attest to this as well. As I mentioned in the experiencing OCD section, one component of the OCD I experience has to do with religious obsessions; these obsessions typically have to do with fear that God is going to condemn me. However although it is difficult, I am able to distinguish between an OCD led thought vs. what I know to be true from my experiential knowledge of God, and what lines up in the Bible. Therefore, I am still able to turn to God and Jesus for support and alleviation of OCD symptoms.
There is a difference between religiosity/legalism, vs. theology and faith. As a Christian, I believe in Jesus. Jesus said the following:
“do not worry about your life, what you will eat or drink; or about your body, what you will wear… look at the birds of the air; they do not sow or reap or stow away in barns, and yet your Heavenly Father feeds them. Are you not much more valuable than they? Can any one of you by worrying add a single hour to your life?” – Matthew 6:25-27
There are examples throughout the Bible of people experiencing hardship- persecution, oppression, captivity, to name a few. Jesus wasn’t immune to this hardship either, because he wanted to show people that he understood what we go through in this world. However, time and time again God showed his care for his people, by providing them with what they needed. With that being said, I understand that there’s a lot of hardships in each of our lives and in the world. Although God may not swoop in to take away every concern, every evil, every anxiety in the world, I do believe that he is not the cause of these hardships.
I do believe, and have experienced and witnessed, that God does care for us and wants to be the answer to our needs. I also believe that he has called each of us to be the answer, by serving others and meeting the needs of our families, friends, communities, and truly, the world.
My friend kindly reminded me of this bible verse- “Cast all your anxiety on him, because he cares for you.” – 1 Peter 5:7
Another reminder that I often have to lean on is this: [Jesus speaking] “I have told you these things, so that in me you may have peace. In this world you will have trouble. But take heart! I have overcome the world.” – John 16:33
When I am struggling under the weight of stress, anxiety, and my struggles with OCD, these verses, along with many others, bring me peace and help me to cope. <3
Conclusion
OCD is a very complex disorder, with different subtypes and symptoms. Due to the complex and confusing nature of OCD, it can leave people feeling alienated and helpless. The good news is, it doesn’t have to be that way! As an individual with OCD who suffered with the disorder for about 17 years before properly being diagnosed and treated for it, I can attest that there is help out there, and this can be managed! If you or someone you know struggles with OCD/OCD-like symptoms, I would encourage you to get help, coping can be less challenging with a support system!
For those who know someone who struggles with OCD- I know it can be a struggle to understand what the OCD sufferer is going through and how to best be of help; I also know it can be a struggle to be patient with that person, with all of their specific symptoms and behaviors. However, I hope this blog evoked some sympathy and understanding. Thank you for your support, and please continue to give grace to that individual, I’m sure they appreciate it more than you know 🙂
Please remember, I am simply providing information from my professional and personal experience, as well as references and resources that I have researched. I am in no way diagnosing anyone with OCD, or suggesting that anyone needs to receive treatment and/or medication. If you feel you may have OCD, please consider seeking help from a medical or mental health professional. Additionally, please do your own research to better understand and explore all treatment options and available resources. For more resources, please see references at the bottom of this page, and refer to my resource page.
Hang in there- there is help and you are not alone! Please feel free to reach out to me via my contact page with any questions or concerns.
Keep pressing on!
-Amanda
Artwork Credit:
Adam Sally, Oxford, Michigan. Adam is the creator of the banner image for this blog post. Through the use of photoshop, Adam created a life like image of my experience with OCD- a constant resistance and wrestling with this shadow figure, or “bully.” I have so much appreciation and gratitude for my awesome friend, and his obvious talent!
Adam is a man of many trades! Along with his art skills, Adam is talented at graphic design, logo design, social media content creation, real estate videography, wedding/event videography, and video marketing. If you need services that exceptionally represent your visions and businesses, Adam is your guy! Check him out on Facebook and Instagram
References
Diagnostic And Statistical Manual Of Mental Disorders, Fifth Edition- American Psychiatric Association
Life Application Study Bible, New International Version (NIV)
Psychopharmacology: Straight Talk on Mental Health Medications- Joe Wiegmann, RPh, LCSW
The Mindfulness Workbook for OCD: A Guide to Overcoming Obsessions and Compulsions Using Mindfulness and Cognitive Behavioral Therapy- Jon Hershfield, MFT, Tom Cowboy, MFT
Treating Your OCD with Exposure and Response (Ritual) Prevention, Second Edition- Elna Yadin, Edna B. Foa, Tracey K. Lichner
Other OCD Resources:
Can Christianity Cure Obsessive-Compulsive Disorder? A Psychiatrist Explores the Role of Faith in Treatment- Ian Osborn, MD
OCD- Be Still and Know: A Christian Guide to Overcoming Obsessive Compulsive Disorder- P.A. Kennan
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