Understanding Obsessive Compulsive Disorder (OCD): How to Overcome Its Pains

Understanding Obsessive Compulsive Disorder (OCD)

OCD is an an anxiety disorder.  It is one of the most severe anxiety problems and one of the most difficult to diagnose and deal with.  OCD causes an immense amount of suffering, although it often goes undiagnosed and untreated.  On average, people are diagnosed with OCD over 10 years after their problems began.  Most people who suffer from this condition hide it from others and they are ashamed of their symptoms. And many people do not identify their actions and thoughts as symptoms of OCD. Understanding OCD is essential for your well being

OCD manifests by three cardinal sets of symptoms:

1-Obsessions

2-Compulsions

3-Severe Anxiety

There is a number of other symptoms in OCD, but they more or less can all be boiled down to one of the three main domains mentioned above.

Defining obsessions

Obsessions are recurrent unsolicited thoughts that come to our minds uninvited.  These are “weird” thoughts that we cannot get rid of even when we try to fight them off.  They are frequent, repetitive–broken-record–type thoughts.  But they are senseless and illogical and they cannot be worked through by logic.  Obsessive thoughts are magical and superstitious.  These thoughts may appear logical on the surface; but when examined more in depth, one realizes that the logic that supports these thoughts is weak or nonexistent.  An example of an obsession would be something like this: “If I do not count all the black square tiles on this floor, my father will die of a heart attack.”

Differential diagnosis of obsessions

Obsessions are not to be confused with fixed ideas, fanaticism, or addictive thoughts, such as those that happen when an image reappears in our minds with intensity. These intense repetitive thoughts often occur when people are too focused on religious or political ideologies. They take place when fanatical people keep on focusing of their ideologies, their drug of addiction, or their favorite foods.  All of these thoughts have obsessive elements to them, but they are not the type of true obsessions present in OCD. 

These types of over-invested thought processes are frequent–but not compulsive and repetitive as obsession–and they are not uninvited.  They do not just pop up in our heads for no good reason, they are manageable, and they are the source of intense anxiety coupled with guilt.  These are thoughts that support ideology systems that we ascribe to in our minds, i.e., our belief systems.  They may be a personal “cause” that sustains us in life, such is any “ism.”  Or they may be intense repetitive thoughts caused by things we like too much. These are things or objects that are a strong source of intense pleasure or gratification.  So, for example, if you have an eating disorder and keep ‘obsessing” about restricting the amount of food you eat, that is not an OCD symptom–but a symptom of your underlying eating disorder.  That is a preoccupation with food, not a true OCD obsession.

Another example of repetitive thoughts that are not part of OCD are Flashbacks.  Flashbacks are vivid visual scenes and only secondarily auditive and they occur in the context of Post-Traumatic Stress Disorder (PTSD).  Flashbacks are triggered by a thought–or by an external circumstance–that evokes the original traumatic situation.  While obsessions are stated in verbal sentences, flashbacks are vivid scenes.  Obsessions are made out of words. But, unlike auditory hallucinations, they are not heard. And obsessions are recognized by the subject as part of their own thinking and not as the product of an alien being. 

Obsessions often start with clauses such as “If I do not do this and this and that” …then, this and that (usually a terrible catastrophe) will happen.”  The “catastrophe” feared is something that will magically happen to someone else the obsessed loves.  And, on occasion, the catastrophe may befall the obsessed individual as a form of self-punishment.

So, most obsessions start with a clause, “If this and that… then…..” They are followed by an “action” or “thought that must take place compulsorily” (the obsession, the compulsion, or the ritual that must be carried out). And they are coupled with a form of punishment (the “catastrophe” that God or the Universe will impose on the obsessed person in case the obsession or ritual is not carried out properly and according to the specifics of the mandate stated in the obsession.

Defining compulsions

Compulsions are actions that we feel must be carried out to avoid anxiety from arising or a catastrophic event from happening.  Compulsions are often the result of obsessions, but they may take a life of their own and be carried out automatically.  The usual situation in OCD is that an obsession pops up first and for unconscious reasons.  And the compulsions appear as a result of the mandate or as a form of self-soothing for the anxiety caused by the obsession.  The compulsion is then an action. It is geared towards decreasing the anxiety caused by the obsessive thought.  But the compulsion itself can also be based on thoughts, such as compulsive counting. This is a case in which a mental action, and not a physical one is compulsive. In the physical realm, a compulsion may take the form of self picking or of hoarding useless stuff.

The magical element in compulsions

The compulsions have a magical element of cancelling (undoing) the event that is feared.  For example, “If I count (compulsive thought) all the black tiles in this floor and check (compulsive action) all the locks in this room, my father will not die.”  So, compulsions are actions that must be carried out to decrease the anxiety caused by the fear of the catastrophic event and used to offset the possibilities of its occurrence.  They are reinforced by the feeling of guilt that arises as a result of not carrying out the compulsion.  So, not carrying out the compulsion is synonymous with “sinning;. it is guilt-inducing; and it is anxiety producing.

“Displacement” as a main defense mechanism in OCD

There is a process of unconscious displacement from obsessions to compulsions.  And then, there is another displacement from compulsions to “catastrophizing”. Finally, guilt reappears and the process must be started all over again.  The element behind it all is severe anxiety that pervades every thought and action of the obsessive and that moves (displaces itself) from one thought to another in a never-ending torturing process.  This “displacement” is unconsciously triggered by guilt. It is caused by a nagging feeling of guilt that crops up everywhere in the life of the obsessed.  This unconscious guilt leads to a demand for self-punishment and expiation.

So, carrying out the compulsive action helps lower anxiety temporarily. But later on, the obsession will crop up elsewhere in the same or in a different form.  So, the same compulsion–or a new one–must be found in order to calm the anxiety again and again making the feeling of guilt go away only temporarily. That is why, over the years, multiple obsessions fester out and more and more outlandish compulsions develop. 

If untreated, the entire life of the individual is affected.  He or she is haunted by these never ending obsessions and compulsions. They will take longer and longer to be carried out over time. And these compulsive activities will more and more interfere with normal activities of daily living. They make the life of the obsessed a true hell on earth as he or she is now behind in every activity of his life.  This unending obsessing leads to a state of exhaustion and eventual depression.

Anxiety in OCD

The obsessive person is a chronic worrier.  As it is well known, worrying is a source of constant anxiety.  For that reason, the obsessive meets criteria–not just for OCD–but for Generalized Anxiety Disorder (GAD).  However, most people who suffer from GAD, do not suffer from OCD.  So, OCD is a more severe disorder than mere GAD.  And while GAD–along with Social Anxiety Disorder—are the two most common anxiety disorders in the general population, OCD comes fifth in frequency in the US.

Anxiety is a feeling of internal discomfort 

Anxiety manifests in three domains of our mental life:

1-The cognitive level, which are the anxiogenic thoughts (anxiety producing thoughts called obsessions).  Best case in point of “anxiogenic thoughts” are worries, obsessions, and phobias.  Also, there can be states of “mind going blank” and problems paying attention.  Anxious people usually have problems concentrating. In the US, this symptoms lead to frequent misdiagnosis of ADD (Attention Deficit Disorder).  In OCD, however, the mind wanders from thought to thought. It goes from one fearsome situation to another.  People mistakenly call these thoughts “racing thoughts,” but that is not the proper psychiatric technical term for this phenomenon.

“Racing thoughts” are thoughts that are too rapid to be followed. They are seen in a the manic state of bipolar disorder.  While the problem in the anxious person is not the excessive speed of the thinking process–but the inability to stop thinking.  This means an inability to shut up the inner chatter while going from one worry to another.  This unceasing chatter takes place especially at night and leads to insomnia.

2-The emotional level. This level includes feelings of insecurity, doubt, and fear.  Anxiety is a feeling that most people experience subjectively but that is hard to describe in words.  It is a feeling of dread and angst.  It is fear of something unknown that is hard to put your finger on.  There is the feeling that something is wrong or that something terrible is going to happen to you or to someone else.  If too intense, it can reach the level of panic attacks.

3-The physical level in anxiety.  The physical manifestations of anxiety are multiple.  There are more than thirteen physical symptoms that can be caused by anxiety.  But in general, when people feel anxious, they can tell because they experience symptoms in their bodies.

Common bodily symptoms of anxiety are:

• A rapid or irregular heartbeat
• A sensation of choking or chest oppression
• Feeling a lump in the throat
• Excessive sweating and clammy hands
• Hyperventilation or excessive sighing (the sensation of not being able to catch your breath)
• Frequent yawning coupled with a sensation of shortness of breath
• Dizziness and instability of gait
• Queasy stomach or feeling nausea
• Tremors
• Dry mouth.

Going forward

In the next post I will continue to explore OCD. I will describe the theories behind its cause. And, in upcoming posts in this series, I will make suggestions to cope with obsessions and compulsions. I will also indicate the current state of the art forms of treatment for OCD. 

OCD is a chronic and debilitating condition. But, with available treatments, obsessive people can do very well.  The treatment of OCD is long-term and it requires medication and psychotherapy. For this reason, do not waste your time. If you have any of the symptoms mentioned above, stop postponing, and consult with a psychiatrist and start treatment right away.  Your life will change around for the better. You will feel one hundred percent better, you will not squander your life away–and you will become more productive in your love and work lives.

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I hope to see you in my next post,

Till then,

Dr T