Anxiety is a natural reaction of the psyche in a situation of suspense, and even outwardly unperturbed people are tormented by disturbing thoughts from time to time.
The brain, in order to unload, launches its own campaign to combat excitement: the subconscious mind invents small rituals, the implementation of which allows you to switch.
When such a protective mechanism fails, experts talk about signs of obsessive-compulsive disorder (OCD) – while anxiety becomes a constant companion of life, and “saving” actions turn into an endless elimination of the threat.
We find out what lies behind the symptoms of OCD, how to deal with it, and why perfectionists should be on the lookout.
Types of Obsession
The external manifestations of obsessive-compulsive disorder are divided into the actual obsessions and compulsions.
Obsessions are fears that are embedded in the general stream of thoughts as if from nowhere, but have been unsettled for a long time.
Obsessions appeal to enduring beliefs or deep emotions, such as fear, which makes them difficult to manage. To compensate for itchy anxiety, a person commits compulsions – forced rituals, as if capable of preventing what he fears.
A classic example of obsessive-compulsive disorder is often called obsession with cleanliness, including hands that seem to collect the most amount of surrounding dirt.
The annoying idea that bacteria and viruses enter the body, lead to infection or an incurable disease, instills horror in a person, pushing him to wash his hands thoroughly many times a day and treat them with an antibacterial gel. But hypochondria does not necessarily indicate OCD – it can be one of the symptoms, and an independent form of anxiety.
With OCD, obsessive thoughts do not always revolve around potential diseases – sometimes they are associated with fear of harming oneself or others, with unwanted and frightening sexual images, with the desire to perform tasks ideally and with other obsessions.
Strong motivation for performing rituals also becomes confidence in one’s own “magical” thinking. It may seem to a patient with OCD that if he only imagines how one of his relatives will be hit by a car, this will certainly happen.
In order for things to develop successfully and nothing bad happens, a person invents and in a certain way performs intricate actions, compulsions – they play the role of magical “protecting” rituals.
This can be, for example, laying out objects on a table by color or size or trying not to step on the joints between tiles when walking so that something terrible does not happen.
“Compulsions, mental and physical, I do all the time,” says Amanda. – I am afraid of almost everything, any thing may seem dangerous to my family. When such an idea comes, I most often redo what I did: go back a few steps, and then go forward, re-enter the door, press the button, send a letter.
I also want to count repetitions and objects all the time. There should be four, eight, nine or ten – the rest of the numbers are “bad” for me. True, bad and good numbers can vary depending on specific fears.
The same with color: there is good, there is bad. I am afraid to buy clothes of a bad color and with the wrong number of buttons. Buying things is generally the most difficult. I can’t give presents, because it’s hard to choose what suits my superstitions.
There are days when I didn’t complete the compulsion and I feel “dirty”, that is, I can’t do anything important – on such a day I really can’t work. As a result, I give shower gels to my best friends and relatives, but I don’t buy new things for myself.
Sometimes I am ashamed that I look like a ragged woman – and shame makes me go to the store and buy something new; usually these are very cheap things that you won’t mind throwing away or not wearing when they seem to me “dirty” as a result of obsessive thoughts. ”
“I had different obsessions – Andrew shares his experience. – Strange images came constantly: during walks, during communication with relatives, at a time when I was alone.
I remember how wildly I was afraid to commit some ridiculous act: to stand up and yell at my work colleagues, beat the cook of the restaurant in which I worked then, and hit my mother. I began to feel constrained in communicating with other people.
I felt that something was wrong with me, and I can’t talk about it – after all, everyone will think that I am sick.”
Today, in the medical classification, OCD is referred to as neurotic conditions, although until recently it was defined as a mental illness.
This ailment is radically different, for example, from schizophrenia by awareness: a person understands that not everything is in order with him, he is critical of the problem and is trying to deal with it.
Who is at risk
According to studies, obsessive-compulsive disorder affects up to 3% of the population. Men and women get the disease with the same frequency.
But the age at which OCD first makes itself felt can be different: usually symptoms occur in adults, but according to some reports, up to 4% of children and adolescents experience the disorder; older people are no exception.
The fact that not everyone seeks help also affects the indicators, although in many ways OCD reduces the quality of life, and its impact on the person’s social skills is comparable to the harm from depression and alcohol dependence.
Often, an ailment occurs and develops in those who live with other diseases, such as depression or bipolar disorder. The tendency to perfectionism, known for its negative side, can also become a background for the development of OCD.
By itself, obsessive-compulsive disorder does not develop into a more serious illness and does not lead to loss of mind, despite the fears of many patients.
However, it also happens that OCD is not a diagnosis, but a symptom in the framework of diseases of a completely different kind. But only the doctor can determine the difference in this case: self-diagnosis will not lead to anything other than nervous breakdowns and new disturbing thoughts.
“I got obsessive, “strong“ rituals when, at the age of fourteen, I began to lose weight actively,” says Lydia. – It was such a hellish cocktail of neurotic: anorexia, nervous exhaustion and OCD.
There were several basic rituals: I could look in the mirror until I liked my expression (it sounds strange and a little creepy), lay my socks at bedtime at a specific angle from the bed, move the chair or curtains in a certain way. It was necessary to say goodbye to the house when you left somewhere — otherwise he would “be offended”.
Six years have passed since then, I said goodbye to anorexia by the age of sixteen, with the rest of the eating disorders a little later.
It’s now almost two years behind a more or less adequate life – with the exception of sometimes nightmares and OCD still living with me.”
How the disorder is treated
Specialists still cannot unambiguously explain why OCD is developing. There are many hypotheses on this subject, but not one of them has rigorous evidence so far.
The genetic factor, of course, is taken into account: the probability of inheriting OCD from immediate relatives can be from 7 to 15%. Sometimes the reason is seen in a decrease in the level of serotonin, the “hormone of happiness”, but this theory has not received enough evidence.
Since OCD is considered to be a neurosis, they are treated accordingly, often using cognitive-behavioral therapy. It allows you to determine the causes of anxiety, to understand where the internal conflict arose, followed by obsessions and compulsions.
Having dealt with the source of OCD, the therapist helps a person to see the irrationality of fears and their contradiction with reality and life experience.
One of the specialist’s tasks at this stage is to change the negative attitude to the symptoms to a neutral one, to teach the patient to accept and experience his fear, and not to avoid it, renewing the vicious circle of obsessions and compulsions.
For this, an exposure (immersion) technique can be used in which the state of anxiety is artificially amplified to the limit, and the patient is not allowed to perform his usual compulsions. Having reached a peak, anxiety unexpectedly disappears.
Andrew recalls that at first he apprehended the therapist’s suggestion to try the exposure with caution.
“Of course, I was scared, I was afraid that it would make me worse. I was afraid of obsessive images and thoughts, used to run away from them – and then I had to meet them face to face. This slightly violated my picture of the world.
Once, when the obsessions tormented me especially hard, I decided to try. I began by introducing in paints how I am hurting myself. Of course, during the exercise, I noticed increased anxiety. I was scared. But the more I plunged into my fears, the easier it became for me.
By constantly reinforcing negative thoughts, I made sure that they caused less and less discomfort. They come unnoticed – but they can leave just as easily.”
However psychotherapy is a long and difficult way to treat obsessions. More often in the case of OCD, a course of antidepressants is prescribed – they inhibit arousal and cause anxiety to recede.
But, as some psychotherapists claim, this method does not work as well as we would like. In most cases, the patient, although to a lesser extent, still has to perform rituals. In addition, there is no guarantee that anxiety will not worsen again after some time.
At the same time, psychotherapy and antidepressants do not exclude each other. The options may be different: you can combine sessions with a specialist with taking antidepressants or first use psychotherapy and then consolidate the effect of drugs.
“I went to a specialist when I entered university and moved to Boston,” says Lydia. – Then there was some terrible stress, huge difficulties with the team and personal life.
I ran to a therapist because of depression, but it turned out that I also had long-standing OCD. The doctor called me a classic neurotic and prescribed tranquilizers and antidepressants.
By the end of the course, everything had practically passed – but after about six months I found myself saying goodbye to the house again, apologizing to the walls when I touched them, and committing another, as if funny, but very annoying nonsense.
As new rituals, verification of closed and unclosed doors in each room, bringing the mess on the table to a specific geometric shape and so on was added.
I don’t think that there have been more compulsions – there are always about the same number of them – but they definitely became harmless. In general, my OCD attacks are wave-like and always combined with stress.
When the next wave rolls in, the first thing I do is go shopping, do manicures, hair masks and other simple things from personal care – this helps to calm down.
And then my program is meditation, breathing exercises, stretching exercises, various variations of yoga, always ending with shavasana. This is incredibly helpful.
I think this way oxygen gets better to the muscles and head, cortisol gets smaller, more endorphins, stress goes away, and OCD is hidden behind the wall until next time.”
How to provide support
Most often, people with OCD are tormented by the thought that they can be dangerous to themselves and others. If they share their feelings, to an untrained listener, many obsessions may seem wild and inadequate.
In fact, such reflections in obsessive-compulsive disorder are no more than exaggerated images, which are drawn by an anxious imagination.
But the stormy reaction of the interlocutor, especially the accusations of insanity and reproaches, can hurt a person with OCD and further increase anxiety.
If you notice that a loved one has signs of frustration, it is important to understand that he is not guilty of this, and to provide the correct support, avoiding accusations.
“I started talking about OCD with my friends when I was twenty-one,” says Amanda. – In general, it doesn’t matter to everyone. I can’t say that my relatives support me – and I’m not sure that I need this.
As I said, shame can defeat OCD for a while, shame is more important and more unpleasant than fear. So for me the best help is when they scold me for my shoals and do not say: “Well, you have OCD, it’s good that you’ve come at all, and I don’t give a damn what’s without a present.”
The only thing that no one knows about is that OCD in my every movement, that this disorder determines my whole life in general. I can’t talk about this because it is inexplicable.
It’s impossible to understand how a person can be so selfish and self-interested that he even chooses milk in a store according to his own scheme.”
People with OCD are hostages of their own subconscious, sometimes it may seem to them that they are doomed and nothing will help. But, fortunately, the existence of the disorder and its manifestations has been talked more and more recently.
Vivid examples of people with obsessive-compulsive disorder are the heroes of Leonardo DiCaprio in “The Aviator” and Jack Nicholson in “As Good as It Gets”, as well as the autobiographical heroine Lena Dunham in the TV series “Girls”.
Bloggers also do not hide how people with OCD live. More recently, the Intrusive Thoughts website has appeared, where you can find useful information about the symptoms, treatment, and course of the disorder.
And yet, if a person is not yet ready to take action, do not force him to treatment: the effectiveness of therapy depends on how much the patient is involved in the process.
You need to understand that a person with OCD will have to spend almost as much strength and energy on treatment as it takes on his experiences and symptoms.
This requires tremendous dedication and continuous work on oneself – which for many people with OCD means literally becoming a different person.