First things first - What is OCD?
According to the DSM-IV, Obsessive-Compulsive Disorder is an anxiety disorder most commonly characterized by obsessive, distressing intrusive thoughts and related compulsions (tasks or rituals) which attempt to neutralize the obsessions.
The Obsessive Compulsive Foundation states that, "In OCD, the brain gets stuck on a particular thought or urge and just can't let go. People with OCD often say the symptoms feel like a case of mental hiccups that won't go away. OCD is a medical brain disorder that causes problems in information processing. It is not your fault or the result of a "weak" or unstable personality."
This condition is characterized by two sepaprate behavior sets or manerisms: Obsessions and Compulsiuons. Moreover, these behavior sets affect each person differently. There are textbook behaviors to OCD, but no one set way to suffer from it. It affects each person differently.
Types of OCD - What are the differences?
There are three distinct types of OCD, each with their own specific needs and behaviors. They are each connected by the basics of the condition: obseesion and compulsion.
Obsessions are thoughts, images, or impulses that occur over and over again and feel out of your control.
Compulsions are acts the person performs over and over again, often according to certain "rules."
Again, each type of OCD is simply a variation on these two principle components of the disorder. Likewise, standard OCD is usually sorted into six groups: washers/cleaners, checkers, orderers, hoarders, obsessers. A sufferer may have some or all of these symptoms, but one will be more outstated than the rest. There are also three main behavior types of OCD.
These types are: Scrupulosity, Compulsives, and Pure Obsessives.
Scrupulosity, or Scruples is based on the person's concern not for themself, but directed toward the well-being of others They can sometimes feel the intense feeling that God (whichever forms the persons belief) is watching and is often displeased with the sufferer or their actions.
Compulsives structure their life on compulsions designed to ease the nervous or panic feelings of the OCD. These compulsions becaome paramount in preventing the worry or doubt that can plague daily life.
The Purely Obsessional, or Pure-O involves the escape or avoidance (through excessive mental behavior) of noxious and unwanted thoughts. In its most generic form, persons might have upsetting words or phrases repeated in their head, not unlike what most experience when an unpleasant song is played over and over in our mind without our active choice in it being there. Persons with the Pure-O classification also can experience what seems to them to be threatening ideation involving the potential that they might do harm to others or that merely the idea of having the threatening thought suggests something evil or depraved about their identity, capability, or self worth. This classification periodically also involves persons who engage in a tremendous amount of problem solving (also referred to as ruminating), as a ritual. Endless attempts to answer questions related to one's own sexual orientation or even something as simplistic as the name of one's third grade teacher might occupy endless hours of problem solving.
Other conditions or behaviors associated with OCD include:
- Body Dismorphia or Olfactory Obsession
- Hyperresponcibility for others
- Compulsive skin or hair picking
- Avertion to Sex
Okay, okay. Let's go back to the beginning - What are Obsessions and how do they affect those with OCD?
The Obsessive-Compulsive Foundation states, "Worries, doubts, and superstitious beliefs are common in everyday life. However, when they become so excessive such as hours of hand washing or driving around and around the block to check that an accident didn't occur then a diagnosis of OCD is made. In OCD, the brain gets stuck on a particular thought or urge and just can't let go. People with OCD often say the symptoms feel like a case of mental hiccups that won't go away. OCD is a medical brain disorder that causes problems in information processing. It is not your fault or the result of a "weak" or unstable personality."
By definition, obsessions are thoughts, images, or impulses that occur over and over again and feel out of your control. The person does not want to have these ideas. He finds them disturbing and intrusive, and usually recognizes that they don't really make sense. People with OCD worry excessively about dirt and germs and become obsessed with the idea that they are contaminated or contaminate others. They may have obsessive fears of having inadvertently harmed someone else even though they usually know this is not realistic. Obsessions are accompanied by uncomfortable feelings, such as fear, disgust, doubt, or a sensation that things have to be done in a way that is "just so."
How is that different from a compulsion?
People with OCD try to make their obsessions go away by performing compulsions. Compulsions are acts the person performs over and over again, often according to certain "rules." People with an obsession about contamination may wash constantly to the point that their hands become raw and inflamed. A person may repeatedly check that she has turned off the stove or iron because of an obsessive fear of burning the house down. She may have to count certain objects over and over because of an obsession about losing them. Unlike compulsive drinking or gambling, OCD compulsions do not give the person pleasure. Rather, the rituals are performed to obtain relief from the discomfort caused by the obsessions.
OCD symptoms cause distress, take up time (more than an hour a day), or significantly interfere with the person's work, social life, or relationships. Most individuals with OCD recognize that their obsessions are coming from their own minds and are not just excessive worries about real problems. They realize that the compulsions they perform are excessive or unreasonable. When someone with OCD does not recognize that their beliefs and actions are unreasonable, this is called OCD with poor insight. OCD symptoms tend to wax and wane over time. Some may be little more than background noise; others may produce extremely severe distress.
Behavior - Why does he or she act this way?
Ok. Apparently there are only about two people of the planet that get this, so I'm spelling it out once and for all.
I have Obsessive-Compulsive Disorder. I cannot change this, no matter how much I dislike it. I will have it for the rest of my life.
If you are part of my life, then there are some things you are going to have to accept and understand. Some of the big ones are, as stated by the National Foundation of OCD Research, as follows:
These are unwanted ideas or impulses that repeatedly well up in the mind of the person with OCD. Persistent fears that harm may come to self or a loved one, an unreasonable concern with becoming contaminated, or an excessive need to do things correctly or perfectly, are common. Again and again, the individual experiences a disturbing thought, such as, "My hands may be contaminated--I must wash them"; "I may have left the gas on"; or "I am going to injure my child." These thoughts are intrusive, unpleasant, and produce a high degree of anxiety. Sometimes the obsessions are of a violent or a sexual nature, or concern illness.
This is why:
*You should announce you entrance into an area of the house. It will disturb me for hours to come if you do not and I am startled.
*I drive you all up the wall with seemingly endless discussion about one particular thing. If you think its annoying to listen to, try hearing it nonstop in your head...
*I roam the house aimlessly, get the frequent headaches, and sometimes insist on doing things myself. Even if you did it perfectly, I'd still have to do it over again. Don't be insulted.
*I seem completely uninterested in something or someone around me. It's like I'm muti-tasking all the time. Even when listening to you, I'm thinking at length about something/someone else.
*I can be very bitchy at times. I am critical of people, including myself, because I tend to see the fault in things immediately. It could be days before I actually notice the merit in that same thing. The fault or imperfection in things almost lights up as compared.
* "Sometimes the obsessions are of a violent or a sexual nature" Do I even need to go here, or do we all understand where I'm going?
In response to their obsessions, most people with OCD resort to repetitive behaviors called compulsions. The most common of these are washing and checking. Other compulsive behaviors include counting (often while performing another compulsive action such as hand washing), repeating, hoarding, and endlessly rearranging objects in an effort to keep them in precise alignment with each other. Mental problems, such as mentally repeating phrases, listmaking, or checking are also common. These behaviors generally are intended to ward off harm to the person with OCD or others. Some people with OCD have regimented rituals while others have rituals that are complex and changing. Performing rituals may give the person with OCD some relief from anxiety, but it is only temporary
This is why:
*I am ALWAYS relating whatever is being done/said/thought about to what's on my mind.
*Why I ask things over and over, and why I habitually make lists.
*Why I'm repetative, I'm funny about who touches my things, and I rearrange things so much.
*Why I have a tendency of talking down to people and overexemplifying when I'm telling people about things.
*Understand, if I bank on a compusion, then I feel in control for a few moments. It makes the obsessions easier in that it seems that there are fewer things going on in my head.
*Why I can be very depressive and critical and angry if something doesn't work out. It's designed to give me relief, but if it doesn't, then I'm stuck back where I started. Without any solice.
People with OCD show a range of insight into the senselessness of their obsessions. Often, especially when they are not actually having an obsession, they can recognize that their obsessions and compulsions are unrealistic. At other times they may be unsure about their fears or even believe strongly in their validity.
This is why:
*I make running jokes of Conan, Joy Division, and even Doctor Who. I understand how this must look from your point of view.
*I CONSTANTLY poke fun at myself for these very things. I find myself rediculous, but there's not a whole lot I can do about it.
Most people with OCD struggle to banish their unwanted, obsessive thoughts and to prevent themselves from engaging in compulsive behaviors. Many are able to keep their obsessive-compulsive symptoms under control during the hours when they are at work or attending school. But over the months or years, resistance may weaken, and when this happens, OCD may become so severe that time-consuming rituals take over the sufferers' lives, making it impossible for them to continue activities outside the home.
This is why:
*I love working and enjoyed school so much.
*I aviod sleep, and can get by with so little of it.
*I always want to be doing something, at all times.
*I hate being alone.
Shame and Secrecy
OCD sufferers often attempt to hide their disorder rather than seek help. Often they are successful in concealing their obsessive-compulsive symptoms from friends and coworkers. An unfortunate consequence of this secrecy is that people with OCD usually do not receive professional help until years after the onset of their disease. By that time, they may have learned to work their lives--and family members' lives--around the rituals.
This is why:
*I don't like talking about myself, or my past.
*I prefer that no one look at me when I'm preparing to go out, brushing my teeth, eating, and why I hate people looking directly at my face.
*It isn't as obvious as you might presume it would be, and you might believe I could just stop if I wanted to.
If you want to understand me better, here's a road map. Perhaps now things I do on a daily basis will make more sense.
Let's Talk about Sex - Intrusive thoughts and the dark frontier of sexuality
Sexual obsessions involve intrusive thoughts or images of "kissing, touching, fondling, oral sex, anal sex, intercourse, and rape" with "strangers, acquaintances, parents, children, family members, friends, coworkers, animals and religious figures." Like other intrusive, unpleasant thoughts or images, most people have some inappropriate sexual thoughts at times, but people with OCD may attach significance to the unwanted sexual thoughts, generating anxiety and distress. The doubt that accompanies OCD leads to uncertainty regarding whether one might act on the bad thoughts, resulting in self-criticism or loathing
Sexual obsessions are obsessions with sex, and in the context of Obsessive-compulsive disorder, these are extremely common. These obsessions are involuntary, repetitive, and unwelcome. Attempts to suppress or neutralise obsessions sometimes do not work and in fact make the obsessions more severe. Up to a quarter of people with OCD may experience sexual obsessions. In the same way that those who have OCD fears of contamination avoid anything that will 'contaminate' them (i.e., doorknobs, puddles, shaking hands), those who are suffering from such sexual obsessions may feel an overpowering need to avoid all contact with anything that can cause them to have anxiety, or 'spike'. Such avoidance may be: Not looking at (for instance) another member of the same sex in the face, avoiding locker rooms, showers, and beaches, etc. It can also mean avoiding sexual situations with members of the opposite sex, for fear of what a particular circumstance (not being aroused enough, intrusive thoughts, etc.) might mean. A sufferer may also avoid hugging children, including their own, a compulsion which may cause severe damage to the well-being of the child. It may cause social problems as the sufferer avoids being with gay, or straight, friends, or people with children. The social isolation feeds the anxiety, and therefore the OCD.
It cannot be overemphasized that the sexual obsessions in OCD are the opposite of the usual sexual daydream or fantasy. Normal sexual fantasies are enjoyable and generally harmless. They may consist of wishes or memories of past sexual experiences. However, the sexual ideation in OCD is unpleasant and distressing. The individual with OCD does not want the thought to become real. The idea of acting out the obsession fills the OCD victim with dread. The sexual ideation in such situations is termed "Ego-dystonic" or ego-alien, meaning that the behavior and/or attitudes are seen by the individual as inconsistent with his or her fundamental beliefs and personality. Sexual obsessions in OCD rarely produce sexual arousal because anxiety and arousal cannot occupy the same space.
As a result, OCD usually decreases sex drive. However, the sufferer's constant focus on not becoming aroused or checking that they do not become aroused may lead to 'groinal response'. Many OCD sufferers take this groinal response as actual arousal, when in reality it is not. OCD sexual obsessions often result in guilt, shame, and may interfere with social functioning or work.
Stop calling me crazy - Common faux pas and where OCD is unique
Of all the difficulties surrounding OCD, quite possibly the cruelest is obsessing about obsessing, and its quite common. The knowledge that you are different, and there is something different orwrong with you can make even the simplest errand the mightiest task. When talking to someone who has OCD, ask yourself:
What is my body language saying to this person?
Do I seem engaged?
Am I being supportive in a way that he/she would understand?
Do I seem engaged?
Am I being supportive in a way that he/she would understand?
Think of your behavior as small pebbles. Each one is really nothing, but if enough of them are in your shoe walking becomes impossible. Never forget that the person in question is an obsessive personality. He/She will be thinking of these things long after you've dismissed them.
Equally important is your approach. The most concerned person will still look judgemental and standoffish if the appraoch is wrong. Use your best judgement and aviod things like, Are you okay? or What's wrong? You don't seem yourself. This will make the person immediately self conscious and panicy. Remember that the best appraoch is an indirect one. Ask conversation questions like, What did you think of the movie? and remember - Be Patient. What you are reading as attitude is very likely a difficult attempt to keep focus. Have compassion, take your time, and be patient.
Caring for those who suffer - How can I help?
Remember first that where you can be supportive, you may not understand where the person is coming from and that is ok. Even if you have a diagnosed disorder, it could differ drastically from OCD. Try to remember that it is very hard on those who suffer from it, and put yourself in their position instead of trying to force them into your own. Again, be patient. Don't forget that this is a social disorder, and attacks or 'spikes' as they are sometimes referred can consist of insomnia, panic attacks, and severe headaches. If you have questions, ask them, but do it at the right time. Asking in the eye of the storm is only going to make things worse. Find a time when everything seems fine.
One of the most important things tyou can do is be available. The DSM-IV actually lists social interaction among it's home treatment options. So if you really want to help, make yourself available. But, once again, be patient. People suffering from OCD aren't going to light up the first time. Or perhaps the first few times, but if you love someone, you keep trying.