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- When life stops, but you can’t - OCD (Obsessive Compulsion Disorder)
When life stops, but you can’t - OCD (Obsessive Compulsion Disorder)
Jackson Gatlin Crawford
April 05, 2024
You think and think and think. It’s you against your thoughts, but you can’t win. They repeat themselves over and over again. The solution seems so close, just one more thought, and you’ll know for sure, that nothing bad happened or will happen. Just one more thought, and you can continue your day and relax. But the relaxation won’t come. You feel this uncomfortable feeling that something isn’t right, and you must reflect on it right now!
About 2-3% of the world's population is affected by obsessive-compulsive disorders (Carmi et al., 2022). The deep suffering of those is often unseen by outsiders because people with OCD often try their best to hide the symptoms. Outsiders may notice the suffering of those with obsessive-compulsive disorders. But, they can't understand the behavior and fears. They may even consider them crazy or absurd.
Even people with obsessive-compulsive disorder don't know what makes them ruminate or feel compelled. They do things they can't let go of, even if they would like to. Whether it's the constant washing of hands, the endless checking of the stove, or the inner tension of thinking about that one thing over and over again without coming to a satisfying solution.
Those affected usually suffer alone. Some develop the feeling of going crazy and being able to watch themselves go crazy. The person with OCD and others don't quite understand the cause of those symptoms. So, the sufferers often feel ashamed of their tormenting thoughts.
The most common types of obsessions (American Psychiatric Association):
Contamination ("But maybe I have HIV on my hands...")
Control ("What if the stove wasn't off?")
Sexual content ("But maybe I'm homosexual...")
Aggressive content ("But maybe this image in my head of stabbing my children means that I am a murderer after all...")
Religious content ("What would happen if I suddenly started cursing God during a church service?")
Moral content ("Maybe my university degree would be revoked if everyone knew that I cheated on this one exam...")
Thoughts about the compulsion itself ("Maybe I don't have a compulsion after all, and my thoughts really do have a meaning and say something about my bad character or my perversion...")
Magical content and incompleteness ("But maybe something will happen to my parents if I don't touch my head six times...")
…
The following examples are just a few of the many possible compulsive behaviors.
Examples of mental obsessions:
Washing hands for a long time to get rid of all bacteria
Checking the stove several times to keep the house from burning down
Checking the car for scratches to make sure you didn't accidentally run over someone
Take pictures to verify the situation
Repeatedly asking your husband if he still loves you
Searching the Internet for answers to your nagging obsessive thoughts
Create compulsive order and symmetry
Avoid unlucky numbers such as the 13
...
Examples of mental compulsions:
Suppressing thoughts
Replacing thoughts
Checking if certain thoughts or feelings are still there
Distracting yourself
Rejecting thoughts with arguments
Revisiting past events
Calming yourself
Magic counting or reciting lists
Taking an "inner picture'' of a situation
...
No wonder, most affected people stay quiet. They even isolate themselves more. Not only do they not understand themselves, they rarely see similar behavior in others. It is estimated that two-thirds of those affected do not seek professional help. On average, six years pass before the first treatment (Swierkosz-Lenart et al., 2023).
The obsessions often involve shameful content. They clash with the person's personality and are called ego-dystonic, which means that the thoughts are not congruent to the personality of a person. Because of that, the content of the obsessions is rarely discussed by people who suffer from them.
There is little media awareness of OCD. Only the familiar hand-washing or endless stove-checking is thought of as OCD, but OCD can appear in many different forms. They can manifest themselves in a variety of behavioral rituals, and the compulsive symptoms can even occur in the mind alone.
Affected Individuals often maintain a facade and try to live their lives as normally as possible. If you don't understand yourself, how can others understand you? It's already enough that others see you’re acting strangely. What if they also knew how you truly feel about it?
Tips that could help people without OCD don't help with obsessive-compulsive disorders. Many affected individuals have turned to the internet for advice. They've started meditating, tried relaxation exercises, or looked for balance in sports. They may have tried to distract themselves. Furthermore, they tried to suppress thoughts and feelings, and desperately focused on positive things. They often change their lifestyle. Some people give up coffee and sugar, avoid stress, and in some cases even end partnerships or relationships. Others try to relieve their tension with alcohol or other drugs. Perhaps all of this has helped in the short term, but none of these interventions solves the underlying problems. Instead, their lives become more and more restricted because they try to avoid the things that they are afraid of at all costs. Even if this means not going outside anymore or breaking off relationships.
Those with OCD often notice that others behave and think similarly. But, the intensity of the thoughts and behaviors differ enormously. Obsessive compulsions develop slowly over time. If untreated, they get worse and take over more of your life.
Doubt and Uncertainty - Driving Forces of Compulsion
We see that obsessive-compulsive disorders manifest in a wide variety of ways. Some people compulsively wash their hands. Others fear making the wrong decision with their partner. Others are afraid of harming their children, even though they don't want to. Still, others keep asking themselves if they are homosexual, even though they have been heterosexual for quite a while and aren’t interested in same-sex relationships. OCD can be very different in their subjects, but the main thing they all have in common is the fear that something doesn't seem sure. What if I did hurt someone after all and possibly forgot about it? What if I am indeed homosexual, but now I'm in a heterosexual relationship? What if I haven't washed the bacteria off my hands well enough and something bad could happen if I don't wash them again etc..
The goal of overthinking and ruminating is to stop the terrible thoughts and unpleasant feelings. But can we always have 100% certainty? If we try to achieve it too hard, won't we even paint irrational scenarios that we begin to believe due to perceptual errors?
In the search for 100% certainty, people suffering from compulsions often do themselves no favors with their intelligence, creativity, and high conscientiousness. The fantasies that trigger their fears seem more and more real as they continue to ruminate and overthink. With each supposed solution or distancing from the obsessive thought, the question arises, "What if...?" And a new problem is thought of, which is extremely distressing. The never-ending cycle begins again.
People with obsessive-compulsive disorders are aware of this. But, they struggle to let go of the obsessive thoughts and compulsive actions. So they continue to think about the obsessive topic, and the paradoxical effect occurs that what we focus on more can also trigger stronger emotions in us. There is always a new "What if..." and sometimes it works… At some point, they manage to calm themselves through the compulsive habits and rumination. The brief calmness might seem like a permanent fix for troubling thoughts. Since those affected usually don't know any alternatives to their symptomatic behavior, they believe in this illusion and learn that the thinking, the routines, the rituals, and the whole repetitive behavior could be the only working solution.
Eventually, they realize this approach won’t help. The compulsions and obsessive thoughts find new chances to return.
What’s the long-term Solution for Obsessive-Compulsive Disorders?
Clearly: Psychotherapy.
Depending on how advanced the symptoms are, outpatient psychotherapy can be used to work on the symptoms and even causes of the disorder. However, if the compulsions impact daily life to the extent that maintaining a healthy lifestyle is very difficult or the quality of life suffers drastically, then attending a day clinic or full inpatient clinic is also recommended.
It’s very important to note that people who suffer from OCD are not crazy, and there is no shame in seeking treatment. Just as we should see a doctor for a broken bone, mental disorders are illnesses that should and can be treated. The earlier treatment begins, the better so that further consequences of the illness can be prevented.
Cognitive-behavioral therapy with its special approach of exposure-interventions is usually the treatment of choice for obsessive-compulsive disorders. However, it can also be treated with psychodynamic therapy if the symptoms allow it.
People with OCD often have the hope and belief that they can somehow conquer it on their own. But the advice is clear: Don't take on false pride! Our health should come before our pride. Professional help is available from psychological psychotherapists and should be taken advantage of.
We hope you find this article helpful.
Feel free to write us about topics, that you would like to know more about and maybe we’ll cover it in one of the next articles.
Kind regards, Gatlin Crawford
Source:
Carmi, L., Brakoulias, V., Arush, O. B., Cohen, H. & Zohar, J. (2022). A prospective clinical cohort-based study of the prevalence of OCD, obsessive compulsive and related disorders, and tics in families of patients with OCD. BMC Psychiatry (Online), 22(1). https://doi.org/10.1186/s12888-022-03807-4
Swierkosz-Lenart, K., Santos, J. E., Elowe, J., Clair, A., Bally, J., Riquier, F., Bloch, J., Draganski, B., Clerc, M., Moyano, B. P., Von Gunten, A. & Mallet, L. (2023). Therapies for obsessive-compulsive disorder: Current state of the art and perspectives for approaching treatment-resistant patients. Frontiers in Psychiatry, 14. https://doi.org/10.3389/fpsyt.2023.1065812