The symptoms of Obsessive Compulsive Disorder can be confusing and frustrating for both the person battling OCD as well as the people around them. It is important to understand the ways that OCD presents and how to begin to fight against it.
It all starts with anxiety.
At the basis of OCD is anxiety. We need to start by breaking down anxiety and exactly what is happening in our body when we are feeling anxious. Anxiety is the body's fear response. It is designed to alert us to potential dangers and to have the body react appropriately to help protect us. Generally, this response is controlled by a small part of the brain named the amygdala which is able to react in three ways: fight, flight, or freeze. In an attempt to prepare us for danger, we will feel a variety of physical symptoms such as:
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Remember that this response is because our mind has detected a threat and puts systems into place to help you survive.
Anxiety can be formed in two ways.
All anxiety is not created the equally. When our fight, flight, or freeze response is activated, it can be activated in two ways.
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The first way that anxiety is formed is the fastest acting and often referred to as the more instinctual response. A stimulus (either something in the environment or a thought) is perceived through the senses and is directly routed to the amygdala. This process happens without you even thinking about it. For instance, if you are driving and someone pulls out in front of you, you instinctually swerve to avoid the collision. Another example is if you are walking along a path in the woods and see ahead of you a stick laying across the path, you may initially may feel alerted, perceiving it initially as a snake. The trade off for this response is that it is quick to help protect us, however, since the amygdala has no ability to be rational, we may be alerted by non-dangerous stimuli.
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The second way anxiety is formed takes a bit longer because it travels a "further route." A stimulus (something in the environment or a thought) is perceived through the senses and then it processed through the cortex / our thought process. We interpret and evaluate the stimulus and what the situation or thought means. Information is also fed from the hippocampus to the cortex from previous memories of events similar to this stimulus. From here, information is sent to the amygdala. For instance, if your boss calls you and says "come to my office" (stimulus & senses), you think "I bet I am in trouble!" (cortex), and you remember the one experience where your boss called you at your old job and were fired (hippocampus), you amygdala would react because of this possibly dangerous situation.
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Anxiety's connection with OCD
OCD is a combination of obsessive (fearful thoughts) and compulsions (attempts to reduce the anxiety). While many times we think of OCD in relation to someone washing their hands often or being organized, there are many other ways that OCD can manifest. It is also not uncommon for various obsessive thoughts to occur at the same time or to have the obsessive thoughts shift their focus over a period of time. The obsessive thoughts are intrusive, barging unwanted into the persons mind.
Common obsessions with OCD include:
- Fears of contamination - these would include dirt/ germs, household items, environmental contaminants, body waste / secretions, animals and insects.
- Fear of causing harm by accident - accidentally hitting someone while driving, leaving on a stove, oven, curling iron, etc, or leaving a window / door unlocked resulting in a robbery
- Fear of causing harm on purpose - Harming themselves or others impulsively, doing something shocking or embarrassing
- Symmetry and exactness - Distress associated with ordering and arranging items, magical thinking (if I don't do X, Y, Z then something terrible will happen to my family), thoughts about needing to protect themselves or others, and the need to "feel right"
- Sexual obsessions - unwanted sexual thoughts about family, children, violence, animals or even religious figures
- Sexual orientation obsessions - Concerns about attraction or sexual thoughts for the same sex or for the opposite sex, concerns about the meaning of their thoughts and their sexual orientation
- Pedophilia obsessions - intense fear of having sexual attraction towards children resulting in minimizing contact with children because of the feared thoughts
- Religious obsessions - concerns of blasphmy and sacrilege, excessive concerns about right and wrong, accidentally omitting someone from a prayer, performing a religious ritual incorrectly
Common compulsions with OCD include:
- Washing and cleaning - excessively washing or cleaning, avoiding contaminants
- Checking - checking locks, stoves, appliances, switches, checks about harming themselves or others, checking for catastrophes, checking for mistakes, and checking for health concerns
- Repeating - rereading parts of a book, rewriting and correcting, repeating routine activities, and repeating words or phrases
- Counting - counting steps, counting items, counting out loud, mental counting, and counting numbers of devices
- Ordering and arranging - ordering and arranging things until they are the "right way"
- Mental rituals - self-reassurance, mental counting, mental list making, saying prayers, mental "un-doing"
- Somatic compulsions - concerns about bodily feelings and sensations and what they could mean (health anxiety and sexual worries)
Interpretation and Certainty: the Dangerous Duo of OCD
There are two aspects of OCD that continue the cycle of symptoms that people experience. Interpretation and meaning of the obsessive thoughts starts the process of anxiety for the individual with OCD. When the person has an obsessive thought such as: what if I didn't turn off the stove? (my house could burn down), did I hit someone? (while driving),
Certainty is one of the aspects of OCD that makes the compulsions so damaging.
Certainty is one of the aspects of OCD that makes the compulsions so damaging.