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Have you ever experienced thoughts that seem very strange or out of the ordinary? What about thoughts that you know are illogical yet still produce distress when they pop in your mind? Aside from being strange, do these thoughts ever scare you? Do they ever make you wonder if you are a horrible, dangerous person? Do you have certain behaviors or mental acts that you have to do, NO MATTER WHAT….even if they are inconvenient, take up a lot of time, and cause conflicts with your loved ones? Well, answering “yes” to some/all of the above-mentioned questions might indicate the presence of Obsessive-Compulsive Disorder (otherwise known as OCD). OCD is often portrayed in media as a quirky character (e.g., Monica Gellar, Monk, etc.), the punchline of a joke, or as an adjective used to describe someone who is anal retentive. Despite this portrayal, specialists understand that OCD is certainly not a joke, the sufferer is not simply quirky, and it is not synonymous with anal retentiveness. The reality of this psychiatric illness is that it can be debilitating and often causes impairment in many domains of a person’s life. The general public typically understands OCD in terms of contamination fears, excessive cleanliness or orderliness, counting, and superstitious beliefs. And while all of those aspects can be true for OCD sufferers, there are other domains within OCD that are less understood and kept quiet due to sufferers’ shame, embarrassment, and fear of being judged by others. Below are the top 5 aspects of OCD that are misunderstood and/or not discussed in the public:
1) The difference between obsessions and compulsions.
OCD is an anxiety disorder that is comprised of a cycle of obsessions and compulsions (also referred to as rituals). Obsessions are recurring thoughts, images, ideas, or impulses that are unwanted and intrusive. All of us have strange thoughts that pop into our mind, and these thoughts might be dark or make us think, “Wow, where did that thought come from? That was random and weird…moving on.” For OCD sufferers, however, there is no moving on and they do not chalk it up to randomness. They perseverate over the thought and become extremely distressed by it, regardless of their age, intelligence level, or ability to “know it sounds ridiculous.” The content that pops into the minds of OCD sufferers just feels real and is impervious is logic. Compulsions or rituals are strategies that sufferers use to make themselves feel better– to lower their distress and anxiety. Strategies could include overt behavior such as repetitive checking or washing, covert behaviors such as seeking reassurance or re-reading content, or mental acts such as repeatedly replaying the events of an evening or repeating special words to themselves. While it can sometimes be difficult to differentiate between these two components of OCD, doing so is very important in the treatment process.
2) Harm obsessions.
Harm obsessions are characterized by thoughts, images, ideas, or impulses of hurting oneself or another person. Examples of this type of obsession could include thoughts such as “What if I pick up that knife and stab my mother” or “What if I yell out a racist slur on the subway.” One of the biggest misunderstandings of this obsessional domain is that sufferers are not actually suicidal, homicidal, or aggressive at all. In fact, these obsessions terrify OCD sufferers. And while they begin to fear their thoughts and believe that they are a danger to themselves or others, they are typically the least dangerous people we know. Furthermore, sufferers might begin to avoid objects that could produce harm (e.g., knives) or interacting with other people altogether, as OCD convinces them that avoidance is the only way to ensure safety. Not surprisingly so, this obsessional domain is correlated with a lot of social isolation and depressive symptoms.
3) Sexual obsessions.
Perhaps the best-kept secret amongst OCD sufferers are obsessions that are comprised of sexual content. Despite being so under-discussed, this obsessional domain is extremely common in OCD. Sufferers might experience thoughts related to their sexual orientation, sexual aggression (e.g., rape), or pedophilia—all of which are NOT congruent with what they actually find sexually arousing or pleasurable. These obsessions typically produce an excessive amount of anxiety, shame, and embarrassment. Examples of sexual obsessions are as follows: “What if I am gay and I don’t know it yet;” “What if I just molested my niece when I changed her diaper;” “What if I raped someone last night when I went out and I don’t remember it.” Common compulsions for these obsessions could include repeatedly mentally reviewing the sequence of events, seeking reassurance from a loved one, or strict adherence to safety behaviors (e.g., only nodding hello as a greeting instead of hugging a loved on). Avoidance is also quite common here– again, to ensure others’ safety. Many OCD sufferers who experience these obsessions judge themselves harshly and believe that they are a terrible monster of a person (particularly in the case of pedophilic obsessions.) One of the first steps in sufferers’ recovery process is to learn that although these obsessions might produce a lot of shame and questioning of one’s character, they are merely a symptom of the illness and have no implications on their character.
4) Just right.
One of the most overlooked domains of OCD is the rigidity and incessantness of needing things to be “just right.” The reason this often goes unnoticed is because perfectionism runs rampant in Westernized culture. Many of us strive for perfection or like to do things in our special way that feels “just right.” In the case of OCD, however, this degree of perfectionism, orderliness, or rigidity become maladaptive and impairing. It can result in excessive tardiness, missed deadlines, or complete avoidance of tasks altogether. The OCD sufferer might spend countless hours re-reading or re-writing a term paper or even an email to a colleague to ensure that it is free from error or that they articulated their points in the most effective and efficient way possible. One might also spend hours cleaning and re-organizing the whole house before being able to sit down and begin math homework or keep putting off a decision about which paint color to choose because they might not have found the best one yet. This obsessional domain often feeds on an inherent feature of human life, uncertainty. OCD wants people to live in the world of absolutes and complete certainty, which is most often impossible. Many individuals with OCD experience reluctance to give up this part of the illness because they attribute their successes to this “thoroughness” and fear that they might become a “slacker” in the absence of these rituals. The irony, however, is that it often results in their biggest fears: a series of recurrent failures and incomplete tasks. Breaking this crippling cycle of perfectionism begins with learning how to tolerate uncertainty, mistakes, and “good enough.”
5) Religious scrupulosity.
Many people believe in a higher power, engage in religious rituals and traditions, and aim to behave according to their morals. Furthermore, it is true that plenty of these people find great fulfillment from their faith. Unfortunately, OCD can turn religion and morality from fulfilling to fretful. Scrupulosity is a domain of OCD that is characterized by a pathological level of guilt related to moral or religious issues—this can manifest in believers and non-believers alike. These individuals may find themselves preoccupied with fears about heaven and hell, spending the majority of their waking hours praying or reading religious script, or being terrified to act in an immoral way (e.g., ignoring a person in need or drinking alcohol). OCD often “attacks” what people care about most, so it is not uncommon for OCD to manifest in scrupulosity for those who care deeply about their faith or morals. While sufferers may still genuinely care about their faith at their core, religious rituals, prayer, and desires to follow the word of their faith become associated with a great deal of guilt and fear rather than joy and inner peace. Conquering scrupulosity does not mean that religion and morality are erased from one’s life, but rather that they can exist in a person’s life in a way that is rooted in peace and fulfillment rather than fear and guilt. This process may involve consultation from a clergy member.
Many people with OCD believe that they need their OCD to succeed or that their compulsions and avoidances are needed for survival and safety. It must be stated that OCD can be quite convincing to both sufferers and their loved ones, so it might often feel easier to just give into the cycle rather than challenge it. Challenging it will result in a lot of temporary discomfort, distress, and anxiety. And it will not feel pleasant to challenge it, but this is the way to recovery. Help is out there! OCD specialists exist and are trained in a specific form of Cognitive-Behavior Therapy called Exposure and Response Prevention (commonly referred to as EXRP or ERP) to help sufferers overcome this encumbering illness. This treatment successfully treats OCD symptoms by activating what makes it tick the most. Specialists will help sufferers break free from the chains of OCD by systematically exposing them to their biggest fears in the absence of compulsions. Although this treatment can feel difficult and frustrating at times, the gains can be life changing and incredibly empowering.