What is OCD

by Sarah Chana Radcliffe, M.Ed., C.Psych.Assoc.

Normal Obsessing

Maybe all of us are a little obsessive at times. Certainly it’s common to think about things over and over again.  For example, someone in the middle of purchasing a new house may not be able to get the matter out of his mind for days on end. He’s thinking about every detail, even when he’s at work and even in his dreams!  He’s temporarily out-of-balance, as his whole mind seems to be taken over with this major life event – he’s “obsessed.”

And who isn’t obsessed with the well-being of their newborn infant?  It’s certainly normal to check many times a night whether the little one is still breathing, at least for a few weeks after birth. And some people continue to check on the breathing of their family members for years – a little quirky perhaps, but still “normal.”

Another common obsession is checking several times to see if the door is really locked and the stove is really off, before leaving the house or retiring for the evening. As long as this involves only one extra look (“just to be sure”), this is also probably no reason for concern.

And, of course, there are some people who are “obsessive” about the cleanliness of their homes – and this is always pathological.  (Just kidding)

Obsessions Are Anxieties; Compulsions Relieve Them

As can be seen from the above examples, obsessions are anxious thoughts.  “Have I got all the numbers right on this deal?” “Is my baby alive and well?” “Did I remember to lock the door or did I leave it open to robbers?” A person experiencing these kinds of thoughts feels uncomfortable, unsettled. She wants to return to a calmer state.

Certain actions will relieve the anxiety.  Adding the numbers again, provides reassurance. Going to check the baby, restores peace of mind.  Making one more trip to the door or stove puts the mind at rest – and so on. Behaviours which calm obsessive thoughts are called “compulsions” - specific actions taken to make the anxiety go away.

Abnormal Obsessions and Compulsions

There are times when obsessive and compulsive behaviours move from the “normal” realm to the “abnormal” realm. This may appear as a gradual process.  At first, for example, a lady realizes that the doorknobs in public washrooms probably have people’s germs on them; she decides to take precautions and open such doors with a tissue rather than with her bare hands.  Had her anxiety stayed at that level, she wouldn’t have had a diagnosable illness. (When our obsessions and compulsions don’t cause us significant distress and don’t interfere with our school or work lives or our relationships, they are still considered to be within the normal realm.)

However, suppose that after awhile, this lady decides that the tissue wasn’t “strong” enough to prevent passage of bacteria, so she is careful to wash her hands when she gets home.  Soon, she is buying special soap for the purpose, and eventually a scrub brush which she uses for increasingly long periods of time.  Now she spends twenty minutes or more washing her hands every time she returns home from a public outing.  Soon, she must wash her hands scrupulously even if she only passed a public washroom and didn’t actually use it.  Eventually, other anxieties (obsessions) and calming routines (compulsions) occur as well.  Several years into this kind of behaviour, the lady’s life is very constricted, with obsessions and compulsions taking up a good part of her day, interfering with her work and her relationships. Her condition is called “Obsessive-Compulsive Disorder.”

Obsessive-Compulsive Disorder

Obsessive-Compulsive Disorder exists when a person’s life is disrupted by obsessions and compulsions. The person suffers from recurring, persistent thoughts or images which intrude into his awareness, causing distress.  Such thoughts just won’t go away. In order to find relief from the anxiety they cause, the person develops calming routines such as checking repeatedly, handwashing, changing clothing, counting things, silently repeating words, or other similar strategies.  Unfortunately, the compulsions only provide very temporary relief and they become ineffective after awhile. In order to increase their effectiveness, more time may need to be spent on them or they may need to be performed with more special rules and conditions.  Eventually, normal living is interrupted, as the person spends more and more time quelling anxiety.

Treatments For OCD

OCD (Obsessive-Compulsive Disorder) is a biological illness. It is a disorder that is reported more often among the upper classes of society and in those of higher intelligence.  Symptoms can start in childhood, but they tend to intensify in adolescence and early adulthood. They wax and wane, worsening during periods of stress. Untreated, the condition is chronic (it will not go away) and it can become debilitating as it tends to worsen with time.

Fortunately, there are excellent treatments available for this condition.  When successfully treated, a person with OCD can have a significant reduction in symptoms and lead a normal, functional and happy life.

Unfortunately, failure to avail oneself of treatment, can result in complete dysfunction and inability to have a normal life. Marriages in which there is an untreated partner with OCD frequently end in divorce or suffer on-going intense pain. In addition to these unpleasant realities, it must be noted that OCD often co-exists with a particularly lethal form of depression, one that results in the highest suicide rate of all mental illnesses.

OCD is not viewed as an “attitude problem” or an “emotional problem.”  Most professionals feel that it cannot be corrected by psychotherapy alone, although some feel that psychotherapy may be helpful. OCD is generally seen as a physical problem that responds well to a combined approach of psychotropic medication and cognitive-behavioural therapy. It is most often treated in mental health settings such as hospitals and treatment centres, where specialized programmes are available. Although it has been found that people who have had successful treatment are sometimes able to go off medication at a later date, others will have to be on medication life-long.  This is similar to those who must take heart-medicine in order to preserve their functioning, or insulin to regulate their diabetes; those of us who wear glasses can appreciate the concept of a condition which does not improve but rather needs constant correction in order for normal functioning to occur.

What If My Child Has OCD?

If you see that your child has some of the kinds of behaviours described above, take him to a competent psychologist or psychiatrist for a proper assessment.  It is essential to use a professional who has expertise in this disorder – not a general practitioner and not your GP.  OCD can be difficult to diagnose. You will certainly not be able to diagnose your child yourself.  The assessment may show that your child does not have OCD but has some other sort of disorder: various disorders are closely related to and co-existent with OCD such as Tourette’s Syndrome, ADHD, depression and other anxiety disorders. It may also turn out that your child has no disorder at all, but is just “perfectionistic” or normally obsessive. However, it is important to find out, because failure to treat a child with true OCD is a form of parental negligence.  Some people don’t want to look for problems in case they find them; however, we cannot put our heads in the sand while our child suffers. Just like not going to our GP for our annual check-up does not stop us from having a disease, not going to the psychiatrist does not prevent having OCD!  If a child has it, he has it and he then needs treatment.

It is up to you, the parent, to address the issue and seek all the appropriate information and advice.  Although we are never happy to find that our child is ill, we know that the future begins to brighten the moment we start him on the healing path.