Obsessive Compulsive Disorder: Without treatment, it’s a life-long heartbreak

Lisa Garmezy, Psych Services

Fighting OCD with logic is as useful as spraying air freshener on an oil spill, says psychologist Tamar Chansky. These behaviors simply make no sense, like David Beckham’s insistence on having an even number of Pepsis in the frig. In 2010, the star said he’d tried and failed to conquer his OCD. Since medication and therapy offer relief, let’s hope he has since sought treatment.

Slightly more than one percent of people in the U.S. have OCD—a lot. There is no minimum age for the disorder, which is diagnosed in children as young as three or four. Most often, OCD begins during adolescence or young adulthood.

The statistics help explain why one in six Americans has a diagnosable mental health or substance abuse problem. For parents, the numbers may be alarming. If your kid freaks out because his sandwich is cut in squares instead of triangles, is that normal?

Magical Thinking

To find out, let’s first examine two definitions. Obsessions are “intrusive and unwanted” thoughts, according to the American Psychiatric Association. An example in Chansky’s book, Freeing Your Child from Obsessive-Compulsive Disorder, is fearing that an everyday medication is contaminated and toxic.

Compulsions, on the other hand, are repeated behaviors that a person “feels driven to perform in response to an obsession or according to rigid rules.” Compulsions are performed superstitiously to prevent or reduce distress, perhaps by “preventing some dreaded event or situation,” according to the American Psychiatric Association. Mental behaviors, such as counting and praying, are included.

Usually the fear and the behavior are connected in a way that is more magical than logical. Yes, it’s normal for a child to want his sandwich cut a certain way, but not to live with terror that if it’s wrong, mom or dad will die.

Sometimes the fear and the compulsive behavior are linked semilogically, as when people obsessed with germs shower for hours. Game show host Howie Mandel, at least in the past, created paths of clean towels to navigate “contaminated” hotel room carpets.

As always, disorders aren’t diagnosed when no genuine life problem exists. A woman who worries about poor quality control in factories but takes her blood pressure meds anyway does not have OCD. If she’s in trouble at work because she loses an hour every morning struggling to swallow her pill, or if she jeopardizes her health by skipping it, she has the disorder. Symptoms are time-consuming, often lead to shame and depression, and interfere with concentration at work and school.

My Way Or . . . ?

To digress for a bit, healthy children and their parents engage in power struggles. Even without those conflicts, little ones still like to be in charge in small ways, such as picking their own outfits. Choices help them feel competent and in control. Familiar routines let them make sense of their lives.

Long ago, my then three-year-old son watched with interest as his bathroom walls changed from pale blue to peach. Afterward, he asked, “What color will it be next?” He didn’t know that we didn’t know, and that the walls wouldn’t keep changing. Kids’ normal rituals decrease the anxiety their cluelessness can spark.

Also, there are children and adults whose truly fussy habits help them feel organized and ready to face the world. The coworker who keeps his desk just so may have an Obsessive-Compulsive Personality, an actual diagnosis which is different than OCD. People with obsessive-compulsive personalities seem perfectionistic, rigid, detail-oriented, and overly conscientious. They can be fabulous employees, but frequently have relationship problems.

When OCD is present, on the other hand, completing a compulsive behavior offers brief relief from crippling, irrational fear but not true comfort. In very short order, it’s time to repeat the compulsive behavior.

All Around Us

Although clinicians say no two people with OCD will have the same symptoms, their problems fall into recognizable subtypes. Adult clients are usually preoccupied with contamination and cleaning, symmetry and order (count it like Beckham), thoughts of harm to oneself or others, or religious or sexual obsessions. Children and teens typically show concern about harm to themselves or loved ones. As they grow older, young people might develop obsessions with sexual thoughts. In OCD, this reflects deep anxiety about being “bad,” not sexual activity or abuse.

Officers should know about postpartum OCD, when new mothers with absolutely no desire to harm their babies become so afraid of hurting them that the thought enters their minds and won’t leave. A mom might wonder, “What if I go crazy while trimming the baby’s hair and decide to stab her?” If she locks knives and scissors in the trunk of her car to protect her child, she needs treatment but probably is not dangerous.

Recovery

Folks don’t have to live like this. Typically OCD treatment is the same for adults and kids, namely, a form of cognitive behavioral therapy called Exposure and Response Prevention, often paired with medication. The client becomes desensitized to the anxiety that comes from not performing a ritual such as counting ceiling tiles. With a therapist’s support, the client learns to live with the feeling and watch it fade over time.

In Chansky’s words, the OCD client has to “practice living with maybe.” Maybe something bad will happen if the sandwich isn’t cut just right or the lock isn’t checked exactly nineteen times. Probably not.

People with the disorder learn to regard OCD as unwanted genetic baggage, like color-blindness. This perspective bypasses the self-hatred so many people with the disorder feel. OCD is often diagnosed with anxiety or depression, but it doesn’t have to be.

For more information visit the website of the National Institute of Mental Health and search “OCD.” Or, fill out the quiz that’s part of diagnosing the disorder at psychres.washington.edu/clinicaltools/ybocs.pdf. If you check “yes, yes, and constantly,” call HPD Psychological Services at 832-394-1440 for a free, confidential appointment, talk to your doctor, or use your insurance to visit a mental health professional. Without professional help, OCD is a life-long heartbreak.